How to Talk to Someone with Dementia

What is dementia?

Dementia isn’t just one condition. Instead, there are several types of dementia, each with unique causes and symptoms. Below are some of the most common types of dementia and a few hallmark symptoms of each.

Alzheimer’s disease

Alzheimer’s disease is by far the most common type of dementia, accounting for 60-80 percent of all dementia cases.^[1] Alzheimer’s is caused by a buildup of amyloid plaques and tau tangles, both of which are proteins.

As these proteins become more and more prevalent in the brain, they cause irreparable changes to the brain’s functioning. The results are dementia symptoms like short-term memory problems, difficulty planning, and impaired judgment.

Vascular dementia

Vascular dementia is the second-most common type and, in some cases, occurs alongside Alzheimer’s disease. This condition is called mixed dementia and might also include Lewy body dementia.^[2]

Vascular dementia results when blood vessels in the brain are damaged. This damage reduces blood and oxygen flow in the brain, which causes symptoms such as difficulty reading and writing, forgetting current or past events, and losing interest in activities or other people.^[3]

Frontotemporal dementia

Frontotemporal dementia also develops due to protein buildup in the brain, specifically TDP-43 and tau. As the levels of these proteins rise, symptoms like temper tantrums, compulsive behaviors, loss of executive functioning, and personality changes may occur.

This type of dementia is scarce and typically affects people under 60.^[4]

Lewy body dementia

Like Alzheimer’s disease and frontotemporal dementia, Lewy body dementia is caused by protein buildup in the brain. However, the specific protein that causes this disorder is alpha-synuclein, also known as Lewy bodies.

As Lewy bodies continue to build up, they cause significant disruptions in the ability of neurons to send their messages. As a result, people with this type of dementia might experience difficulty with body movements, changes in sleep patterns, hallucinations, and problems with autoregulatory processes (e.g., rapid changes in body temperature).^[5]

Aside from the more specific symptoms outlined for each type of dementia above, there is a broad range of symptoms typical for all kinds of dementia. These include:

• Forgetfulness
• Diminished problem-solving and reasoning skills
• Diminished ability to complete complex tasks
• Personality changes
• Difficulty producing or understanding speech

Top tips for communicating with dementia patients

Learning how to talk to someone with dementia mainly involves understanding how to be an empathic listener and a purposeful speaker. However, you can use some specific strategies to make communication between you and someone with dementia much easier.

Plan ahead

Communicating with dementia patients begins with planning. Ensure you’re in a quiet place with minimal distractions. This allows them to hear you and you to hear them. It enables you both to concentrate on your conversation as well.

Part of your planning should be to engage a dementia patient in a conversation at a time during the day when they’re most alert. For example, trying to have a conversation with someone immediately after they’ve woken up is not likely to garner the results you want.

Likewise, maximize your time with dementia patients on their good days. Though it’s difficult or impossible to plan ahead for days when they are more alert and aware, try to spend as much time with them during those periods as you’re likely to have much more fruitful conversations.^[6]

The planning process should also entail checking in with the patient and meeting their needs. If they’re thirsty, hungry, need to use the restroom, and so on, those needs should be met before starting your conversation.

Utilize active listening techniques

To learn how to talk to dementia patients requires that you understand how to listen. Active listening techniques like making eye contact and giving your undivided attention signals to the patient that you’re interested and engaged with what they have to say.^[7]

Active listening also encourages you to repeat back what you’ve heard. This is an excellent way to check if you’ve understood the patient correctly. It also allows them to expound on or revise what they’ve said.

Refrain from interrupting as well. Sometimes, people with dementia can struggle to find the right words. By giving them the time they need to formulate their thoughts, you allow them to express themselves fully.

Be practical

When communicating with someone with dementia, it’s essential to be practical in your approach. For example, keep things simple - use short sentences and easy-to-understand words. Ask simple questions, too. For example, rather than asking, “What would you like to do?” ask, “Would you rather go for a walk or read together?”

Use their name often so they understand you’re a trusted ally and to remind them of who they are, too.

Moreover, use the person’s body language to help guide how you approach communicating with them. If they’re smiling and laughing, you’re onto something. You’ll need to adjust your communication strategy if they seem withdrawn or frightened.

If you don’t understand what a dementia patient is saying or asking, ask them for clarification, but do so in a kind and supportive way. Though this might seem like common sense, some people pretend they understand or ignore what the dementia patient has said, neither of which is an appropriate or practical approach to communication.

When you’re among others, invite the person with dementia to join the conversation. Make them comfortable and heard. Make them feel like they’re part of what’s happening. At the same time, understand when the situation is overwhelming. If need be, take the patient to a quieter place where you can have a one-on-one conversation.

Regardless of when or where you’re conversing with a dementia patient, ensure you’re on their level. Doing so makes eye contact easier, and it makes it easier for you to hear one another. Avoid standing, as that can be intimidating, especially if you’re standing over them or standing too close.

Practice patience and empathy

As previously noted, communicating with dementia patients requires that you be patient. For example, you should:^[7]

• Take your time and speak slowly.
• Give them plenty of time to verbalize their thoughts.
• Allow them to speak for themselves - resist the urge to speak for them.
• Supplement verbal communication with nonverbal communication (e.g., hand gestures, gentle touches, or even smells and tastes).
• Know that you will have to repeat yourself. Try not to become frustrated, as dementia patients might feel like it’s the first time they’ve had a conversation with you and might not be aware of their condition.

Perhaps above all, be willing to simply sit with the person. Sometimes, nothing needs to be said. Your presence and love might be all the person needs at that moment.

Another component of learning how to talk to dementia patients is empathy.^[8] Put yourself in their shoes and try to understand what they might be feeling. Moreover, try to imagine how you would feel and how you would want others to communicate with you if you were the one with dementia.

Use humor

Though dementia is a severe condition, it shouldn’t mean that laughter and fun can’t be part of your communication. Share funny stories, read humorous articles, and watch TV shows or movies that elicit laughter.

When mistakes are made or there’s a misunderstanding, laugh about it instead of getting frustrated.^[6] If you’re lighthearted and cheerful, it will rub off on the dementia patient. If you’re testy or angry, that will rub off too.

What should you not say to someone with dementia?

It’s important not to patronize or talk down to someone with dementia.^[9] They have every right to say, feel, and think what they do. Arguing with a dementia patient or trying to correct them is not a good use of your time and makes effective communication more difficult. As such, avoid saying things like:

• “No, that’s wrong.”
• “You’re confused.”
• “You don’t know what you’re talking about.”

Also, avoid treating someone with dementia like a child. If you have a question, ask them, not their caregiver. If a question is asked of them, don’t answer for them. Allow them to think and act independently as an adult, then provide appropriate assistance as needed.

When considering what not to say to a dementia patient, also consider how not to say things. Avoid being terse or short. Don’t frown or scowl as you’re speaking or listening. Avoid a negative tone of voice as well.

Again, these seem like common sense tips, but it can be intimidating to speak with someone with dementia. When intimidated or unsure of what to say or how to say it, take a step back, evaluate the situation, and understand that it’s better to be purposeful in your communication - for you and your loved one with dementia.