There is no proven universal ranking of the "needs used most often" on dementia communication boards. A practical starter board should begin with pain, thirst, hunger, and toilet needs, then adapt to the person. A dementia communication board is a page of words, pictures, or symbols that helps someone express needs when speaking becomes difficult. It supports conversation but does not replace attention, observation, or patience.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What should go on a starter board?
- Which extra needs matter for this person?
- How should the board be individualized?
- How should caregivers use it?
- What are the board's limits?
What should go on a starter board?
Start with needs that may signal discomfort or trigger agitation: The Alzheimer's Association recommends checking these needs when agitation occurs, making them sensible first choices for a basic board. The Alzheimer's Association's emergency guidance does not establish them as a universal frequency ranking.
Add "yes" and "no" options, along with a simple way to identify pain. A person may need to point to a body area, select "nurse," or indicate whether they want help.
- Pain
- Thirst
- Hunger
- Toilet
Which extra needs matter for this person?
A board can include constipation, a full bladder, fatigue, infection, skin irritation, temperature, fear, or frustration. These choices make more sense when they reflect the person's health, routines, and recent behavior. The Alzheimer's Association's comfort guidance lists these as possible causes of distress. A cue-card resource hosted by Oxford Health groups communication choices into daily living, emotions, events and leisure, memory or confusion, and empathy.
Its sample page includes pain location, nurse, toilet, shower, hungry, hot drink, cold drink, yes, and no. Oxford Health's communication cue cards offer a useful model for organizing choices. Avoid filling the first page with every possible request. Too many symbols can make scanning harder, especially when the person is tired, distressed, or experiencing visual or motor difficulties.
How should the board be individualized?
Choose words and pictures that match the person's daily life. Consider the person's goals, usual settings, preferred language, sensory and movement abilities, and the people who will use the board with them. American Speech-Language-Hearing Association guidance on augmentative and alternative communication recommends this broader assessment.
For one person, "coffee," "walker," and "daughter" may be more useful than general categories. For another, "cold," "quiet," or "leave me alone" may help communicate discomfort or emotion. Observe when communication breaks down. Meals, dressing, bathing, conversations, and transitions may reveal needs that do not appear during a formal test.
How should caregivers use it?
Present one choice at a time and give the person time to respond. Point to the board, use yes-or-no questions, and watch gestures, facial expressions, and changes in behavior alongside the selected symbol. Agitation, screaming, striking out, or strong emotion may signal an unmet need rather than a deliberate refusal.
Observe what happened beforehand, look for a possible cause, and record which response helped in the person's care plan. The Alzheimer's Association advises using one question at a time, visual cues, written notes, and extra response time to support communication. Its communication guidance describes these supports as complements to human interaction.
What are the board's limits?
Communication boards do not work equally well for everyone. In one study of 30 adults with moderate-to-severe Alzheimer's disease, personalized boards alone showed no effect, while voice output was detrimental; a separate 11-person experiment using spaced-retrieval training found more targeted-word use with AAC. The 2012 study indexed by PubMed also reported that board components had not been studied systematically.
Treat the board as a changing support, not a permanent checklist. Progressive dementia can alter communication needs, so reassess it during everyday activities and remove choices that no longer help. ASHA's dementia guidance recommends periodic reevaluation as needs change.
