Clinicians, caregivers, and people with Alzheimer's themselves, all experience the impact of communication breakdown caused by progression of dementia. The loss of language that occurs is hierarchical in nature. Those skills most recently acquired appear to be the first disrupted. Actual and hypothetical perspectives are offered. Spending time with people with Alzheimer's, getting to know them, and making them feel comfortable can reduce their communicative isolation. Additional means of maintaining connections across the stages are suggested.