How to Cope with Communication Challenges

Reviewed by: HU Medical Review Board | Last reviewed: June 2019

As Alzheimer’s disease progresses, communication becomes more and more impaired. A person with Alzheimer’s disease experiences progressive difficulty remembering things, and as more nerve cells in the brain are destroyed, they might have word-finding difficulties, trouble understanding things, be unable to concentrate during long conversations, or losing their train of thought while talking.1 In late-stages of Alzheimer’s disease, they may be unable to verbally communicate at all. While this may be difficult for family members or caregivers, this is also difficult for the person with Alzheimer’s disease. There are things that can be done to help support the person and help them cope with communication challenges.

Communication tips

When talking with someone with Alzheimer’s disease, it’s important to be aware of the tone of voice used, the volume of voices, and body language. The person may be especially sensitive to any or all of these things, and especially in earlier stages of Alzheimer’s disease, they may be able to pick up on nonverbal cues from others. It’s important to encourage a two-way discussion as long as possible, make eye contact with the person, and have patience.

During the middle stage of Alzheimer’s disease, communication challenges can vary over time, since this stage is so long and can encompass a wide variety of symptoms and levels of impairment. Communication in the early part of this stage looks very different than communication in the later phases of this stage. As the disease progresses, communication strategies will be adapted to the person’s specific symptoms and needs, and this is normal. During the earlier part of the middle stage, family and caregivers can use these tips for communication2:

  • Try to communicate one-on-one, in a distraction-free setting
  • Maintain eye contact and speak slowly
  • Allow enough time for the person to process what has just been said and respond
  • Ask one question at a time, preferably yes or no questions
  • Provide visual cues when necessary
  • Offer reassurance and be patient
  • Try not to correct, criticize, or argue with the person
  • Use different words if they don’t understand at first

In the later part of the middle stage of Alzheimer’s, as it progresses to late-stage Alzheimer’s, here are some things that family and caregivers can do to cope with communication challenges2:

  • Identify yourself when talking to the person with Alzheimer’s disease and always approach them from the front, so as not to startle them
  • Use and encourage nonverbal communication, like hugs, smiles, gestures, etc
  • Use the senses to communicate – touch, smell, sight
  • Avoid condescension or talking down to the person; be respectful
  • Sometimes simply being there as a reassuring presence is enough; the perfect words don’t need to be said

Things to consider

At the beginning of the middle stage of Alzheimer’s disease, the person may be very aware of their memory difficulties and the ways that the disease is affecting their communication. Make space for them to be able to talk about their frustration, sadness, or feelings, and validate what they’re going through. Take cues from the person about what they’re trying to say, and rather than speaking for them, help them find the words they need to express themselves.

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