Dementia and communication

Also called Alzheimer's and communication, Communication in dementia, Primary progressive aphasia

Word-finding, understanding and memory change through dementia; the conversation techniques that keep people connected are learnable, and most of them are about you.

What it is

Dementia is a set of progressive conditions affecting memory, thinking and language, and the Health A-Z covers it as dementia. Communication changes are part of every type, and in some, such as primary progressive aphasia, a form of frontotemporal dementia, language goes first while memory holds.

The common pattern: word-finding difficulties early, with "the thing" and "you know" standing in; then trouble following long or fast talk, losing the thread of a story, repeating questions because the answer didn't stick; later, shorter sentences, then single words, then communication mostly through tone, touch, expression and behaviour. At every stage the person is still communicating, and the partner who adapts stays connected for far longer.

Who it can help

Families, friends and care staff of anyone with dementia, at any stage. The person themselves, early on, when learning strategies is still possible and the person's own wishes about later communication can be recorded.

It isn't the entry for delirium, a sudden confusion that's a medical emergency and usually reversible; a sharp change in communication over hours or days needs a doctor, not a technique.

How it works

What works is well established. Approach from the front, make eye contact, say your name and use theirs. One short sentence at a time, with the key word at the end. Ask one question, offer two choices at most, and prefer questions that can be answered with yes, no or a point. Wait; the reply takes longer. Don't correct or argue with a false memory; respond to the feeling behind it. Fill in a lost word only if the person wants you to.

The environment does half the work: a quiet room, no television underneath the conversation, good light on your face. Pictures, objects and written words support understanding long after speech is difficult, and a life-story book gives the person topics they can lead on. Talking Mats let a person show what they feel about things when they can't say it.

Later, communication becomes touch, music, singing and presence. The person still knows a warm voice from a cold one.

Getting started

This week, turn off the television before you talk and sit where they can see your face. Slow down. Try one question at a time and count to ten before you help.

Make a life-story book or a photo album with names written under the pictures and keep it on the table. Write a communication passport with what helps and what upsets, and give it to every carer and the ward if they go in.

Ask the GP or memory service for a speech and language therapy referral; it's available for dementia and rarely offered. Learn one song they loved and sing it.

Where to get help

Alzheimer's Society covers every type of dementia, with a helpline, local services and detailed communication guidance. Dementia UK runs the Admiral Nurse helpline for families. Age UK helps with the wider practicalities. The NHS route is the GP and the local memory service; speech and language therapy is via either, and the RCSLT describes it.