When your spouse has Alzheimer’s disease or another type of dementia, it’s natural to wonder how you can maintain your emotional bond or if, as the cruel disease progresses, it is possible at all.

The truth is, you can express love and feel connected throughout all the stages of dementia, although the disease will change the relationship—for both of you.

To learn how to better foster intimacy, we turned to marriage counselor Gary Chapman, PhD, coauthor of Keeping Love Alive as Memories Fade: The 5 Love Languages and the Alzheimer’s Journey…

How can I show love to my spouse who has dementia? In many ways, especially in the early stages of dementia, the way you experience intimacy remains the same for both of you.

People perceive emotional love in five distinct channels of communication—words of affirmation (“I love you”…“You look great in that dress”…“You did a great job”)…quality time (giving someone your full, undivided attention)…gifts (a visible symbol of love)…acts of service (shopping, setting the table)…and physical touch (making love, but also a hug, back rub or kiss—or even just sitting close together).

Once couples figure out how to express love to each other in the way that matters most to each of them, both will feel emotionally loved. This is especially important when one of the spouses has dementia.

What are some of the best ways to maintain intimacy in the early stages of my spouse’s dementia? One of the least talked about aspects of dementia is the fact that the disease will eventually rob the couple of their sexual relationship. In the very earliest stage of Alzheimer’s, however, little changes in the couple’s sexual relationship. This is a time when the couple can make the most of their opportunities for intimacy.

How will I know when it’s no longer appropriate to have sex? There often comes a time when sex is no longer appropriate or even feasible. If you feel that you are taking advantage of your spouse with dementia, it may be time to stop having sex.

As the brain changes, a person may begin to forget how to do things such as cook and get dressed, as well as how to make love. He/she may forget the foreplay routine the couple has shared. As a result, the person may feel embarrassed and shy away from sex. As Alzheimer’s progresses and affects the parietal lobe, the part of the brain responsible for processing sensory information, too much sensory input can be disturbing—making sexual contact uncomfortable.

Conversely, some people with Alzheimer’s may become hypersexual—they may want or even demand far more sexual activity than the couple has even had before. The healthy spouse may or may not be comfortable with this—and may need professional advice to figure out how to handle it.

Eventually, the person with Alzheimer’s disease may also forget who the spouse is or confuse the spouse with another family member, such as a sister or brother or even an adult child. When this happens, many caregiving spouses no longer feel comfortable maintaining a sexual relationship.

How can I maintain intimacy without sex? Let me share an anecdote from my coauthor Dr. Edward Shaw. His wife, who had early-onset Alzheimer’s, would become startled and upset when he came up from behind and gave her a hug and a peck on the cheek. However, she felt safer at night when snuggled under the covers and the lights were dimmed. At that time, they were able to connect as she enjoyed some gentle hugging and kissing. Surprising your spouse might have worked when you were younger, but now it may be better to be gentle, open and calm.

Other ways of maintaining intimacy with your partner without having sex are holding hands…sitting close by or holding him if he is afraid, angry or agitated…rubbing his feet or back or gently stroking his cheek…massaging his hands and arms with lotion…dancing or moving to music with him.

In later stages of the disease, will my spouse with dementia even appreciate the kind and loving things I do? The amygdala, the emotion center of the brain that plays a key role in emotional memory, is not immediately affected by dementia or Alzheimer’s. A person’s deep need for love does not disappear, even after the actual actions or words are forgotten. Even in late Alzheimer’s, when the amygdala is affected, one’s ability to perceive emotional love endures far longer than the ability to express it. You must remind yourself daily that your loved one is capable of receiving love—even though you may not receive a thank-you, hug or kiss in acknowledgment of your expressions of love.


Delusions such as this may occur starting in middle-stage dementia or later. It is hard for a faithful spouse not to take an accusation of infidelity personally and lash out. First, realize that it’s the disease speaking, not your spouse. Then try the three-step approach below.

Consider this hypothetical scenario in which Dan, an Alz­heimer’s patient, accuses his wife, Marian, of being unfaithful. His wife should… 

  • Acknowledge. “Dan, I hear you saying that you are worried that I am seeing someone else.”
  • Affirm. “Well, let me reassure you. We’ve been married for 50 years, and I’ve been faithful to you for 50 years—there’s nothing that’s going to change that.”
  • Redirect. “So let’s go sit down on the couch together, turn on the TV and have some popcorn.”

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