Why Someone With Dementia Doesn’t Listen or Pay Attention
Can we talk about this one for a minute?
Because this one hits.
You say their name.
Nothing.
You say it again.
Still nothing.
Maybe you move closer. Maybe you get louder. Maybe you feel that tight feeling rise up in your chest.
It feels like they’re not listening.
And if I’m being honest, sometimes it feels personal.
That reaction makes sense.
But here’s where I want to gently slow things down.
We’ve been talking about how behavior is often communication that function is struggling. And if that’s true, then when it feels like someone with dementia isn’t listening or paying attention, we have to ask a different question.
Not, “Why are they ignoring me?”
But, “What part of function is under strain?”
Cognition drives function.
And when cognition shifts, daily life shifts.
Today, we’re starting with attention.
Attention Is the Gatekeeper
When I say attention, I don’t mean focus like a child sitting still in school.
I mean the brain’s ability to sort through everything happening in the moment and decide what matters most.
Your voice.
The sound of the television.
The feeling of clothing on their skin.
Hunger.
Fatigue.
A full bladder.
A bright light.
A random thought drifting through.
If attention is working well, the brain filters. It prioritizes. It tunes things out.
If attention is struggling, everything comes in at the same volume.
Everything feels equally important.
And when everything feels loud, your voice may not rise to the top.
Not because they don’t care.
Because the brain can’t sort.
That changes the meaning of the moment, doesn’t it?
It’s Not Just About Noise
When people search “why someone with dementia doesn’t listen or pay attention,” they often think about distraction.
Too much noise. Too many conversations.
And yes, that matters.
But attention isn’t only about external noise.
It’s also about internal signals.
If someone is hungry but can’t clearly interpret that sensation, it may show up as irritability.
If they need the bathroom but can’t prioritize that feeling, it may show up as restlessness.
If they’re tired, everything feels harder.
When filtering weakens, internal discomfort competes with your words.
Sometimes what looks like “not listening” is actually the body asking for help.
Before we correct the behavior, we check the body.
The Instinct to Repeat
Let’s be real for a second.
When someone doesn’t respond, our instinct is to repeat ourselves.
Usually louder.
Usually faster.
I’ve seen it in countless homes. I’ve done it myself.
We say it again because we think they didn’t hear us.
But here’s what we don’t always consider.
In many types of dementia, processing speed slows down.
That means the brain is working, but more slowly.
If attention is already strained and processing is slower, repeating too quickly can actually interrupt the brain while it’s still trying to process the first sentence.
Instead of helping, it can increase pressure.
That’s hard to hear. But it’s important.
Sometimes, without realizing it, we increase the strain on a brain that’s already overloaded.
Not because we’re careless.
Because we’re human.
Here’s the Shift
If you remember nothing else from this post, remember this:
Before repeating, pause.
I know that feels unnatural.
But that pause does two powerful things.
First, it gives you space to assess.
Is the body okay right now?
Hungry?
Thirsty?
Needing the bathroom?
Too warm?
Too cold?
Uncomfortable in their clothing?
Overstimulated?
Second, it gives their brain space to process what you already said.
One short sentence.
Eye contact if possible.
Pause.
Let the brain catch up.
More words rarely improve attention.
Less often does.
One Person Talking at a Time
After you check the body, simplify the environment.
One voice.
Not instructions layered over background noise.
Not three people talking at once.
Not directions shouted from another room.
One voice. One short direction. Pause.
If attention is the gatekeeper, your job is not to push harder.
It’s to reduce the load.
You are not lowering dignity.
You are supporting success.
That’s the difference.
Cognition → Function → Behavior
Let’s make this explicit.
If attention is struggling, then:
Instructions don’t land.
Tasks start but don’t finish.
Needs go unnoticed.
Conversations feel scattered.
That affects function.
And when function shifts, behavior shifts.
What looks like:
Ignoring
Zoning out
Walking away
Irritability
Resistance
May actually be attention overload.
Behavior is communication that function is struggling.
If we only respond to the behavior, we miss the message.
This Is Where the PT Lens Matters
As a physical therapist, I was trained to look at function first.
If someone can’t bend their knee, I don’t assume they’re refusing. I assess strength, range, pain, coordination, environment.
The same applies here.
When someone with dementia doesn’t seem to listen or pay attention, we assess.
What system is under strain?
Is it attention?
Is it processing speed?
Is it sensory overload?
Is it physical discomfort?
That lens preserves dignity.
It removes blame from the person living with dementia.
It also removes shame from you.
If you’ve been reacting in those moments, that doesn’t mean you’ve failed.
It means you were working without the full framework.
When It Makes Sense, It Feels Different
I’ve watched this shift happen so many times.
The moment goes from “He’s ignoring me” to “His brain is overloaded.”
And that one shift softens everything.
The tone changes.
The pace changes.
The tension lowers.
Not because dementia disappears.
But because the moment makes sense.
And when something makes sense, we don’t have to react the same way.
This Is What We Work On Together
In coaching, we slow these moments down.
We look at what part of function was under strain.
We adjust the environment.
We adjust expectations.
We build a plan around your home, your routines, and your person.
The blog gives you the framework.
Coaching applies that framework directly to your home and your real-life moments.
Because once you understand the why, you know what to do next.
Let’s Bring It Back to You
If you’ve been feeling frustrated when someone with dementia doesn’t listen or pay attention, you’re not alone.
It’s exhausting to feel unheard.
But what if the issue isn’t unwillingness?
What if it’s overload?
Before repeating, pause.
Check the body.
Reduce the noise.
Say one short sentence.
Then wait.
That small shift might change more than you expect.
And if you’re realizing that you’ve been reacting because no one ever explained the function behind the behavior, that’s not failure.
Most caregivers were never taught to look at cognition this way.
But once you understand what part of function is struggling, you can move from reactive to calm and confident.
That’s not instinct.
That’s insight.
And it’s something we can build together.
Next, we’re going to talk about memory. And why repetition is often about storage, not stubbornness.
Notes
- Alzheimer’s Association. (2024). 10 early signs and symptoms of Alzheimer’s and dementia. https://www.alz.org/alzheimers-dementia/10_signs
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://www.psychiatry.org/psychiatrists/practice/dsm
- Centers for Disease Control and Prevention. (2011). Cognitive impairment: A call for action, now! https://www.alabamapublichealth.gov/brfss/assets/cognitiveimpairmentcallforaction.pdf
- National Institute on Aging. (2023). What is dementia? Symptoms, types, and diagnosis. https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis
- National Institute on Aging. (2023). Alzheimer’s disease fact sheet. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
- National Institute on Aging. (2023). Cognitive health and older adults. https://www.nia.nih.gov/health/cognitive-health-and-older-adults
Disclaimer
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual’s needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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