Many people with dementia notice gradual changes in how they express themselves or follow conversations. These changes can feel frustrating or embarrassing for the person, and confusing for family, friends, and colleagues. But meaningful communication remains possible, but it may simply require different approaches.
What communication changes might look like
The medical term for difficulty with language and communication is aphasia. Aphasia is often described as ‘receptive’ meaning it is difficult to understand spoken or written communications, and ‘expressive’ meaning it is difficult to express oneself. Aphasia not only affects spoken communications, but can affect writing, reading and understanding numbers.
Communication difficulties vary depending on the type of dementia. (For more information see section 1.2 Understand the types of dementia) For some people, especially those with language variants of dementia, communication can be one of the earliest or most prominent symptoms. These may include:
- Trouble finding the right word
- Using the wrong word without realising
- Speaking less or losing conversational confidence
- Repeating stories or questions
- Difficulty following fast or complex conversations
- Taking longer to respond
- Reduced ability to understand jokes, sarcasm, or subtle cues
- Relying more on gesture, facial expressions, or tone
Importantly, communication changes rarely occur in isolation. Tiredness, stress, pain, anxiety, or excess noise and busyness in the environment can make communication much harder, and may lead to misunderstandings that look like irritability, withdrawal, or behaviour change.
The role of supporters and carers
Carers play a key role in helping communication feel easier and less stressful. This is not about speaking on behalf of the person or finishing sentences for them. It’s about:
- Giving time to respond and reducing pressure
- Adjusting how information is presented (e.g. one idea at a time, using simpler language, facing the person and ensuring they know you are talking to them)
- Creating calmer communication environments, such as minimising distractions and having one person speak at a time
- Checking understanding without criticism
- Helping others understand how best to communicate
These approaches help maintain dignity and autonomy for the person with dementia while reducing frustration for the carer. Practical strategies are outlined in Section 3.11, Strategies to help with communication changes.
When to seek extra support
A speech pathologist can assess communication strengths, offer therapy to support language and social communication, and help develop strategies that work for both the person and their support network. Early referral is particularly helpful in young-onset dementia, as people may still be active in work or community roles.
Strategies to communicate more effectively
Go to section 3.11 ‘Strategies to help with communication changes’ for more tips
The Australian Aphasia Association has a Guide to assist people living with Primary Progressive Aphasia
You can read our story about the guide and more tips to improving communication here
Speech Pathology Australia has developed a website ‘The Communication Hub’ that provides easy to read information about supporting communication for people with disabilities, including dementia.
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