Naomi Feil developed effective methods for communicating with people who have “Alzheimer’s-Type Dementia.” She identified four stages. The third and fourth stages require certain approaches which can create meaningful interactions with confused persons.


Persons in the third stage engage in repetitive motion. They may pace or wander as if they had endless energy.  They may repeat certain words or sounds over and over again.  They may make movements with the hands in a rhythmic fashion.

Since people in the third stage have lost speech and the ability to think logically, verbal techniques rarely work.  Non-verbal methods such as appropriate touch, genuine eye contact, matching facial expressions to emotion, and linking behavior to universal human needs (to be loved, to be acknowledged, to be useful) help to restore, if only for a moment, the quality of life.

Mirroring the sufferer’s movements can spark immediate, direct eye contact.  Copy the person’s body movements, breathing, hand and feet movements, and facial expressions.  Follow the person’s lead and dance to his or her rhythms.  However, be careful not to use mirroring in a mocking way.  As with all people stricken with dementia, our purpose is to build trust and lower anxiety.  Do not use mirroring if there is any sign of resistance or agitation.

A caregiver once encountered a lady who wandered the hallways of The Baptist Home.  As she pushed her walker, eyes looking straight forward, she made annoying wooing sounds of a train whistle louder and louder.  The caregiver walked with her matching the same gate and sound. Eventually, she stopped, made eye contact and said softly, “If you’ll stop, I’ll stop.”  By matching her body movements, the caregiver was able to gain the attention of the confused person. Eventually, the caregiver worked with the repetitive mover to replace the annoying train whistle sound with the less disturbing rubbing of the hands.

Much of the same occurs for those in stage four, vegetation.  Speech is lost, as well as the ability to think logically.  Again, non-verbal techniques; such as, touch, genuine eye contact, matching facial emotions and linking behavior to universal human needs is the most effective.  Stage four people often do not acknowledge old friends or recognize family.  Breathing is shallow and soft, the sufferer barely moves on his or her own initiative.  He or she may lay in bed in a fetal position, eyes shut with an expressionless face.

Appropriate touching often kindles memories from long ago.  The early, emotionally tinged memories are permanently stored in the brain and are sometimes stimulated by gentle touching. By touching different parts of the face and shoulders, memories arise of significant relationships.  A gentle petting of the top of the head may evoke pleasant father-like memories or a tender touch of the cheek may cause lovely maternal thoughts.  Signs of meaningful interactions are when the vegetative person awakens, turns his or her face towards the caregiver, eye contact is made, and the face of the sufferer is relaxed and warmly animated.  Avoid touching if there is any sign of resistance or unpleasantness.

The use of soft music is beneficial in all the stages of resolution previously mentioned.  Familiar songs learned in early childhood become permanently imprinted on the brain.  Often these songs become associated with loving relationships and strong emotions.  They can elicit pleasant responses and experiences of those in the final stages of dementia.

We must be careful to always acknowledge the person in a confused stage.  That is, when we are in his or her presence we should never talk about them as if they were not there.  We never know what people are able to perceive while in this state of mind.  His or her soul may be alert and alive, but in a wearied body that can no longer communicate effectively.