The Center for Brain/Mind Medicine > Support & Education

Communication Changes

What Is Communication?

Communication is more than just talking.  It is the act of giving, receiving, and exchanging information, ideas, needs, and opinions.  It involves a combination of attitude, tone of voice, facial expressions, and body language in addition to any words being said.  It’s the way we relate and connect with one another.

Dementia & Communication

Due to changes in the brain, dementia causes progressive changes in a person’s ability to express themselves.  Much like the behavioral changes associated with dementia, communication changes will vary from person to person depending on where they are in the disease process.  Dementia can cause fluctuations in memory, difficulty understanding language (both verbal and body language), personality changes, and visual or perceptual changes, which can make the person’s ability to communicate more difficult.  Learning about these communication changes and how to communicate despite these changes can help both you and your person navigate day-to-day frustrations and find more ways to connect. 

Changes (by Stage) & Tips to Address Them

Dementia Stage



Caregiver Tips

Early – Mild


Still able to participate in meaningful conversation and engage in social activities.

Trouble staying on topic.

Needing more time to respond.

Increased frustration.

Difficulty finding the right word.

Losing their train of thought more often.

Repetition of stories or questions.

Becoming overwhelmed by too much stimulation compared to the past.



Continue to include the person with dementia in conversations.

Avoid assumptions about the person’s ability to communicate on any given day.

Speak directly to the person rather than to their caregiver or companion.

Take time to listen to the person express themself.

Give the person time to respond.  Try not to interrupt.

Ask the person what help they need.

Discuss which methods of communication are best (face-to-face, phone calls, email, etc.).

It’s okay to laugh.  Sometimes humor lightens the mood and makes communication easier.

Resist the urge to pull away.  Your honesty, friendship, and support are important to the person.


Middle Moderate


Increased difficulty participating in long conversations.

Difficulty reading.

Trouble explaining or understanding abstract concepts.

Difficulty finishing sentences or trains of thought.

Speaking in vague or rambling sentences.

Decreased interest in conversation.


Needing more help with day-to-day tasks.

Making up stories or details that are untrue or different from what you recall.



Provide a choice to promote autonomy.  For example, ask “Would you like coffee or tea?” instead of “What would you like to drink?”

Listen and try to find the meaning.  Clarify by repeating what they say.

Choose your battles and avoid arguing, criticizing, or correcting.  If the person says something and you don’t agree, let it be.

Try one-on-one conversations.

Maintain eye contact.

Be patient and offer reassurance.

Ask one question at a time.

Offer clear, step-by-step instructions for tasks.  Lengthy requests may be overwhelming.

Give visual cues.  Demonstrate a task to encourage involvement.

Written notes may be helpful when spoken words are confusing or easy to forget.

Avoid contradiction.


Late – Severe


Decreased understanding of what is being said to them.

Less likely to respond verbally.

Not realizing they are being addressed by others.

Repeating the same phrase or sound.

Saying things that don’t make sense.

Relying more on nonverbal communication (behaviors, facial expression, gestures, or sounds) to communicate needs or feelings.

Around-the-clock care is usually required in this stage.


Approach the person from the front and identify yourself.

Encourage non-verbal communication.

Use touch, sights, sounds, smells, and tastes as forms of communication.

Consider the feelings behind words and sounds.  Sometimes the emotions or needs being expressed are more important than the actual words.

Continue to treat the person with dignity and respect.  Avoid talking down to the person or acting as if they are not there.

It’s okay if you don’t know what to say; your presence and friendship are most important. 

Five Steps to Support Communication

1) Take a breath and center yourself.
2) Observe your person.  What emotion is their body language communicating?
3) Empathize with their position or experience.
4) Listen for the need behind their words or behavior.  Do they need love/connection?  Something to do/a sense of purpose?  Are they scared or anxious/in need of security?
5) Connect through verbal and non-verbal techniques.

Communication Takeaways

As you adjust to changes across the continuum of the disease, a number of tools can bridge understanding and connection with your person over time:

    • Give your person time to understand and respond to what you’ve said; repeat if necessary.
    • View your person’s world through their eyes, not yours.
    • Choose your battles—avoid arguing or passing judgment unless safety is at risk.
    • Speak concisely and clearly.
    • Ask one question at a time.
    • Minimize distraction, background noise, or interference.
    • Offer a choice, no matter how simple it may seem.
    • Maintain dignity and respect.
    • Be present in the moment—give your full attention and make eye contact.
    • Use humor to lighten the mood as you are able.
    • If the needs of the person are already being met, distract and/or redirect.
    • Offer validation of the person’s feelings or experience through verbal and non-verbal measures.
    • Ask for help and learn new skills.