Communicating with dementia patients is one of the most challenging — and most heartbreaking — experiences families face.
You ask your mom what she wants for dinner. She stares at you, frustrated, struggling to find words. After a long pause, she says something that doesn’t quite answer your question.
You try again. She gets agitated. You get frustrated. The conversation ends with both of you feeling defeated.
Sound familiar?
Communication breakdowns are one of the most common challenges families face when caring for someone with dementia. The person you’ve known your whole life suddenly can’t find words, misunderstands what you’re saying, or responds in ways that don’t make sense.
Here’s what most families don’t realize: The problem isn’t that your loved one can’t communicate. It’s that dementia changes how they communicate — and if we don’t adapt our approach, we’re essentially speaking different languages.
This guide will help you understand why communication changes, which strategies actually work (backed by research), and how to maintain meaningful connections at every stage of the disease.
Why Dementia Changes Communication
Dementia doesn’t just affect memory. It disrupts the brain’s language centers — the areas responsible for finding words, forming sentences, understanding speech, and processing complex information.
Think of the brain like a complex electrical system. In a healthy brain, messages travel smoothly between regions. In a brain affected by dementia, some circuits are blocked or damaged. Sometimes signals find a clear path; other times, they get stuck.
This explains why someone with dementia might:
- Answer clearly one moment and struggle the next
- Understand a question but be unable to form a response
- Use the wrong word without realizing it
- Become overwhelmed by too much information at once
- Respond to your tone and body language more than your words
The most important thing to understand: The emotional part of the brain remains intact much longer than language abilities. Your loved one may not understand your words — but they absolutely feel your frustration, your patience, your love.
Common Communication Challenges
As dementia progresses, families typically encounter these challenges:
Word-finding difficulties
- Pausing mid-sentence, searching for words
- Substituting incorrect words (“hand me the…thing”)
- Describing objects instead of naming them (“the thing you drink from”)
- Using familiar words repeatedly
Comprehension problems
- Difficulty following conversations, especially with multiple people
- Confusion when given multiple instructions at once
- Taking longer to process what was said
- Misinterpreting sarcasm, jokes, or abstract language
Conversation difficulties
- Repeating stories, questions, or statements
- Losing train of thought
- Withdrawing from conversations
- Reverting to a first language (in bilingual individuals)
Important: Vision and hearing loss — common in older adults — make these challenges even harder. Always ensure hearing aids are working and glasses are clean before assuming communication problems are dementia-related.
The Golden Rule: Validate, Don’t Correct
The most important shift families need to make is moving from correcting to validating.
What is validation therapy?
Validation therapy is a communication approach developed by social worker Naomi Feil that focuses on empathy, acceptance, and meeting the person with dementia in their reality — rather than constantly pulling them back to ours.
Research published in 2024 found that validation techniques, such as affirmations and verbalizing understanding, were significantly more likely to elicit cooperative responses than correcting or contradicting. Non-validating communication was associated with increased resistance and distress.
The core principle: When someone with dementia says something that isn’t factually true, respond to the feeling behind the words rather than correcting the facts.
Examples of Validation vs. Correction
Situation: Mom says, “I need to pick up the kids from school.”
✗ Don’t say: “Mom, your kids are grown. They’re in their 50s now. You don’t need to pick anyone up.”
✓ Do say: “You were always such a good mom. Tell me about picking up the kids — what was their favorite after-school snack?”
Situation: Dad accuses someone of stealing his wallet (which he misplaced).
✗ Don’t say: “No one stole your wallet. You probably just forgot where you put it.”
✓ Do say: “That must be frustrating. Let me help you look for it. Where do you usually keep important things?”
Situation: Your spouse asks about their deceased parent as if they’re still alive.
✗ Don’t say: “Your mother passed away 10 years ago, remember?”
✓ Do say: “You’re thinking about your mom. What’s your favorite memory of her?”
The Do’s and Don’ts of Communicating with Dementia Patients
Do’s
✓ Give short, one-sentence explanations — Break complex information into simple chunks.
✓ Allow plenty of time for response — Then triple it. Rushing creates anxiety.
✓ Repeat instructions exactly the same way — Rephrasing forces them to process new information.
✓ Offer simple choices — “Would you like coffee or tea?” not “What do you want to drink?”
✓ Respond to feelings, not facts — Acknowledge the emotion behind what they’re saying.
✓ Use positive phrasing — “Let’s walk this way” instead of “Don’t go that way.”
✓ Maintain eye contact — Get at their level if they’re seated.
✓ Use touch appropriately — A gentle hand on the arm can be reassuring.
✓ Accept blame gracefully — “I’m sorry, I forgot to tell you” can defuse tension.
✓ Practice 100% forgiveness — They’re not trying to frustrate you. The disease is causing this.
Don’ts
▶ Don’t reason or argue — You cannot logic someone out of dementia symptoms.
▶ Don’t confront or correct — Correcting damages trust without improving memory.
▶ Don’t remind them they forget — Reminders just highlight their disability over and over.
▶ Don’t quiz them — “Do you remember who I am?” causes anxiety and shame.
▶ Don’t take it personally — Hurtful words are symptoms, not character judgments.
▶ Don’t talk over them — Include them in conversations, even if they can’t fully participate.
▶ Don’t use baby talk — They’re adults who deserve respect and dignity.
▶ Don’t have important conversations when they’re tired — Cognitive abilities fluctuate throughout the day.
Communication Strategies by Stage
Communication needs change as dementia progresses. Here’s how to adapt your approach at each stage.
Early Stage: Supporting Independence
In early-stage dementia, your loved one can still participate in meaningful conversations and social activities. They may have occasional word-finding difficulties or repeat stories, but they’re largely able to communicate.
Strategies for early stage:
- Don’t assume they can’t communicate — Many people function well in this stage
- Be patient when they search for words — Don’t finish their sentences unless they ask for help
- Include them in decisions — They can still express preferences and participate in planning
- Use humor appropriately — Laugh with them, not at them
- Keep them socially engaged — Isolation accelerates decline
- Use photos and objects to prompt memories — Visual cues support conversation
Middle Stage: Simplify and Support
Middle-stage dementia is typically the longest stage and can last for many years. Communication becomes more challenging — your loved one may confuse words, get frustrated easily, or have difficulty following conversations.
Strategies for middle stage:
- Approach from the front — Identify yourself by name each time
- Speak slowly and clearly — But don’t raise your voice unless they have hearing loss
- Use one-on-one conversation — Minimize distractions and background noise
- Ask yes/no questions — “Are you hungry?” not “What do you want to eat?”
- Use visual cues — Point to objects, show pictures, demonstrate actions
- Go with the flow — Join their reality rather than forcing them into yours
- Watch for non-verbal cues — Behavior often communicates what words cannot
Late Stage: Connect Through the Senses
In late-stage dementia, verbal communication may be minimal or absent. But your loved one can still feel your presence, hear your voice, and respond to sensory experiences.
Strategies for late stage:
- Focus on emotional connection — Your tone matters more than your words
- Use touch — Hold their hand, gently stroke their arm, give a soft massage
- Play familiar music — Songs from their past can evoke powerful responses
- Read aloud — Even if they don’t understand the words, your voice is comforting
- Use pleasant scents — Familiar smells can trigger positive memories
- Show photos and videos — Visual connection remains meaningful
- Simply be present — Your company matters, even in silence
Special Considerations by Dementia Type
Different types of dementia affect communication in different ways.
Alzheimer’s Disease
- Memory loss is the primary challenge — they may not remember recent conversations
- Word-finding difficulties are common
- Repetition is expected — answer the same question patiently each time
Lewy Body Dementia
- Cognitive abilities fluctuate dramatically — they may be lucid one hour and confused the next
- Visual hallucinations are common — don’t argue about what they see
- Movement difficulties may affect their ability to speak clearly
Vascular Dementia
- Executive function (planning, organizing) is often affected more than memory
- May have difficulty following multi-step instructions
- Physical symptoms (weakness on one side) may also affect speech
Frontotemporal Dementia
- Personality and behavior changes may be more prominent than memory loss
- Some forms specifically affect language (primary progressive aphasia)
- May say inappropriate things or lose social awareness — this is the disease, not their character
Parkinson’s Disease Dementia
- Soft, mumbled speech is common due to motor symptoms
- Facial expressions may be reduced (“masked face”), making emotions harder to read
- Allow extra time — both thinking and speaking may be slowed
When Communication Becomes Frustrating
Even with the best strategies, there will be difficult moments. Here’s how to handle them:
When you feel frustrated:
- Take a deep breath before responding
- It’s okay to step away briefly — say “I’ll be right back” and take a moment
- Remember: they’re not doing this on purpose
- Your frustration is valid — caregiving is hard
When they become agitated:
- Stay calm — your anxiety increases theirs
- Lower your voice and slow your speech
- Redirect to a pleasant topic or activity
- If a topic is causing distress, try again later
When nothing seems to work:
- Try a different time of day — cognitive abilities fluctuate
- Try a different approach or sensory channel (visual instead of verbal)
- Accept that some days will be harder than others
- Seek support — you shouldn’t do this alone
Taking Care of Yourself
Communication challenges are emotionally exhausting. Caregiver burnout is real — and it affects your ability to communicate effectively.
✓ Get respite — Regular breaks are essential, not optional
✓ Join a support group — Connecting with others who understand helps immensely
✓ Learn and practice — These communication skills improve with time
✓ Forgive yourself — You won’t get it right every time, and that’s okay
✓ Celebrate small victories — A moment of connection is meaningful, even if brief
How Professional Caregivers Can Help
Professional caregivers trained in dementia communication can provide crucial support — both hands-on care and relief for family members.
At All Heart Home Care, our caregivers receive specialized training in dementia communication techniques, including:
- Validation therapy approaches
- Stage-specific communication strategies
- Techniques for managing challenging behaviors
- Understanding different types of dementia and how they affect communication
- Creating meaningful activities and engagement
If you’re struggling with communication challenges or simply need a break, call us at (619) 736-4677 for a free in-home consultation.
As a veteran-owned, nurse-led agency serving San Diego families since 2014, we understand that quality dementia care is about more than physical tasks — it’s about maintaining connection, dignity, and quality of life.
References
- Campbell, K.M., Coleman, C.K., & Williams, K. (2024). Responses of Persons Living with Dementia to Caregiver Validating Communication: A Secondary Analysis. Research and Theory for Nursing Practice, 38(1), 28-42. doi.org/10.1891/RTNP-2022-0154
- Sunjaya, A.M., et al. (2025). Communication strategies for delivering personalised dementia care and support: a mixed-methods systematic review. Age and Ageing, 54(5). doi.org/10.1093/ageing/afaf120
- Alzheimer’s Association. Communication and Alzheimer’s. alz.org/help-support/caregiving/daily-care/communications
- Harvard Health Publishing. (2025). Bridging the gap: Dementia communication strategies. health.harvard.edu
- Validation Training Institute. vfvalidation.org
- Harris, C., et al. (2024). What are the communication guidelines for people with dementia and their carers on the internet and are they evidence based? Dementia, 24(3), 577-594. doi.org/10.1177/14713012241292486
Disclaimer: This article is for informational purposes only and is not intended as medical advice. Communication strategies should be adapted to each individual’s specific situation, stage of dementia, and personal preferences. Consult with healthcare professionals for guidance on your loved one’s specific needs.
