You may find it challenging to communicate with people who have dementia. Such difficulties have different causes, one of which relates to the progress of dementia. Communication is about receiving messages, understanding and responding. Carers can first modify their communication style and use communication skills to help a person with dementia receive, understand and respond to messages. As long as there is understanding, patience and consideration, all communication barriers can be removed.

Communication Challenges


  • Stress
  • Inappropriate Expectations
  • Use of Language


  • People
  • Light
  • Sounds
  • Smells
  • Temperature & Humidity

People with Dementia

  • Declining Senses
  • Cognitive Decline
  • Emotional Distress

Communication Barriers

Mild Dementia

Causes Responses
Receiving messages
  • Not able to see or hear clearly
  • Reduced focus
  • Give those with dementia appropriate eye glasses and hearing devices
  • Avoid changing the topic suddenly
  • Summarise or repeat the content when necessary
  • Keep the ambience quiet and comfortable
  • Cognitive decline, such as: difficulty to grasp long sentences or abstract content
  • Declining focus
  • Use simple and direct sentences
  • Allow them ample time to respond
  • Diminished ability to express oneself, thus giving vague answers like “whatever you say” or “not sure”
  • Difficulty to find the right words, thus using broad terms to identify a person, item or location, such as “that person”, “those things” or “there”
  • Encourage seniors to express themselves, such as saying how they are feeling about things
  • Be gentle
  • Avoid arguing with them

Moderate Dementia

Causes Responses
Receiving messages
  • Slow to take in, such as taking longer to grasp a message
  • Losing focus further, such as suddenly recalling past events or not paying attention to what others are saying
  • Face them when talking to them
  • Address them by name and tell them your name before talking to them
  • Maintain the right volume for your voice
  • Note their facial expression, to see if they show unease, and then say it simply, one more time
  • Keep the ambience quiet and comfortable
  • Further decline of cognition, such as ability to grasp only simple commands, what’s right in front, or mother tongue
  • Further decline of focus, such as ability to respond to only one phrase in a sentence, thus not really answering a question
  • Aid comprehension with real objects, tone, pictures, words, facial expression and hand gestures
  • Allow more time to comprehend and respond
  • Avoid third-person terms such as "he" or "they"
  • Further decline of expression skills, such as unable to use a complete sentence
  • Difficulty in finding the right words, such as naming the wrong persons or places
  • Losing the ability to use sound or tone
  • Be gentle
  • Use more prompts and praise
  • Avoid arguments

Severe Dementia

Causes Responses
Receiving messages
  • Limited ability to comprehend, such as not noticing people are talking to him/her
  • Make sure there is eye contact before talking
  • Address him/her by name and say your own name before starting a conversation
  • Keep the right tone
  • More smiles and touches, such as touching the arm or the back of the hands
  • Keep the ambience quiet and comfortable
  • Limited cognition, such as not comprehending speech, but only gestures or touches
  • Aid comprehension with objects, tone, pictures, words, facial expression and hand gestures
  • Speak slowly and clearly
  • Limited expressive skills, such as can only answer yes or no, and difficult to grasp sound
  • Express oneself only by gestures or sound
  • Always believe he/ she understands what you’re saying and keep talking, even if you are not getting a response
  • Observe non-verbal signs
  • Try to respond to ambiguous gestures, such as touching his/her hand when he/she takes your hand