Games for Dementia Patients

The one rule

A person with dementia will forget the game within minutes. They will not forget how it made them feel. That is not a figure of speech: the emotional memory of an event outlasts the factual memory of it, often by hours, sometimes by the rest of the day. So the only rule for a game with someone who has dementia is that it cannot be failed. Not "we go easy on them". Cannot be failed, by design, so that nothing you do and nothing they do produces the small sting of being wrong.

Every activity on this page is built that way. A wrong tap is quietly greyed out and the right one is still there. There is no timer, no score, no round to lose. The instruction is one sentence, in large print, and a button reads it aloud as many times as needed. The pictures are photographs of ordinary things, because a photograph of a cow is recognisable to someone who no longer reads, and a cartoon of one may not be.

The five activities

Which games at which stage

Dementia is not one thing and stages are rough, but they are the most useful way to choose. If the person you care for does not fit a row, go down one.

How to play alongside someone

This matters more than which game. Care homes that train staff in it see fewer difficult afternoons, and it is all learnable.

• Sit beside, not opposite. Opposite is a test. Beside is company. Put the tablet flat on the table between you, not held up.
• One instruction, then wait. "Tap the same one." Then count to ten in your head before saying anything else. Processing is slow, and a second instruction wipes the first.
• Never "do you remember?" It is a question they may fail. Say "I remember you told me about the shop on the corner" and let them pick it up or not.
• Do not correct. If they tap the wrong picture it greys out and the right one is still there. Say nothing, or "there's the other one". If they call a giraffe a horse, it is a horse today.
• Let them lead the talking. Remember when is not a quiz. One question can fill twenty minutes. Do not move to the next card because you are bored.
• Do it with them, not for them. Sorting is more fun if you both sort. Breathing works if you both breathe.
• Stop while it is going well. Ten to twenty minutes. A good short session is remembered as good; a long one that ends badly is remembered as bad.

Fifteen games to do at home, ranked by how well they hold up

1. Sorting real things. Buttons, coins, socks, cutlery, playing cards by suit. A job with a visible finish, no wrong answer, and it can be done every day. The best activity in dementia care and the least glamorous.
2. Music they knew at twenty. Not a game, and better than every game. Make a playlist from the years they were 15 to 25 and watch what happens. Add a song from a wedding.
3. Photographs with names written on. An album where every face has a name under it, so nobody has to ask "who's that?" and nobody has to fail to answer.
4. Dominoes. Matching, turn-taking, a tactile piece to hold. Use large ones and drop the scoring.
5. Picture bingo. Cards with photographs instead of numbers. Works in a group and works one to one.
6. Balloon or soft ball, passed back and forth. Movement, eye contact, laughter, no rules. Works into late dementia.
7. Jigsaws with fewer, larger pieces and adult pictures. Twenty to fifty pieces, a landscape or a shopfront, never a children's cartoon. The picture on the box matters more than the puzzle.
8. Folding towels and pairing socks. A real job that helps, which is what most people with dementia say they want. Unfold them again later if you have to.
9. Simple card games they already know. Snap, beat your neighbour, rummy in the early stage. A new card game is not worth teaching.
10. Sing-alongs and hymns. The words are still there long after the day of the week has gone.
11. Reminiscence with objects. A tin of buttons, an old camera, a ration book, a tool from their trade. Hand it over and say nothing.
12. Gardening in a pot. Soil, seeds, watering. Sensory, purposeful, and something to look at tomorrow.
13. Baking something simple together. Stirring, smelling, tasting. The kitchen is often the last room where a person still feels competent.
14. Hand massage with lotion. Late stage, when almost everything else has gone. Touch and scent do not need memory.
15. Watching birds at a feeder. Put the feeder at the window. Ten minutes of calm attention a day, for both of you.

What the evidence says, briefly

• Nothing slows the disease. No game, puzzle or app has been shown to slow dementia once it has started, and anyone selling one as if it does should be ignored.
• Structured mental activity helps a little. Cognitive stimulation therapy, which is a programme of themed group activities much like the ones above, is recommended by the UK's health guidance body for mild to moderate dementia. Reviews of the trials find small improvements in thinking and quality of life. Small, real, and worth having.
• Music helps distress. Personalised music, meaning songs the person chose or loved, is one of the better-supported ways to reduce agitation, and it has no side effects.
• Purposeful activity beats entertainment. Approaches built on real tasks and the person's own history, often called Montessori-based dementia care, consistently reduce difficult behaviour in care homes. Folding the towels is doing something for the household. That is the point of it.

So the honest goal of a game here is a good half hour: attention, a little laughter, a feeling of managing something. Measured that way, a game of pairs face up with a person who forgets it by lunchtime was a complete success.

Accessibility notes

• Large print and high contrast by default, with an even bigger setting in the gear menu. The names under the pictures can be turned off for a person who finds text distracting.
• Read aloud. Every instruction and every remember-when card has a speaker button, and the read-aloud setting speaks the instruction automatically.
• Tap only. Nothing to drag, nothing to hold down, nothing timed. The whole screen can be used in full screen with the browser out of the way.
• Keyboard and switch. Everything is a real button, so Tab and Space work, and a switch interface that sends Space can run the same picture game with a carer moving the focus.
• No account, no download, and nothing about the person is recorded. The settings are kept on the device.