You prepare a worksheet, a puzzle, or a game, thinking it might be good for them. However, when you start, your family member sits still, says "I can't" or "I don't know," pushes the material away, and ends up getting angry. It is easy to interpret that moment as a sign that they can no longer participate in activities.
But it is more common for it to be something else: the proposal was too difficult, it came at a moment of fatigue, it contained too many instructions, or it was presented as a test. In activities for people with Alzheimer's, adjusting how, when, and why it is done is just as important as choosing the what.
Step 1: shift the goal from exercising to connecting
An activity does not have to be finished or done "right" to be valuable. Success can also consist of choosing a color, moving hands to the rhythm of a song, keeping up a conversation, helping set the table, smiling, or sharing a few quiet minutes.
Structured cognitive stimulation can produce small, short-term benefits in the cognition of people with mild or moderate dementia, and can also foster communication and social interaction. Even so, results vary between studies and do not justify turning every exercise into an exam. Activities do not cure Alzheimer's, they do not reverse the disease, and no specific exercise guarantees slowing its progression. Its realistic goal is to promote participation, well-being, the greatest possible autonomy, and the use of the capabilities the person still retains.
Questions to ask yourself before choosing the activity
NICE recommends that activities aimed at promoting well-being be adapted to each person's preferences, and that they be able to express their opinions about their care whenever possible. Before proposing an activity, it is advisable to ask yourself a few questions about the person:
- What did they like to do, and what are they still interested in now?
- What capabilities do they retain without needing excessive help?
- At what time of day are they most alert or receptive?
- Do they prefer to do something alone, with you, or in a small group?
- Do they have vision, hearing, mobility, or coordination difficulties?
- Can they understand the proposal, or do they need to see it instead of hearing it?
- Does the activity make sense to them, or does it just seem "good for the memory"?
The environment matters too. A television turned on, several people talking, a table full of materials, or being in a hurry can increase the difficulty without us realizing it. Communication guides advise reducing distractions, using short sentences, giving time to respond, and offering simple choices.
Step 2: choose the activity
Not all activities work for everyone (nor at all times). We give you some ideas for you to evaluate if they might work for your family member.
Everyday activities with a purpose
Familiar tasks can reinforce the sense of identity, usefulness, and participation. In addition, occupational interventions and personalized rehabilitation can improve performance in specific activities of daily living, especially when the person helps choose the goal.
You can try folding towels, matching socks, setting out napkins, watering a plant, cleaning vegetables, or mixing ingredients. To simplify, prepare only the necessary objects, you start the first movement, or break down the task: "first, we put a napkin here."
In mild phases, they can take on several steps with discreet reminders. In moderate phases, they can perform a specific part while another person completes the rest. In advanced phases, they may enjoy touching fabrics, smelling an aromatic herb, or accompanying the mixing motion.
It doesn't matter if the towels don't end up perfectly folded. Avoid knives, fire, toxic products, or tools if they cannot use them safely, and supervise any task involving water, heat, or a risk of falling.
Music and personal memories
Familiar music can open up a space for enjoyment, expression, and connection, even when maintaining a conversation is difficult. The most recent Cochrane review indicates that music interventions likely improve depressive symptoms at the end of treatment and perhaps some general behavioral problems or social behavior, but have not shown clear benefits regarding agitation or cognition.
Create a list with songs chosen by the person, listen to a piece together, or accompany the rhythm with clapping and simple movements. In advanced phases, simply listening or swaying gently is enough; there is no need to sing or recognize the performer.
Instead of asking "do you remember this song?", you can say: "This one used to play a lot at parties; it brings me joy." This way, you offer a gateway to conversation without putting their memory to the test. Observe the response: some songs can awaken sadness or unpleasant memories and should be changed if they cause distress.
Adapted physical activity
Walking, standing up and sitting down with support, chair dancing, throwing a soft ball, or performing gentle arm movements can promote mobility, participation, and the capabilities needed for daily life. The evidence on cognition is not uniform, but various reviews point to possible functional improvements with exercise programs.
Adapt the activity to their balance, endurance, and health instructions. You can shorten the route, use a stable chair, imitate the movements instead of explaining them, or turn the walk into a conversation about the neighborhood.
Assess footwear, obstacles, temperature, hydration, and the risk of disorientation. If there are falls, pain, dizziness, breathing difficulties, or significant limitations, seek medical or physiotherapy guidance before starting a new routine.
Creative and manual activities
Painting, modeling, making a collage, arranging flowers, or working with yarn allow for self-expression without there being one single correct answer. Reviews of artistic interventions show promising results in cognition, quality of life, or neuropsychiatric symptoms (although studies are varied and do not yet allow us to ensure which modality works best).
To facilitate the activity, offer two colors instead of a full box, prepare large pieces already cut out, or start a composition that the person can continue. In mild phases, projects with several steps fit; in moderate phases, repetitive and visible actions work better; in advanced phases, exploring colors, materials, or movements may be enough.
Avoid childish designs unless the person chooses them. Use non-toxic glue, safe scissors, and pieces that cannot be mistaken for food.
Games and cognitive stimulation
Games for people with Alzheimer's can include matching images, sorting objects by color, completing well-known sayings, reading a short news item and discussing it, doing everyday calculations, or solving an adapted puzzle. Cognitive stimulation in Alzheimer's makes more sense when it combines conversation, participation, and varied activities than when it repeats decontextualized exercises.
Choose a level where the person can start with a little help. Reduce the number of cards, remove the timer, accept approximate answers, and allow collaboration. If a sudoku was a hobby, perhaps it is now more pleasant to complete a few squares with you; if they never liked numbers, there is no need to introduce them just because they have a diagnosis.
Exercises for people with Alzheimer's on paper are a resource, not an obligation or a measure of a person's worth. An activity can be beneficial even if only part of it is done or if it ends in conversation.
Social activities
Having a coffee with someone they know, looking at photos with a grandchild, making a short call, singing in a small group, or preparing a snack together are activities to do with a family member with dementia that combine participation and bonding.
Some people are stimulated by a group, others struggle to follow multiple voices and feel more comfortable in one-on-one encounters. The recommendation is not to "socialize more" at any price, but to create an accessible situation. Few people, time to respond, and the possibility of observing without having to talk.
Speak directly to the person and not about them as if they were not present. Presence and company also count when verbal response is scarce.
Sensory and relaxing activities
A box with fabrics and meaningful objects, watching the movement of the trees, listening to soft sounds, smelling coffee or a familiar cream, or receiving a hand massage can offer calm and connection without demanding a verbal response. In advanced stages, broadening the idea of "activity" allows us to recognize that looking, touching, or listening are also ways of participating.
Ask for or anticipate consent, stop at any gesture of rejection, and avoid oils or products that may cause allergy, irritation, or interactions. Physical contact should never be taken for granted.
Outdoors and nature
A short walk, watering pots, touching leaves, watching birds, or sitting in the sun can bring together movement, sensory stimuli, and conversation. Therapeutic horticulture has shown promising results in reducing agitation and increasing participation, although the evidence comes from a few heterogeneous studies.
Simplify the route, choose a quiet time, and avoid turning the outing into a succession of instructions. Check temperature, hydration, accessibility, traffic, and the risk of falls or disorientation. In advanced phases, a window with a nice view or taking care of an indoor plant can bring some of that experience closer.
Step 3: adapt the activity according to the moment
The phases help orient us, but they do not determine on their own what a person can do. Sleep, pain, mood, noise, or an infection can significantly change their response from one day to the next.
In the mild phase, it is usually possible to maintain greater autonomy, choose between several proposals, and perform known activities with discreet help. Personalized cognitive rehabilitation can be especially useful for working on daily goals that the person considers important.
In the moderate phase, one-step instructions, few materials, visual demonstrations, and accompaniment work better. It is advisable to preserve the part of the task that they can still perform and help only when necessary.
In the advanced phase, music, gentle movement, observing previously identified photographs, touching familiar objects, looking outside, or sharing consented contact may become more valuable. It is not necessary to demand a verbal response: a look, a gesture of relaxation, or staying present can also express participation.
Signs of frustration
They will not always tell you "I want to stop." Frustration, fatigue, or overstimulation can manifest as:
- Sudden abandonment or pushing materials away
- Irritability, a louder tone, or rejection
- Silence, a blank stare, or withdrawal
- Constantly repeating "I can't," "I don't know," or "leave me alone"
- Restlessness, repetitive movements, or a change in expression
First, lower the demand. Speak calmly, acknowledge the emotion ("it seems like this is proving difficult"), and avoid arguing or proving that the answer was simple. You can remove elements, show the next step, change the proposal, or take a break. If they want to stop, finish it without presenting the withdrawal as a failure.
Help them move forward
To remember how to stimulate a person with Alzheimer's without turning the activity into a test, we recommend:
- If they can't start, show the first step
- If they get stuck, reduce the options
- If they make a mistake, avoid correcting every detail
- If they get tired, take a break
But be careful, helping the person to start does not mean doing everything for them. The goal is to offer the minimum support that allows them to participate.
Frequent errors in activities with people with Alzheimer's
Some well-intentioned attitudes increase the difficulty or damage trust:
- Choosing materials that are too childish
- Correcting every mistake or asking them to repeat until they get it right
- Giving several instructions at once
- Talking about the person as if they were not present
- Insisting on finishing because "it's good for them"
- Measuring the value of the activity only by the result
- Comparing what they do today with what they used to do
If you are looking for new ideas, every Wednesday we share free activities in our Cognitive Reserve Wednesdays. For those who prefer to work without a computer, at Mr. Loris you will find cognitive stimulation workbooks and packs on paper, such as the Attention, Memory, and Calculation Pack and the Language, Reading, Writing, Praxias, and Gnosias Pack. These are resources with structured activities, not medical treatments: it is advisable to select, simplify, or stop each proposal according to the person's capabilities, preferences, and response.
