How does dementia affect communication?

As human beings, we communicate with each other using an array of verbal and non-verbal communication. From our facial expressions and body language to the words we speak and tone we use, these are the tools we often take for granted to help us express ourselves and feel understood.

All forms of dementia can affect communication in all kinds of different ways. Although this can be challenging and sometimes frustrating or distressing – there are ways that you can help to support and maintain communication.

How does dementia affect communication?

Dementia’s like Alzheimer’s disease, for example, can cause a symptom known as “aphasia”. This means losing the ability to speak and to understand speech. 

Dementia most commonly affects language and someone’s ability to find the right words. Sometimes, related words may be used (‘boot’ instead of ‘shoe’, for example) or substitute descriptions (eg ‘drinking thing’ instead of ‘glass’). Sometimes it can be hard to find a replacement word at all. 

In other cases, words and grammar can become jumbled up so speech may be fluent but lack coherency or meaning. 

Dementia can also make it hard for someone to communicate because they may not be able to understand what you are saying, or what you meant.  Even what seems like (to you) a simple question or request, may be interpreted differently than you intended.

In the case of frontotemporal dementia, problems with language are likely to be one of the first symptoms that are noticed. Although symptoms depend on the individual and the type or stage of dementia, symptoms will likely vary from day-to-day, being worse on some days than others. 

Why do dementia patients struggle to communicate?

Because dementia affects the brain and cells within, this has an impact on cognitive ability. Someone with dementia may not be able to think as quickly as they used to, may not understand complex ideas or become easily confused. They may need more time to process information and to figure out how to respond. 

It’s also harder for people with dementia to hold more than one idea in their head at once. This is why you may find that someone with dementia can jump from one topic to another, forgetting what they were talking about in the first place. This can make it hard to resume a conversation if there’s an interruption. 

When someone has dementia, there may also be other things that can affect communication. This could be:

• Pain or discomfort
• Illness
• Medication side-effects
• Tiredness or lack of sleep
• Any other conditions in addition to dementia (recovering from a stroke, for example). 

If you think there may be other issues or factors like these making communication more difficult then it’s best to seek advice from a GP. 

Do people with dementia know what they are saying?

Often, words and their meanings can be mixed up for someone with dementia, resulting in sentences that don’t make sense to anyone else. This can be frustrating for everyone involved. 

If someone with dementia says something that sounds wrong or strange, chances are that’s not what they meant or wanted to say – their brain just won’t let them find the right vocabulary. 

Will communication get harder?

As time goes on, communication will likely become more difficult for someone with dementia. Although dementia can take years to advance over several stages, symptoms can worsen in each subsequent stage. 

Making communication easier for someone with dementia

When you have dementia, being unable to make people understand you in the way you want can be upsetting. But, if someone patient and kind can help you, it can ease some of the stress and frustration and encourage communication. 

If you’re finding it hard to communicate with someone who has dementia. Or if you notice they’re not communicating as much as they used to, there are things you can do to help. The NHS recommends a few simple tips you can try:

• Speak clearly and slowly
• Use short sentences 
• Stay away from complex subjects or ideas
• Make eye contact when you – or they – are talking or asking questions
• Be patient and give them time to answer without trying to speed them up or finish their sentences
• Encourage them to join in conversations with others
• Let them speak for themselves during discussions that concern their welfare or health issues
• If their response doesn’t seem to make sense, acknowledge what they’ve said and encourage them to say more
• If they find a question difficult or seem confused, try and rephrase it.
• Try not to be patronising 

Understanding and listening to someone with dementia

As we mentioned at the beginning of this article, there is more to communication than just verbal communication. Learning how to listen carefully and use your facial expressions and body language to communicate is also important. 

You might find that an encouraging pat on the arm, a smile, and turning your body towards someone when you’re talking can make a difference. 

You can also try:

• Minimise any distractions that might get in the way of communication. Try turning down (or off) the television or radio (as long as you check it’s ok to do so).
• If possible, stop what you’re doing and give the person your full attention when they’re speaking.
• If you’re unsure about what was said, repeat what you heard back and ask if it’s right. Or, ask them if they could say it again.

If you want to read more about Alzheimer’s and communication, you can try the Alzheimer’s Society. They have some additional tips on communication as well as lots of other useful information. 

Related article: How to talk to someone with dementia