There are many ways dementia can lead to social isolation, but one of the first is that verbal communication becomes challenging for dementia patients. Sadly, family and friends sometimes respond by talking to them less. This is a real shame because all of us, dementia patients included, have a deep need to communicate with others. Talking to and listening to other people is crucial for helping dementia patients maintain socialization, emotional connection and cognitive ability.

When we interact with dementia patients we need to understand that communication is still taking place, even if the conversation doesn’t go the way we would expect. Communication can exist, in fact, even if our conversational partner is repeating herself, not finding the right words or not making sense. The rhythm and pace of conversation, the tone of voice, the facial expressions and the response we make to the mood of the speaker are all very important. These things help us keep a human connection with the dementia patient and create opportunities for moments of clarity and understanding.

So much is lost if we stop making the effort to have conversations or (one of my big bugaboos) if we talk over the heads of the dementia patients to others in the room instead of including them in the conversation.

What’s more, if you’ve spent time with early- and mid-stage dementia patients you know that clear communication can come and go, almost as a camera can drift in and out of focus. If you aren’t able to understand what you are being told at the moment, just wait. You never know when a ray of wit, clarity or insight will flash through the mist and dazzle you.

A few years ago we were providing care for a married couple who lived close to my home. At first, we had a home health aide there for just a few hours a week. Over time, the care need expanded, and eventually we were with them around-the-clock.

These two were quite challenging to care for, but a total delight to know. The wife was wheel chair-bound due to a couple of falls, and she also had a little memory loss. The husband, on the other hand, was physically quite robust, but rapidly progressing into advanced Alzheimer’s.

The wife was Florence. She was kind and quietly friendly to everyone–a reserved and gentle person. Her husband Vince was small and slight in stature, but full of energy. He had an outsized, expansive personality, a huge toothy grin, and lots of great stories to share.

These two had many accomplishments in their long and collaborative marriage. Both had served in World War II. Florence in the Women’s Army Corps (WACs), and Vince in the army, where part of his duties had been to give navigational guidance to American pilots flying into Germany.

The walls of their small townhouse were hung with numerous paintings Vince had made after the war. They were scenes of small town neighborhoods and soft evening light. For decades he had managed a thriving photography business in Manhattan, but he was a painter by avocation and the walls of his home showed his skill.

Like many Alzheimer’s patients, Vince’s mind was quite sharply present at times. Other times his thoughts took some lengthy detours of time, person and place. Awareness came and went. With help in the home, most days he was managing quite well.

One day I got a panicked call from our home health aide, telling me that, while she was helping Florence in the bathroom, Vince had wandered out of the house. That’s when we realized we needed a lock high on the inside of the door.

But, in the meantime (Oy vey and Sacre bleu!) our gentleman was on the loose. The home health aide went in pursuit and, as I was nearby, I joined her in few minutes. We found him quickly and gave him a friendly escort home.

Vince wasn’t quite sure what had just happened, but he did have a sense that we had rendered him a service. So like the true Manhattan gentleman he was, he felt a tip was in order. He clutched his pants with his left hand and rummaged deep in his right pocket to find us a $10.00 bill, staggering and almost losing his balance in the process.

It took another five minutes to assure him that the service we had rendered was negligible…”our pleasure… no gratuity required, truly.” Then it was dinner time, and the day ended happily.

Another time I had driven the couple to a doctor’s appointment and, while Florence was being seen, I sat in the waiting room with Vince. To pass the time, I asked him about his service in World War II. Like many dementia patients, his long term memory was often quite sharp and he loved talking about this time in his life.

Remembering that his wife had also been in the military, I asked him, “So, Vince, when you were stationed in France, where was Florence?” His bushy eyebrows raised a bit and he replied slowly (as though to a slightly slow-witted school child), “In the middle of Italy.”

Nothing wrong with his geography.