What to do when a person with dementia or Alzheimer’s doesn’t make sense
Family members often ask me this question. Trying to talk with someone who is not making sense makes us very uncomfortable. There are two primary reasons for why a loved one who is experiencing dementia or Alzheimer’s might say something nonsensical.
An altered sense of reality
Often people living with dementia make a statement that doesn’t make sense or cannot be true—and then defend it as true—although it’s clear to their companions that it cannot be. This can happen when we lose the two sets of cognitive skills that help us interpret reality accurately: our memory skills and our rational thinking skills. Our memory skills allow us to recall information about the past—things that have already happened or been said. Our rational thinking skills let us organize information so that we can draw correct conclusions and comprehend what is likely. When dementia takes away these skills, we become unable to accurately interpret reality—both what is happening around us now and and what has happened in the past.
For example, if I’m your mom and cannot recall that my husband died several years ago, I’d be perplexed about why he isn’t with me now and continuously asking you where he is. If you remind me of the events surrounding his death, I may or may not believe you. If you were to try showing me pictures of his funeral, or that his closet is empty, my lack of rational thinking skills would prevent me from perceiving that those clues add up to a believable story. Your explanations would fall on deaf ears and likely we’ll both end up upset.
Without the ability to recall facts or events that have already happened, people experiencing dementia cannot help misinterpreting what is happening in the present. And then, without the ability to use analysis or comparative thinking (or to see sequences through cause and effect), they will be unable to understand why their beliefs are nonsensical and ours are not.
Don’t correct them, accept their reality
If our response is to correct them, we are asking that they accept our version of reality—something that differs from what their brain is telling them is true—even though they lack the very tools needed to consider our version of the truth. That’s why we usually get resistance and denial instead of acceptance.
When people experiencing dementia are mistaken about reality or truth, it’s kinder to accept their version and try to work with what they believe to help them feel more comfortable. Just as we would do for a child who lacks the experience or maturity to understand a detailed explanation, we can be kind and not demand that someone experiencing dementia use cognitive tools they no longer possess to perceive the complete truth. This means that we shift our goal away from achieving mutual agreement and understanding toward sharing positive emotions and companionship.
It is always preferable to have everyone understand what has happened before and is actually happening now, but it’s unrealistic to demand that when one of us has lost the necessary skills. Instead, we put aside accuracy for companionship.
Dementia causes a loss of language skills
Dementia and word salad
Someone with dementia may also make nonsensical statements because dementia is affecting the part of the brain that enables them to use language to express themselves. This is often referred to as dementia word salad, although the condition is not restricted to dementia.
You’ll find that the person believes they are talking normally and expressing what they are thinking, even though the words they are saying make no sense. Typically, they are using correct syntax and speaking in sentences, but the nouns and verbs don’t make sense. At other times, their words make sense but the subject matter is inappropriate.
You can still enjoy a pleasant interaction and carry on a conversation—even steer them toward more appropriate topics—if you focus on the emotions behind their words. Listen to their intonation and watch their facial expressions, and then respond with a comment and topic that seems appropriate for the situation. Make eye contact and be sure to smile. You will find that you can usually lead the person to a topic that is more comfortable, and you might even be able to lift their mood through sharing a moment together in harmony. Feeling heard and understood brings comfort.
Dementia and lost vocabulary
At other times, the person is using fewer words than they need to fully express their ideas: their words make sense but express a meaning other than what they intended. If you’re in the grocery store shopping with a loved one who says, “You’re spending all my money,” she might actually be trying to say, “My, everything seems so expensive—we’re spending an awful lot of money right now.” The first statement is an overly simplified version of the second.
On the other hand, she may actually believe you have been spending her money against her wishes (a misinterpretation of reality, so we’re back to the first reason). As discussed in the first section, when you’re dealing with a false sense of reality, the best response is to not demand acceptance of your reality (i.e. “No, I am not—I’m doing everything I can to preserve your resources and spending my own on you!”). That would be trying to discuss facts with someone unable to do so. In either case, it’s best to say something along the lines of: “Oh, Mom, I worry, too. Everything seems so expensive.”
Always respond to the emotion behind the words
The better response in every case is to respond to the emotion behind the words. Someone who says, “They stole all my jewelry!” is expressing loss and indignation, whether factual or not. If you avoid the factual issues and respond to the emotions being expressed, you’ll avoid a fight. A nonfactual response would be, “Oh Mom, I’m so sorry… I felt so badly for you when that happened,” and then to move the conversation on to a happier topic.
When our clients’ ability to express themselves falters, we ignore their incorrect words or sentences and focus on their intonation and facial expressions. Their nonverbal communication displays the emotion they want to convey, which helps us discern their intent and meaning, and respond in a way that helps them through the moment and back to a positive mood.
When I respond to my clients in these two ways—accepting their version of reality and listening for the emotion and meaning hidden by their impaired vocabulary or language loss—they begin to feel safe talking with me, and feeling safe means they ask fewer questions and feel more understood.
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Who is Judy Cornish?
Judy Cornish is a former eldercare lawyer and the former owner of Palouse Dementia Care, a dementia care agency that provides in-home dementia care for people in Moscow, Idaho. She is the author of Dementia With Dignity and The Dementia Handbook as well as the creator of the DAWN Method of dementia care. Judy believes that, with training, families can provide dementia care at home and enjoy less stress and more companionship.
