Vascular Dementia (VaD) is a common form of cognitive decline resulting from reduced blood flow to the brain, often due to strokes or small vessel disease. This lack of adequate blood supply damages brain tissue, especially in subcortical areas, leading to characteristic impairments in executive function and processing speed. Effective communication with a person experiencing VaD requires an intentional shift in approach, focusing not just on what to say, but more importantly, on specific language and behaviors to avoid to minimize distress and improve the quality of interaction.
Avoid Confronting False Realities or Memories
It is unproductive to directly correct or argue with an individual about misremembered events or current misperceptions. The person with VaD is not intentionally lying, but is often experiencing confabulation, unintentionally communicating false information to fill memory gaps. This process functions as a coping mechanism, helping them maintain a sense of self and make sense of their world.
When a caregiver says, “That didn’t happen” or “You’re wrong,” they challenge a reality that is genuine to the person with dementia. This confrontation causes emotional distress, leading to agitation, withdrawal, or anger, because the person’s brain cannot reconcile the current memory with the caregiver’s correction. Instead of arguing, validation acknowledges the person’s emotional state or perceived reality without needing to confirm the facts.
A better approach is to use redirection, gently shifting the conversation away from the disputed topic to a more pleasant or neutral subject. Phrases like, “I just told you that five minutes ago” are damaging because they highlight the individual’s memory deficit, which can be embarrassing and frustrating. Since memory loss is a disability they cannot control, asking them to remember is counterproductive.
Validation helps respond to the feeling behind the statement, such as fear or confusion, rather than the factual content. For example, if a person insists they need to go home, responding to the feeling of wanting comfort or familiarity is more successful than asserting, “This is your home.” This empathetic response preserves their dignity and reduces the chance of an emotional crisis.
Avoid Creating Cognitive Overload
Vascular Dementia primarily impacts processing speed and executive function, meaning complex language quickly overwhelms cognitive capacity. Executive function governs abilities like planning, organization, and decision-making, all of which are impaired by the disease. This impairment causes a noticeable slowing of information processing, making it difficult to absorb and respond to multiple pieces of information.
Caregivers should avoid multi-part questions or instructions that require complex decision-making, as this creates cognitive overload. Asking, “Do you want to go to the store, and if so, do you need milk or bread?” places excessive demand on their working memory. The person with VaD may lose their train of thought or struggle to shift attention between the question’s components.
Communication should be simplified into short, clear, single-step instructions, focusing on one idea at a time. Speak slowly and clearly, allowing a long pause for the person to process the words and formulate a response, as their response time is characteristically slowed. Limiting choices is also beneficial; instead of an open-ended question like, “What do you want to do today?” offer a simple binary choice, such as, “Do you want to go for a walk, or listen to music?”
Technical jargon or abstract concepts should be avoided entirely, as these require cognitive flexibility and reasoning that is often compromised. If a message is not understood, repeat the exact same short statement, rather than rephrasing it with different words, which introduces new confusion. Structuring communication simply and deliberately reduces the burden on their compromised processing speed.
Avoid Language That Implies Frustration or Judgment
The emotional subtext of communication, conveyed through tone and non-verbal cues, is often processed more clearly than the verbal content by a person with dementia. Their ability to interpret facial expressions, gestures, and vocal tone frequently remains intact even as their language comprehension declines. Therefore, using language or behaviors that imply impatience or judgment can cause immediate distress and defensiveness.
Caregivers must avoid rhetorical questions that communicate impatience, such as, “Are you serious right now?” or “Why can’t you just remember?” Such phrases convey a sense of being difficult or burdensome, which can severely damage the person’s self-esteem and lead to reactive behaviors. Similarly, testing their memory with questions like, “Do you remember who I am?” is counterproductive and can be deeply humiliating.
Non-verbal communication, like sighing, eye-rolling, or rushing the person, speaks volumes and is often interpreted as hostility or rejection. Maintaining a calm, positive, and friendly tone of voice and making gentle eye contact helps convey empathy and reassurance. If a moment of frustration occurs, it is better to step away briefly to regain composure than to allow that negative emotion to color the interaction.
Avoiding phrases such as, “I already told you that,” prevents the person from feeling patronized or ridiculed for their cognitive state. The focus should be on support and compassion, remembering that the person is not being difficult on purpose, but is navigating a world made confusing by their disease. A consistent, warm, and gentle communication style helps to create a stable and trusting environment.