I. Make certain the patient hears you by speaking loudly (but not so loud as to frighten them), standing face-to face, and maintaining eye contact.

2. If you need to raise your voice to be heard, lower the tone (pitch). A high-pitched voice may suggest to the patient that you are upset. The tone of your voice should always reflect calmness and reassurance.

3. Use over emphasis and exaggerated facial expressions to stress your point. Hand gestures and pointing to objects can be very beneficial in conveying a message.

4. Distracting or competing noises and activities should be eliminated. Alzheimer's patients experience tremendous difficulty sorting out stimuli and focusing their attention.

5. Use short words and simple sentences (no more than 5 to 7 words) conveying only one message or thought.

6. Begin each sentence by addressing the patient by name and by identifying yourself if necessary.

7. Ask only one simple question at a time. Do not include complex or multiple choices in a question.

8. Break each task into simple steps and ask the person to do one step at a time. Most of the things we ask them to do are actually composed of a number of sequential tasks. The Alzheimer's patient may not be able to sequence the events.

9. Speak slowly and wait for the person to respon d. What seems like a long and unproductive silence to you may reflect the Alzheimer's patients attempt to concentrate, comprehend, and formulate a response. If the response does not come in one or two minutes, repeat your question or statement exactly.

10. Use humor in your communication whenever appropriate and encourage the patient to express humor, especially in difficult and trying situations.

11. Even with patients who have severe language problems, do not assume that the patient never understands you. Abilities fluctuates and it is inconsiderate and demeaning to talk in ont of the patient as though he or she were not there.

An important point concems how to recognize growing agitation and negative emotion in a patient. Frustration, fear, hostility, and aggression in the Alzheimer's patient may be communicated through general increase in body movement and agitation, such as such as restless, rapid pacing, kicking doors or rattling door knobs; pushing furniture about; making fists or waving arms; facial changes, such as grimacing, frowning, or darting eyes; changes in voice, such as increasd volume, speech, and tone; and physical changes, such as rapid breathing, widening of the eyes, dilkated pupils, and tightening of muscle tone. When the patient demonstrates such signs of aggitation, approach the person with calmness and reassurance; reduce the surrounding stimulation (i.e., turn off the television or radio, and have others move away); remove dangerous objects from the area; do not pressure the patient or make additional demands; and make certain that all your communications, both verbal and nonverbal are consistent. In such stressful situations, the patient's memory loss may work to your advantage. Distract the patient or removing the individual from the situation may make it difficult for him or her to remember what was so upsetting.