Millions of Americans support loved ones with dementia. While dementia caregiving can be rewarding, it can also be challenging — particularly if your loved one presents with signs of dementia .
A person’s ability to say what they want — and decode what others are saying — becomes increasingly difficult as dementia progresses. Someone with the disease might repeatedly rely on familiar words, begin inventing new words to describe familiar objects and easily lose their train of thought. People with Alzheimer’s will also likely have difficulty organizing words logically and, ultimately, will speak less often. As the stages of dementia progress, dementia delusions may become more noticeable. Understanding how to talk to someone with dementia and learning how to calmly respond to dementia delusions can help you fortify your own well-being while providing care.
“Having a loved one with dementia can be emotionally taxing, and you can’t get it right all the time,” says Hayley B. Kristinsson, a board-certified neuropsychologist at UCI Health. “Remember to give yourself the same compassion that you offer your loved one.”
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The Toll of Dementia Delusions
According to recent data from the Alzheimer’s Association, nearly 12 million family members and unpaid caregivers supported people with Alzheimer’s and other dementias in 2024. Overburdened caregivers can be at increased risk for emotional distress, negative mental health and declining physical health.
When a loved one develops dementia delusions, it can become especially challenging to communicate and interact with them. These false beliefs are a result of brain damage from the disease, and feel very real to the a person with dementia.
What are dementia delusions?
Dementia delusions are a type of neuropsychiatric symptom that causes a person to firmly believe in a false reality. Some, but not all, people with dementia develop delusions throughout the course of their disease.
Dementia delusions can fall into different categories, such as theft delusions, paranoid delusions, poisoning delusions, imposter delusions and phantom boarder delusions.
For example, they might believe that personal items have been stolen by family or staff, a neighbor is poisoning their food, a loved one (often the caregiver) has been replaced by an imposter or there are people living in their home that aren’t really there.
When your loved one begins to believe you or another relative is harming them or they are in severe distress because of delusion that isn’t true, it can be extremely challenging. Research has shown dementia delusions are a leading cause of caregiver burnout and depression.
“Dementia is a difficult condition for caregivers,” says Deborah Vinall, a licensed therapist and the chief psychological officer with Recovered, an organization that provides information and resources for mental health and addiction treatment. “It can feel isolating as increased time is dedicated to caring for a loved one’s needs and safety.”
Some caregivers may “suffer from loneliness as dementia destroys shared memories,” or “feel frustrated as their parent, partner, or other loved one is no longer able to function in ways they once did,” Vinall adds.
[Read: What to Do When You Become the Family Caregiver]
12 Essential Rules for Communicating With Someone With Dementia
Whether you’re caregiving or hosting a family gathering with a loved one with dementia, these expert tips can make your loved one more comfortable.
1. Learn how to get — and keep — attention
Start by limiting the number of distractions nearby — turn off the TV or radio, or go into a quiet room and close the door. Throughout the conversation, maintain eye contact, smile and speak with a calm tone. Touch can help, too. Try holding the person’s hand, placing your hand on his or her shoulder or gesturing by pointing to whatever you’re describing.
2. Prepare to repeat yourself
Someone with Alzheimer’s likely won’t recall certain details for more than a few moments at a time. Keep in mind this isn’t intentional or meant to frustrate you.
3. Identify yourself
A loved one with dementia may not require immediate family members or caregivers to identify themselves until the later stages of the disease, but that’s not necessarily the case for extended family or friends. Even though a person with dementia or Alzheimer’s may not remember who someone is or the nature of the relationship, they will find comfort in knowing a member of the family or close friend has come to visit.
4. Call them by name
If they prefer, Mary — say Mary. If they say Mrs. Jones, say Mrs. Jones. Addressing someone directly helps retain attention too.
5. Speak in slow, short sentences, not paragraphs
If you’re telling a loved one with Alzheimer’s a story or plan to share multiple ideas, consider how confusing it might sound. Instead, limit your requests or stories to short, direct sentences — with only one idea per sentence.
6. Be specific
If you want to show someone with Alzheimer’s where something is, identify objects by name — “here is your hat,” for example, rather than “here it is.” And avoid confusing and vague statements. Rather than saying, “Hop in the shower,” try, “Please come here. Your shower is ready.”
7. Ask direct questions
Opting for closed-ended questions that can either be answered with a “yes” or “no.”
8. Avoid phrases like “Don’t you remember?”
Same goes for: “Did you forget? We already talked about that. I just told you. How could you not know that? Try to remember!” This type of wording can make someone with Alzheimer’s feel worse about their inability to recall certain people, places or things.
9. Offer to help
Making slight accommodations can go a long way. Maybe they’re having difficulty finishing sentences or can’t think of the right word for a certain thing but are still very capable overall. Ask: “Does it help when I fill in the word, or does that frustrate you?” If the answer is that it helps, suggest a word you believe the person is trying to think of. Just be careful not to cause unnecessary frustration by being overly suggestive or taking over the conversation.
10. Don’t rely only on verbal communication
There are many ways to communicate beyond speaking verbally — facial expressions, body language and behavior. Just because someone might not be able to speak as eloquently as before, doesn’t mean you can’t look them in the eye, greet them by name and take them by the hand.
11. Avoid talking as if they aren’t in the room
Your family member or friend with Alzheimer’s disease is still a person. Don’t talk to someone else in the room about them as if they aren’t there. Just because they have Alzheimer’s disease, doesn’t mean they’re not in the room. People notice when they’re excluded from the conversation — it feels demeaning and can strip away dignity.
12. Relax your tone
Like anyone facing a lifelong illness, people with Alzheimer’s disease appreciate a calm and supportive attitude from caregivers, friends and family. It’s easy to get frustrated — or even angry — when one doesn’t understand what the other is trying to communicate. Keep in mind that even when someone loses their words, that person can still recognize tone.
[READ: Sensory Therapy for Dementia Patients]
How to Respond to Someone With Dementia Who Is Confused or Delusional
If your loved one is expressing a dementia delusion not rooted in reality, it can help to validate the emotion behind their delusion, without supporting the delusion itself. At the same time, you don’t want to deny the person’s delusion, as this is their reality. Meeting someone where they are can look like validating their emotions and speaking in slow, simple sentences.
The connection first approach
— Validate and acknowledge their feelings. “I can see you’re feeling a bit (anxious/upset) right now.”
— Agree and offer a comfort-based pivot. “That does sound like a lot to handle. Why don’t we step into the kitchen for some tea while we figure it out together?”
— Remove the trigger and create a change of scenery. Gently guide them to a different room to leave the source of the confusion behind.
The validation method: Meet them where they are
When a loved one insists on a reality that isn’t true, your first instinct may be to correct the facts. This older approach, known as reality orientation, was once the standard. However, experts now recommend the validation method, popularized by Naomi Feil in her book “The Validation Breakthrough.”
The shift is simple but profound: Instead of trying to force the person back into our world, you enter theirs. While reality orientation often leads to shame and agitation (for example, bluntly telling someone their deceased mother is gone), the validation method prioritizes the person’s feelings over the facts. By confirming the emotions behind the confusion, you can de-escalate tension and maintain a meaningful connection.
How to use validation
Keep your interactions calm and supportive:
— Center yourself. Before responding, take a deep breath. Your calm energy is the most powerful tool you have.
— Validate the emotion, not the delusion. If a loved one is searching for a parent who passed away years ago, don’t correct the date. Instead, say, “You must really miss her. Tell me about her favorite music.”
— Rephrase and listen. Repeat what they’ve said in your own words. It shows them they are being heard, even if the logic is missing.
— Use gentle ambiguity. If you can’t understand what they are trying to say, don’t press for clarity. Use vague but kind phrases and a clear, warm tone of voice to keep the conversation flowing without frustration.
— Physical connection. When appropriate, a gentle touch on the hand or maintaining soft eye contact can communicate safety more effectively than words ever could.
[READ Rapidly Progressive Dementia: Reasons for a Sudden Worsening of Dementia Symptoms]
Practical Scripts: How to Respond to Common Dementia Scenarios
| Situation or Symptom | Ineffective Response (Don’t) | Effective Response (Do) |
|---|---|---|
| Memory Loss/confusion | “Do you remember what we talked about yesterday?” | “It sounds like this is confusing. Let’s look at the calendar.” |
| Paranoid delusion | “That’s not true, no one is trying to hurt you.” | “I hear you. I’m here, and you are safe with me.” (Validate emotion) |
| Agitation/restlessness | “You need to calm down right now.” | Use a short, simple sentence, such as “Let’s take a walk” or “Listen to this music.” |
| Need for information | Giving a complex, multi-step explanation | Use short, simple sentences, with one idea per sentence. |
[READ: Dementia Tests: What to Know and How They Work]
How to Calm a Person With Dementia
In addition to conversational tools, you may be able to calm a dementia patient through environmental interventions and decreasing sensory stimulations. This can include:
— Physical environment. Change the lighting, reduce noise, play music or introduce a calming scent.
— Items you can give them. Consider things like weighted blankets, familiar music, favorite foods and fidget tools.
[READ: Dementia Care Activities]
What Not to Say: Phrases That Trigger Dementia Agitation
Caring for someone with dementia can feel like navigating uncharted waters. The good news is, doctors and researchers have mapped out some tips for you to follow — including advice on what not to do with a loved one with dementia.
Three ‘dont’s’ of dementia discussions include:
1. Don’t argue or correct
Vinall explains that “it is a universal human experience to become defensive and double down on positions when contradicted, and this is no different with people with dementia.”
“Arguing with a person with dementia will agitate them further,” Vinall says. “It will be ineffective in changing their mind, potentially increase confusion and shame, and drive a rift between you and them.”
2. Don’t ask “Do you remember?”
Asking questions like “Do you remember?” or “Don’t you remember?” can be some of the “most damaging phrases” to ask a loved one with dementia, when they are confused, Vinall says.
That’s because the questions can cause “feelings of shame, embarrassment and pressure to recall, which can lead to increased agitation,” highlighting their deficit and inciting panic, she says. Instead, Vinall recommends validating your loved one’s feelings and expressing empathy.
She suggests, “I know it must be frustrating or confusing,” as a better phrase.
3. Don’t talk over them
Talking over someone, or treating them like they aren’t in the room, can result in an uncomfortable experience for both of you. Instead, acknowledge your loved one’s presence and practice calm conversations.
[READ: What Is Reminiscence Therapy?]
Do People With Dementia Know They’re Confused?
Some people with Alzheimer’s or other dementias are aware, or partially aware, that their memory is deteriorating. Others may not realize this, or may lose awareness over time. People with progressed dementia may develop a neurological condition called anosognosia, where they become unable to recognize their memory impairment.
Kristinsson says that “awareness of one’s cognitive deficits in dementia varies widely and may change over time.”
“Some individuals, particularly in earlier stages, have partial insight and may recognize that their memory or thinking is not as reliable as it used to be,” Kristinsson adds. “This awareness can come and go, and it is often accompanied by anxiety, frustration or embarrassment.”
Caregivers Should Seek Care Too
Caring for a loved one with dementia can take a toll on your emotional health. Experts stress the importance of self-care throughout your caregiving journey, and recommend seeking professional mental health help if you start to experience more profound mental health symptoms.
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How to Talk to Someone With Dementia: Expert Tips and Phrases originally appeared on usnews.com
