Talking with someone who has dementia

Dementia slowly changes how a person uses and understands words. They may lose a word in the middle of a sentence, lose track of a story, or not follow what you said.² This is the illness, not stubbornness, and it is not your fault.

How you talk can make the day calmer for both of you. This page gives practical do's and don'ts, ways to connect without words, the debate over white lies, and tips for phone and video calls.

Why talking gets harder

Dementia affects the parts of the brain that handle language, memory and attention. A person may struggle to find the right word, put words in order, or hold onto a thought.² Background noise from a TV, radio or other people can make it hard to focus on what you say.²

Changes depend on the type and stage of dementia. In primary progressive aphasia, language is one of the first skills to change. In Lewy body dementia, a person may talk clearly one hour and struggle the next. Every person is different, so do not assume limits based only on a diagnosis.¹

Hearing loss makes everything harder. About 1 in 3 older adults has hearing loss.⁴ If the person has hearing aids or glasses, make sure they are in, clean and working before a talk. See hearing loss, loneliness and the brain.

Do's and don'ts

A few more ideas help in daily life:

• Pick the right place. Talk one-on-one, somewhere quiet. Turn off the TV.¹
• Listen for the meaning. The words may be wrong, but the feeling behind them is real. Repeat back what you think they mean.¹
• Help with a lost word, gently. In the early stage, ask if they want help before jumping in.¹
• Use written notes. A short note or picture can help when spoken words get confusing.¹ A memory notebook can hold names, plans and photos.
• Use humor. Shared laughter can ease a hard moment.¹
• Take a break if you get upset. Step away, breathe and come back. A cyclic sigh takes about a minute.²

If the same question comes again and again, see repeated questions and stories.

By stage

Early stage. Talk to the person directly, not only to the person with them. Ask what they can still do and where they want help. Ask how they like to stay in touch, such as visits, phone or email. Don't pull away.¹ See early-stage dementia.

Middle stage. This is when the do's and don'ts above matter most. Keep steps short, show rather than tell, and let small mistakes go.¹ See middle-stage dementia.

Late stage. Words may be few or gone. Approach from the front and say who you are. Watch the person's face, sounds and gestures, and ask them to point if you are unsure. Connect through touch, music, smells and tastes. Just being there matters, even if you don't know what to say.¹ See late-stage dementia.

Talking without words

As speech fades, people lean more on faces, tone and touch. Their own face may show sadness, fear or anger before they can say it.² You can use the same channel:

• Keep your face relaxed and your voice warm and matter-of-fact.²
• Hold a hand or gently guide an arm, if the person welcomes touch.²
• Get down to eye level instead of standing over someone who is seated.
• Point, gesture, or hold up the item you mean, like a cup or a coat.¹
• Notice their body language. Pacing, pulling away or a tight face may mean pain, fear, hunger or needing the toilet. A behavior diary can help you spot patterns.

When a person becomes very upset, see agitation and aggression.

The white lie debate ("therapeutic fibbing")

Many caregivers face moments like this: your mother asks where her husband is, but he died years ago. Telling her the truth may make her grieve as if for the first time, every time. Some families and care staff answer with a kind untruth, such as "He's at work." This is sometimes called therapeutic fibbing.

Families and care workers often use small deceptions in daily care.⁶ Experts do not fully agree on when, or whether, this is right.

The case for. Some ethicists argue that a kind deception can be justified when the truth would only cause pain the person cannot process.⁶

The case against. Lies can damage trust if the person sees through them. They can become a lazy habit. And there are often more respectful ways to help that carry less risk.⁶

A major UK inquiry by the Mental Health Foundation offers a middle path. It lays out a range of responses, from most truthful to least:⁵

1. Tell the whole truth, gently, when it will not cause needless distress.
2. Look for the meaning behind the words. "Where is my husband?" may really mean "I feel lonely" or "I feel unsafe." You might say, "You're missing him. Tell me about him."
3. Distract kindly, with a walk, a snack, music or a task.
4. Go along with the person's reality, without arguing and without adding made-up details.
5. Tell an outright lie, only when other approaches have failed and the truth would cause serious harm.

The inquiry advised starting as close to the truth as you can. Move down the list only when the truth causes needless distress. It saw outright lies as justified only to prevent serious harm, never as a default.⁵

It also suggested:⁵

• Respond to the emotion first. Reassure and name the feeling: "You sound worried."
• Stay consistent. Agree as a family and with care staff on how to answer common questions.
• Keep reviewing. What works can change as the illness changes.

There is no single right answer for every family. Use your knowledge of the person, their values and their life story. False beliefs that seem frightening or paranoid are covered on hallucinations, delusions and paranoia.

Phone and video calls

Calls can keep grandchildren, faraway family and old friends in touch. They can also be confusing, because there is no face to read on a phone and a screen can feel strange.

Making calls easier:⁹

• Use a simple phone with large buttons, or put photo shortcuts on the home screen so one tap calls a loved one.
• Try a smart speaker or voice assistant for hands-free calling.
• Limit calls to a short list of trusted contacts. This can cut down on misdials and repeated calls.
• Tape a simple printed guide by the phone: "Green to answer, red to hang up."
• Start small and build calls into the daily routine. Something that fails at first may work later.

See technology that helps for devices.

Tips for the caller:

• Say your name and how you are related right away. Don't make it a guessing game.³
• Speak slowly and clearly. Ask one simple question at a time.¹
• Pick a calm time of day. For many people, late afternoon is harder. See sundowning.
• Have a few topics ready, but follow their lead. Let the person set the length of the call.¹⁰

Ideas for video calls:¹⁰

• Plan around their interests, like their hometown, old job, favorite songs or foods.
• Sing or play favorite music together.
• Ask the local caregiver to have a photo album or favorite object ready, then talk about it.
• Share your screen to look at old family photos or a live zoo or park camera, and describe what you see.

Calls add to in-person time but do not replace it.⁹ If you live far away, see long-distance caregiving.

Can you learn these skills?

Yes. A review of 12 trials found that communication skills training helped both family and paid caregivers communicate better. It also improved quality of life and well-being for people with dementia.⁷ Moderate evidence

A larger review of 38 studies agreed that training builds caregivers' knowledge and skills. But on its own, it did not clearly reduce difficult behaviors or caregiver burden.⁸ The best programs had caregivers practice skills and talk them through, not just read or listen.⁸

See caregiver training and support programs. The Alzheimer's Association 24/7 Helpline, 800-272-3900, is free. It offers help in more than 200 languages and free care consultations with dementia experts.¹¹

When to get help

• Call 911 if speech or understanding changes suddenly, especially with face drooping, arm weakness, or trouble walking or seeing. These can be signs of a stroke.¹²
• Call the doctor soon if talking gets much worse over a few days, or with new confusion or sleepiness. An infection, a medicine or another health problem may be the cause. See hospital stays for more on sudden confusion.
• Call or text 988 if you, the caregiver, feel hopeless or overwhelmed. Caregiving is hard, and help is available. See caregiver stress and burnout.

For the bigger picture, return to caring for someone with dementia.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.