How to Communicate Better With Someone Who Has Early-Stage Alzheimer's

Keep these simple techniques in mind when talking to someone with Alzheimer's or other forms of dementia.
dad and son outside

Quick summary

It's so easy to become frustrated when talking to someone with dementia or Alzheimer's. It's hard to know the "right" way to respond to the repetitive or odd things he sometimes says. You won't be tongue-tied if you keep these simple communication techniques in mind.

How to start a conversation

When you want to start a conversation or ask a question, get the person's attention in an obvious, direct way. Start by approaching him from the front and saying his name. This will help him focus on you and prevent catching him by surprise, which may set him on edge and make him less able to concentrate on the conversation. Someone who's older may be somewhat deaf, and this direct approach also makes it easier for him to hear you.

Slow down your usual speaking style a bit. Enunciate your words to be as clear as possible. Also stay conscious of giving the person plenty of time to think about what you've said and to reply. Many people have a tendency to rush in and fill a silence with more words, which often only serves to agitate someone with Alzheimer's or other dementias.

Another way you might need to alter your usual conversational style is to stick to common, plain words and short sentences whenever possible. (It's like talking to a young child, though without using singsong baby talk.) Try to construct sentences that include only one main thought, ask only one question at a time, and give instructions one step at a time.

If the person doesn't understand something you've said, repeat it exactly the way you said it the first time; that will give him more opportunities to figure it out. If you've asked a question that's not connecting, ask it again the same way. Do this within reason, of course -- if two or three repetitions fail, try rewording the message in different, simpler terms.

Rely on nonverbal communication

Words are only a part of the way that all humans communicate with one another. Facial expressions are especially important for someone who has trouble following a conversation and remembering what was just said. So try to face the person as much as possible, and look directly in his eyes.

You can also signal that you're friendly, interested, and approachable with physical cues such as your facial expression, gestures, and posture. Smile or look concerned as you talk to underscore your message. Point to the thing you're talking about; for example, point to the kitchen as you say, "Lunch is ready." Use other gestures such as shaking or cocking your head or raising your hands palms-up when asking a question. Beware of accidentally sending negative signals: a blank apathetic expression, brows knitted in frustration, crossing or folding your arms in front of you, and placing your hands on your hips.

Giving a gentle, encouraging touch can help guide the person when you give him instructions or when you're trying to direct his attention to something. Don't underestimate the benefit of physical affection when you talk, from touching his knee lightly to rubbing his back or ending a conversation with a kiss. All these gestures can help keep him feeling relaxed and less frustrated.

Your tone speaks louder than words, too. So try to keep your voice pleasant and inviting, not overly loud (unless deafness is a real issu e). Be careful not to express anger or frustration -- even when you're reaching your limits.

Provide conversational crutches

You can improve verbal exchanges in lots of casual ways. Refer to people by their name and, when appropriate, their name and relationship to the person with Alzheimer's (such as "your daughter, Anna") rather than using pronouns such as "him" or &q uot;her." Use simple, consistent labels for objects ("your white tennis shoes," "the blue pillbox") and avoid identifying things as "this" or "that."

Stick to familiar, easy-to-understand topics, too. A person with Alzheimer'sor other forms of dementia is less likely to be confused if you talk about his favorite subjects or things he's demonstrated he remembers or relates to well -- the weather, what's for lunch, the birds at the feeder, a ball game. Discussions that require abstract thinking or a great deal of concentration -- politics and current events, for example -- may prove too complicated.

Expect to carry the conversation yourself. It's not that the person doesn't like to chat, but initiating talk can be too much for him now. Also avoid asking too many open-ended questions, which may feel like "tests" of his memory -- causing him to become frustrated and angry and want to withdraw from the conversation. A better solution is easier yes-or-no questions or those with limited multiple-choice answers: "Do you like the robins or the cardinals best?" Best of all is to mostly lead the discussion by providing information rather than asking for it: "I just saw a big squirrel climb into the bird feeder. Maybe we need to put more seed in there."

Reduce background distractions, too. It's easier to connect without the noise and commotion of a TV, radio, or crowd of people, for example.

Be considerate of gaffes

Inevitably the person you're talking to will repeat the same conversation you just had a few minutes earlier. Above all, refrain from pointing this out. Memory lapses are a physical glitch beyond his control, and emphasizing his impairment is likely to make him feel embarrassed or frustrated. Instead, give simple, polite responses (even if they're the same responses you just gave five minutes earlier). Alternately, if appropriate, redirect the conversation -- but if he fixates on getting an answer from you, go ahead and give it. His insistence means the subject is important to him.

An occasional prompt is OK if he's having trouble finding the right word or remembering something -- but tread lightly. Frequent corrections, correcting in a critical or patronizing manner, or showing your disappointment or frustration all eat away at his self-esteem. Responding in these ways just makes him less likely to want to open up and communicate. Use his reactions as your guide. You may just choose to limit corrections to times when it's absolutely necessary.

If you do need to intervene, use "I" statements: "I'm sorry. I'm just having trouble understanding today." Putting the onus on you is far less intimidating than being told, "What do you mean? You're not making sense."

Other helpful tips

Humor is a vastly underrated way to keep the mood light and to encourage someone to open up. Don't laugh at him, obviously, but make light of situations where it's appropriate.

Even if you live nearby, cards and letters can be a concrete way of communicating instead of always relying on phone calls and in-person visits. People with Alzheimer's-related memory problems often appreciate having a written record of what you've "said" to go back to, as it relieves them of the burden of trying to remember. Consider a spiral notebook or datebook in which you can jot down helpful items (whether they're critical or not): "October 30. Mike raked leaves. Tomorrow is Halloween."

Above all, have realistic expectations. Even early on in the disease process, someone with Alzheimer's may occasionally use the wrong word, get confused, or forget what was said just a few minutes ago. Don't let these slips rattle you. Such cognitive problems aren't under his control, and probably already cause him considerable stress and frustration -- he doesn't need to see you upset as well.

Realize that language problems are likely to increase over time. Your patience and understanding now will help cut down on the frustration and irritability these changes create in the person you care about -- and protect him against withdrawing from social situations.


about 1 year ago, said...

VERY INFORMATIVE, I HAVE A CLOSE FRIEND WHO WAS RECENTLY DIAGNOSED WITH AD. I WAS WONDERING IF CONVERSATION WAS HELPFUL TO THEM IF DONE CORRECTLY.


over 1 year ago, said...

This is a beautiful article written with tenderness, caring, warmth and RESPECT. Thank you for your love in written form.


over 1 year ago, said...

I think that this is a great sight I have a profile on here now.


almost 2 years ago, said...

I just began a job as an activities aid in a nursing home and have been away from geriatrics for over 20 yrs. I like this site.


over 3 years ago, said...

Working with many elderly and those in various stages of Alzheimer's and dementia, I learned very quickly many cannot OR do not express themselves very well, making it more difficult for loved ones and caregivers. Things 2Watch4 while visiting mom or dad with Alzheimer's or Dementia. http://bit.ly/Qe5AYL


over 3 years ago, said...

sure was-it's going to slow me down to do it properly. I wasn't doing it the proper way and yes he gets frustrated. Many thanks for the great advice. Joanne


over 3 years ago, said...

Very specific, helpful strategies.


over 3 years ago, said...

Very helpful I didn't realize I might be causing stress by filling in the words. Thank you.


almost 4 years ago, said...

For at least the last 6 months I thought my husband of 34 years was just getting plain ornery-diagnosis mild dementia. At first I was extremely angry at his behavior but going to a support and reading much I have totally changed my tune. After all he was a great husband for all those years.Things are better handled now and he is so much better-he's 84 I love him.


about 4 years ago, said...

As my spouse had dementia for many years before diagnosis, I had found some of the ways of communication necessary already. Learning more is so helpful. Heads up, if your loved one "needs" this kind of communication style, think about dementia being part of what is going on. Wish I had known years earlier.


about 4 years ago, said...

Thanks for the simple, logical guidance. It seems so obvious but is so important to be reminded.


about 4 years ago, said...

These are good hints, and the last one - keep your sense of humor - may be the most important. Ironically, sometimes trying too hard is what makes us lose patience with our loved ones first and ourselves next, creating tension. It's the time you spend together that's important, not the subject matter. I find that cards are great for my mom who has some vascular dementia, not too bad, but who really can look at cards over and over or post them on her bulletin board or ( I) put them in a scapbook. But my friend's mom with progressing Alzheimers started to become upset with cards because she couldn't remember who they were from - and was disturbed that "strangers" were sending them to her. You have to be ready for changes, even from week to week. My mom is fairly well oriented, but she does get "a bug in her head" from time to time - say that a particular resident or aide has "stolen" something. I learned to silence my objections, and very very gently redirect - or let her run out of steam. She also told another resident's daughter that she hadn't seen any family member in weeks - getting murmurs of sympathy while I was sitting next to her. It does take a sense of humor! My friend's mom does sometimes ask where her husband is or when he's picking her up and over time it was pretty clear that you go along. Ther is no such thing as a lie in this case - i have met folks who have a hard time relinquishing the idea that "you have to tell the truth" at all times.Well - their "truth" is now different than yours/ours. The idea is to respect what they can cope with and not seek any validation for yourself from someone who can't give it. And we all really really need someone to vent to and to have real conversations with - so if you do not have friends or family you can talk to, find a support group. ( even like this online one!) main thing to remember is that you are doing your best, and you are there. You can't change the symptoms or the transit of the disease process. If you can relax your expectations for yourself, and reduce your own tension, it may allow your parent (or other elder) to relax as well. [my own mom is pretty content if I just stay with her while we both read). A shoutout to tornapart - take care of yourself. You saw to it that your mom is cared for, and you have the right to see to your own needs. It is daughters who do take the brunt of their mother's anger, frequently, if for no other reason than we're there.


about 4 years ago, said...

I know most of what was said, but it's good to be reminded. I'm having a lot of trouble hiding my frustrations as I see my husband getting worse every day.


almost 5 years ago, said...

keeping is simple. My Mother does not want help. I need ways to let her know that I am here because I love her. Not because I am trying to control her.


almost 5 years ago, said...

It is a real concise overview of some of the major communication problems that arise. It also makes it easier for me to pass this article on to others who are confused by Mom's new behaviors.


about 5 years ago, said...

Communication has been the hardest thing to re-learn. We've been married for 27 years and it's like starting all over again


about 5 years ago, said...

This reminded me of what I need to do when John is having a bad moment or bad day. Thanks.


about 5 years ago, said...

One of the comments asked for ideas for Alzheimer's patients who are blind. Have you tried making one of those aprons where you "decorate" a bib or apron with bits of interesting texture? I'm guessing you could start out with just a plain fabric and bring some items in a box, then let her touch stuff and decide if (or you could pick something and have her show where she'd like it added) she wants something added to the apron; that way she has input. also, I think it could be fun to play a form of the old TV game "Password" where you take an object and describe its qualities while your partner tries to guess what it is. That could be adapted to work with someone who is blind. You also could take a bunch of textured items, cut them in half, then put half on each of two trays or in two boxes and let the blind patient seek for a pair.


about 5 years ago, said...

All the cues foe non intimidating conversation was very interesting to me


about 5 years ago, said...

I think all of us as care givers forget what the loved one is going through when we start communicating to them, and forget that they can't begin to keep up with us. I have to remind myself all the time. "less is more' or too much info- short and sweet and to the point. I have to work on the "here and now" and separate that from "what she use to be"


about 5 years ago, said...

A number of useful tips.


about 5 years ago, said...

If I may add (to build on what was said on page three about the bird feeder) think about whether a question is what you want/need; in other words, if you pose a question instead of making a statement, be prepared to wait for and deal with an answer. Also, don't ask a question in wording that will get a "yes" then reword the same question in different words that will take a "no" for the same concept because that can lock the patient up. Use positive statement not negatives; "keep your hand open" vs. "don't close your hand". The author mentioned humor. It's a good idea to be wary of idioms that the Alzheimer's patient might interpret literally. Also, to the author: on page three, this sentence doesn't make sense to me: You can improve verbal exchanges in lots of casual names. Thanks for a great article.


about 5 years ago, said...

Nice article. I have Alzheimer's and the approaches are good. One of the best works i haev read in awhile.


about 5 years ago, said...

Each of the elements. I'm going to commit them to memory and try to keep them in the front of my mind. I hope to make habits of them as I communicate with my mother.


about 5 years ago, said...

I've bumbled into these solutions on my own over time, and it's nice to see them validated. I recall after my husband's diagnosis (of vascular dementia) being motivated to treat him with consideration. (I also remember thinking hey, isn't this how you are ALWAYS supposed to have treated him? Sigh...). I agree with these suggestions, they do help with the level of peace in the house, and they also calm me when I can practice them. I just wish I were better at following them...so much of the time he's "himself", and I forget... :)


over 5 years ago, said...

These pages have been very helpfull in visiting my sister in alzeimers facility She is 80. the youngest of three sisters trying to visit and make her life as pleasant as possible, She is a sweet person but always wants to go home and we are afraid to take her for a visit because she may not go back. I am her main contact and at 85 some what limited in what ai can do,