Can people with dementia still understand you? A guide to communication

Statistics show that more than 55 million people worldwide live with dementia, a progressive condition that fundamentally alters communication. But can people with dementia still understand you? The answer is nuanced, as verbal comprehension shifts significantly throughout the disease's progression, yet the capacity for emotional connection often endures.

Quick Summary

Verbal understanding in those with dementia changes over time, requiring communication partners to adapt from focusing on words to valuing emotional and non-verbal cues. Despite declining cognitive abilities, meaningful connection is still possible.

Key Points

• Comprehension Declines Progressively: A person's ability to understand spoken language diminishes as dementia advances, requiring adaptable communication strategies.

• Non-Verbal Communication Becomes Crucial: As verbal skills fade, non-verbal cues like tone, body language, and gentle touch become the most effective way to convey emotion and intent.

• Emotional Connection Endures: The capacity for emotional awareness and connection often persists even in the late stages, making validation and reassurance vital.

• Simplify and Clarify: In conversation, use simple, direct sentences and ask one clear question at a time to reduce confusion and frustration.

• Focus on Feelings, Not Facts: Avoid correcting or arguing with a person with dementia; instead, respond to and validate the feelings behind their words or actions.

• Minimize Environmental Distractions: A calm, quiet setting improves a person's ability to focus and engage, especially as their cognitive processing slows down.

• Embrace Patience and Compassion: The most effective approach involves adapting your expectations and providing consistent reassurance, love, and support.

Navigating communication through the stages of dementia

Communication with a person living with dementia is a skill that evolves with the disease. As cognitive function declines, the ability to process and retain information is affected, but it's important to remember that the individual's core emotions and need for connection remain. The progressive nature of dementia means that communication strategies must be flexible and tailored to the person's current abilities.

Early-stage dementia

In the early stages, communication issues can be subtle. A person might occasionally forget a word, repeat stories, or have trouble following a complex conversation, but they can still express their thoughts and needs verbally. During this phase, it is crucial to:

• Include the person in conversations and speak directly to them.
• Give them plenty of time to respond without interrupting.
• Encourage face-to-face conversations in a calm environment.
• Laugh with them when appropriate, as humor can lighten the mood and strengthen bonds.

Middle-stage dementia

As dementia progresses to the middle stage, communication challenges become more apparent. The person may struggle with finding the right words, use incorrect words, or invent substitutes for words they can't remember. Responses may be delayed, and they might have difficulty staying focused or following a fast-paced conversation. In this stage, focusing on feelings rather than facts becomes more effective.

• Simplify language: Use short, clear sentences and avoid complex jargon.
• Ask direct questions: Ask one question at a time, preferably those with simple 'yes' or 'no' answers, instead of open-ended choices.
• Listen actively: Pay attention to their body language, tone, and emotions. What they feel is often more important than the literal words they say.
• Minimize distractions: Limit background noise from the TV or radio to help them focus.

Late-stage dementia

By the final stages of dementia, verbal communication may be severely limited or cease entirely. The person may use gestures, sounds, or other non-verbal cues to express themselves. At this point, sensory communication and emotional connection are paramount. It is important to focus on providing comfort and reassurance.

• Use non-verbal communication: Gestures, facial expressions, and gentle touch can help convey your message and affection.
• Focus on the senses: Use music, pleasant smells, or familiar textures to engage them. Music, in particular, can evoke powerful memories and emotions.
• Embrace silence: Sometimes, your presence alone is enough to provide comfort and bond.
• Validate emotions: Respond to the feelings behind their actions. If they seem agitated, offer reassurance rather than trying to reason with them.

A Comparison of Communication in Dementia

Feature	Early-Stage Communication	Late-Stage Communication
Verbal Ability	Can hold conversations, but may have difficulty finding words.	Minimal to no verbal communication; may use gestures or sounds.
Focus	On facts, words, and forming coherent sentences.	On emotion, comfort, and sensory experience.
Best Question Type	Open-ended questions are possible but may cause frustration.	Yes/no questions or simple directives are most effective.
Primary Cues	Verbal language, with some non-verbal support.	Non-verbal signals (body language, facial expressions) and touch.
Response Time	May need a little extra time to process thoughts.	May be significantly delayed or non-existent.
Strategy	Patience, active listening, and simple explanations.	Validation, reassurance, sensory engagement, and presence.

Responding with affection and reassurance

For many families, one of the most painful aspects of dementia is the feeling of losing the person they knew. However, the emotional bond often remains intact long after verbal skills have faded. People with dementia are highly sensitive to your tone of voice and body language. By responding with patience, affection, and reassurance, you can maintain a loving and meaningful connection.

What to do

1. Maintain a calm demeanor. Your calm presence can provide comfort and stability.
2. Validate their feelings. Instead of correcting a factual error, acknowledge the emotion they are expressing. For instance, if they express a desire to go home, you can respond, "I know you feel that way. What was your favorite part about being home?"
3. Engage through the senses. Use music they love, hold their hand, or offer a favorite food. These sensory cues can bypass verbal barriers and evoke pleasant emotional responses.

What to avoid

1. Arguing or correcting. This can cause frustration and agitation for both of you.
2. Infantilizing the person. Speak respectfully and at their eye level.
3. Speaking about them as if they aren't there. Assume they can hear and understand, even if they don't respond verbally.

The enduring human connection

At its core, communication is about connection, and that connection can persist even when the words do not. It requires a shift in perspective from what is lost to what remains. The ability to feel safe, loved, and valued is fundamental, and care partners can continue to provide this through their presence, tone, and gentle touch. Even in the final stages, moments of lucidity or a simple smile in response to a familiar song can remind you of the person who is still there, beneath the progressive effects of the disease. Focusing on shared humanity and love is the most powerful communication tool of all.

For more detailed guidance on effective communication techniques, visit the official resource page provided by the National Institute on Aging: Communicating With a Person Who Has Alzheimer's Disease.

Conclusion

While the verbal abilities of a person with dementia will change over time, their ability to feel and respond to emotional signals remains. By understanding the progression of the disease, adapting your communication style, and focusing on non-verbal cues like touch and tone, you can maintain a meaningful and loving connection. The journey is challenging, but with patience and compassion, it's possible to continue communicating effectively and reinforcing your bond.

Frequently Asked Questions

Will a person with early-stage dementia still understand me completely?

In the early stages, a person with dementia can typically still follow conversations and understand most things you say. However, they may struggle with recalling specific words or may need more time to process complex ideas. Communication feels relatively normal at this point, but requires patience.

How should I change my speaking style for someone with dementia?

Focus on using simple, clear, and concise sentences. Speak slowly and calmly, and use a pleasant and respectful tone of voice. Avoid slang or complex metaphors that may cause confusion. If they don't understand, repeat the same words or wait a few minutes before rephrasing.

Why does my loved one with dementia get upset when I correct them?

Correcting a person with dementia, even gently, can cause frustration, embarrassment, and agitation because they do not perceive their own memory loss. Instead of correcting them, it's more effective to validate the emotion behind what they are saying and then redirect the conversation to a pleasant topic.

Do people with late-stage dementia still recognize me?

Verbal recognition may fade in late-stage dementia, but the ability to perceive and respond to emotional cues often remains. While they might not remember your name, they can often still feel the comfort and connection your presence brings. Focus on non-verbal cues like touch and eye contact.

What if they can't communicate verbally anymore?

Even if verbal communication is gone, a person can still communicate through body language, facial expressions, and sounds. Focusing on non-verbal cues is key. You can also engage them through sensory stimulation like music, gentle touch, or looking at familiar photo albums.

How can I get their attention during a conversation?

Before speaking, make sure you have their attention. Address them by name and make eye contact. If they are seated, get down to their eye level. Limit background noise and distractions by turning off the TV or radio so they can focus on you.

Is it okay to ask questions about the past?

Yes, reminiscing about the distant past can be very effective and soothing. Many people with dementia have better long-term memory than short-term memory. However, avoid 'testing' them on recent events. Instead, ask general questions about happy memories from their earlier life.