Dementia: how to talk and understand

The problem

When someone with dementia says something that is not real (that their long-deceased mother is waiting for them, that they have to go to work, that someone robbed them), the first impulse is to correct. And correcting almost always ends in distress, anger, or argument.

What is happening underneath

Dementia changes the brain: memory, orientation, and reasoning no longer work as before. The person is not doing it on purpose or to annoy you: their reality is real to them, and they cannot change it because you explain it to them. You never win an argument with the disease.

Step by step

1. Do not argue, do not correct, and do not put them to the test. The golden rule is: validate what they feel and redirect gently.
2. Respond to the emotion, not the fact. If they ask about someone who has died, do not give the news again: accompany the affection ("I can tell how much you love her") and steer the talk to a fond memory or another activity.
3. If they insist "I have to go to work" or "I have to go home," do not contradict them: validate ("you worked so many years, you have earned the rest") and redirect to something comforting ("let's have a tea together").
4. Accept the blame even if it is not yours: "sorry, I forgot to tell you" calms more than "I already told you a thousand times."
5. Do not take it personally. If they accuse you of something or do not recognize you, it is the disease talking, not the person.

The problem

As dementia advances, words get harder: it is hard to find them, to follow a long sentence, or to process several things at once. Talking as before creates frustration in both.

What is happening underneath

The person understands the simple, the slow, and the warm better. And they read the tone and the face a lot: if you are calm, they calm down; if you tense up, they tense up.

Step by step

1. Approach from the front and at their eye level, slowly, and tell them who you are ("hi, Mom, I'm Ana, your daughter"). Dementia reduces side vision, and appearing suddenly is frightening.
2. Speak in short sentences, one idea at a time, and give plenty of time to respond. Then give even more time.
3. Offer simple choices, yes or no, or between two: "would you like a tea?" instead of "what would you like to drink?".
4. If they do not understand a word, say it another way or with a gesture. If they repeat the same question, repeat the same short answer, calmly, as if it were the first time.
5. Instead of "do you remember when...?", use "I remember when...". And recalling things from long ago (their youth, their work, their children as little ones) usually gives them security and joy.

The problem

Sometimes the person gets restless, paces without stopping, repeats, gets angry, or shouts. They do not do it out of whim: when words no longer suffice, behavior is their way of saying something.

What is happening underneath

Behind agitation there is almost always a need: pain, hunger, thirst, needing the bathroom, tiredness, or too much noise and stimulation around. Pain, above all, gets overlooked. The caregiver becomes a bit of a detective.

Step by step

1. At agitation, ask yourself what they may be needing: does something hurt? are they hungry or thirsty? do they need the bathroom? are they tired? is there too much noise?
2. Lower the stimulation: turn off the TV, dim the bright lights, clear the clutter, leave one or two people instead of many.
3. Speak softly, without arguing. If they are very upset or aggressive, take a step back, give them space, and approach again calmly in a moment.
4. Redirect to something that calms them: music they like, a simple activity, a walk, something nice to drink.
5. If they pace a lot, give them a safe place to do it, and make sure they drink fluids and eat something.