Caregivers Guide To Creating Memory Communication Supports

Caregiver’s Guide to
Creating Memory and

Communication Supports
for People with Dementia
Alyssa M. Lanzi, Ph.D., CCC-SLP

Michelle S. Bourgeois, Ph.D., CCC-SLP
Health Professions Press, Inc.
P.O. Box 10624
Baltimore, Maryland 21285-0624
www.healthpropress.com
Copyright © 2022 by Health Professions Press, Inc.

All rights reserved.
Research reported in this publication was supported by the National Institute on Aging, National Institutes of Health,
under Award Number K23AG070185 awarded to Dr. Alyssa Lanzi. The content is solely the responsibility of the authors
and does not necessarily represent the official views of the National Institutes of Health.
Available for download at healthpropress.com/lanzi. For information on ordering print quantities, contact
sales@healthpropress.com.
Photo credits:
Pexels: Pages 6 (top left, Glauber Torquato), 8 (top left, Yan Krukov), 8 (top right, Rodnae Productions),
10 (bottom left, Glauber Torquato), 12 (top left—cards, Midhun Joy), 12 (top left—puzzle, Levent Simsek), 16 (top left,
Tristan Le), 16 (top right, Alex Green), 16 (bottom left, Rodnae Productions), 16 (bottom, second from left, cottonbro), 16
(bottom, second from right, Meruyert Gonullu), 16 (bottom right, Ron Lach).
iStock: Pages 3 (CasarsaGuru), 4 (SilviaJansen), 6 (bottom right—tea, Eva-Katalin), 6 (bottom right—scones,

nicolamargaret), 12 (middle right—tea, Eva-Katalin), 12 (middle right—scones, nicolamargaret).
Alyssa Lanzi (copyright © 2022 Alyssa Lanzi, lanzia@udel.edu): Pages 1, 6 (top right), 8 (bottom right), 10 (top and bottom),
12 (bottom), 13, 14, 17, 19, 20, 21, 22, 23, 24, 26.
CONTENTS
About This Guide 4
Introduction 5
Purposes of Memory Books 6
Choosing the Appropriate 13

Format for the Memory Book
Using the Memory Book 18
Technology Options 19
Sensory Modifications to 20
Memory Books
Reminder Cards 21
About the Authors 26
Caregiver’s Guide to Creating Memory and Communication Supports for People with Dementia, by Alyssa M. Lanzi and Michelle S. Bourgeois.
Available for download at healthpropress.com/lanzi. Copyright © 2022 by Health Professions Press, Inc. All rights reserved.
About This Guide
If you have cared for someone with dementia, you know firsthand how challenging
it can be to have a conversation and engage with that person meaningfully. How can
family members, who may not have professional training, address these challenges
and improve the lives of their loved ones?
Outlined in this family-friendly guide are the information and resources for
developing individualized memory books and reminder cards to enhance the
language and memory skills of your loved one. Each chapter guides you through the
process of selecting, designing, and using memory supports for different purposes.
The ultimate goals of this guide are for you to develop memory supports that are
customized to your loved one’s needs and for you to have a clearer understanding of
how these memory books and reminder cards can be used in everyday life.
Individuals with dementia can have meaningful conversations if provided the

necessary and personalized supports to do so. We hope this guide will be of help to
you and your loved ones.
Caregiver’s Guide to Creating Memory and Communication Supports for People with Dementia, by A. Lanzi and M. Bourgeois.
4
Introduction
The suggestions in this guide are designed to explain the purposes and formats of
memory books and reminder cards that can help when communicating with people
living with dementia or other cognitive disorders that impact communication.
Memory books and reminder cards can be used to:
Reduce challenging behaviors
Help the person make decisions and choices
Provide personalized and engaging leisure materials
The discovery that reading is preserved in people with dementia as their condition
worsens has made an important contribution to the management of dementia.
During her 30 years of research, Michelle Bourgeois and her colleagues first
demonstrated in 1988 that, when provided with a small booklet of 10 to 20 pages,
each consisting of a single photograph and a simple caption, a person with dementia
was able to read the captions aloud and then elaborate on the picture. Instead of
struggling to find the words or remember specific facts, the person used the booklet
to have a satisfying conversation with a partner.
Researchers have repeatedly documented that people at all stages of dementia

respond similarly to pages in a memory book, as long as the size of the font used for
the captions is large enough for the person to read easily and the content of the
pictures is familiar and important to the person. We have synthesized the research
to develop this family-friendly guide. It describes the range of features you can
modify to meet the needs of the individual and how to make those modifications to
develop memory supports for your loved one. We will provide helpful tips and tricks
for designing your own memory books. We will also describe reminder cards, which
provide a written response to a person's recurring question or worry. The card can be
re-read as many times as needed to help the person remember the answer.
You can use this guide to develop memory supports that are customized to meet
your loved one’s needs and that can be used to promote meaningful engagement.
5
Purposes of Memory Books
The original purpose of memory books was to get around the language-processing
problems caused by dementia and help improve conversations between people living
with dementia and their care partners. Over time, evidence has expanded to support
the use of memory books for a variety of impaired memory skills: memory for
words, facts, and events, plus short-term memory for new or recent information.
Memory books have four common uses:
1. Conversation 2. Specific Facts
My granddaughter got married last I live in room number 43.

year. They had more than 200 guests!
3. Decision Making 4. Leisure

Activities My Interests
Music Knitting
I love afternoon tea. The
scones are my favorite.
Poker Crafts
6
It is important to first decide why this person needs a memory book.
Are they having difficulty engaging in conversations because they can't
remember what they want to talk about?
Are they having trouble retrieving specific facts, remembering the answers to
the question you just answered, or recalling steps needed to complete common
tasks?
Are they having challenges participating in making decisions or choices about
their everyday needs?
Are they no longer interested or engaged in hobbies or pastimes?
Once you decide the why, the next step is to decide on the appropriate type of book.
Use the key below as a guide for your decision.
Is the person...
...having difficulty ...forgetting the ...not choosing their ...not
telling complete names of loved food during participating in
stories? ones? mealtime? activities?
Decision-
Conversational Specific Facts Leisure
Making
Memory Book Memory Book Memory Book
Memory Book
Helpful tip: The person may have needs in all of the areas described above.
Decide which one need might be causing the greatest difficulty, and start
there. Although the goal is to create a memory book, focus on creating one
page at a time and sharing it with your loved one. Over time, you can create
new pages as you learn more and as the person’s needs change.
7
1. Conversational Memory Books
To support conversation, a biographical memory book can be helpful. Select photos
of happy memories, such as pictures of the person’s parents, siblings, friends, life
milestones (graduations, wedding, children, pets, or occupation), and favorite
activities or interests. Gather information that you think would be important to
include, and ask the person to select what is most meaningful to keep. A form such
as the Information Form provided on page 8 can be a useful tool for gathering
biographical facts.
Our great-nieces used to visit us over

I went to yoga class every Tuesday. the summer. We loved picking
flowers with them.
My Job
I worked as a lobster fisherman for

30 years. My boat was named
RedClaw, and we fished off the cliffs
My granddaughter got married last year.
of Monhegan, Maine.
They had more than 200 guests!
8
Memory Book Information Form
Complete the following sentences that are most appropriate for your family member, and for which
you have a picture to use in the memory book.
1. My name is ___________________________________________________ (full name or nickname)
2. I was born on ______________ (date) in _____________________________________ (city, state)
3. My parents were __________________________________________________________ (names)
4. I spent most of my career working for ________________________________________________
5. My wife’s/husband’s name is _______________________________________________________
6. Our wedding was on __________________(date) in ___________________________ (city, state)
7. My children’s names are
a) ____________ b) ____________ c) ____________ d) ____________ e) __________
8. What are the current occupations of these children (or their spouse’s name)?
a) ____________ b) ____________ c) ____________ d) ____________ e) __________
9. My grandchildren’s names are
a) ____________ b) ____________ c) ____________ d) ____________ e) __________
10. My ________________ (type of pet)’s name is ______________________________________
11. I went to college/high school at ________________________ in _______________ (city, state)
12. I earned a living ___________________________________________________ (my occupation)
13. Now that I am retired, I enjoy _____________________________________________________
14. I used to play ___________________________________________________ (sport/instrument)
15. My favorite pastime is/was _________________________________________________ (hobby)
16. When I was younger, I used to ____________________________________________ (anything)
17. I attend (went to) __________________________________________________(church/temple)
18. One of my most memorable vacations was ________________________________ (where), on
_______________________(when), with _____________________________ (whom)
Anything else that is particularly important or memorable:
19. _____________________________________________________________________________
20. _____________________________________________________________________________
From Caregiver’s Guide to Creating Memory and Communication Supports for People with Dementia, by Alyssa A. Lanzi and Michelle S.
Bourgeois. Available for download at www.healthpropress.com/lanzi. © 2022 by Health Professions Press, Inc. All rights reserved.
9
2. Specific Facts Memory Book
To answer repeated questions about specific factual information, include pages that
answer the question, anxiety, fear, or concern. The individual may worry about what
they are doing throughout the day or which room is theirs. Below are some great
examples of how to design a memory book to address these specific concerns.
Concern: Fear:
I do not know the plan for the day I will forget where my room is located
My morning schedule: I live in room number 43
7:00 Wake up
7:30 Take shower
8:00 Get dressed
8:30 Eat breakfast
9:00 Join group activity
Avoid documenting sad memories unless the person is asking repeated questions
about the event. If so, you might consider adding a page that addresses that specific
concern or question.
Question: Where is my husband?
My husband rests peacefully here.
10
3. Decision-Making Memory Book
For making choices or decisions, pages of relevant information can help a person
communicate their wishes and desires by pointing to the pictures. A person with
dementia may have difficulty deciding what foods they want to eat for breakfast or
buy at the store, or what activities they would like to do. To support decision making,
we can provide a verbal prompt and a visual support from the memory book.
Prompt: Prompt:
What activity would you like to do next? What would you like for breakfast?
Activities Breakfast
Music Knitting Eggs French Toast
Poker Crafts Pancakes Cereal
It is also important to have a blank page in the memory book to support decision
making. Sometimes the person will have to make a decision that you may not have
planned for, but that you want to support them in making. You can use the blank
page template (see example on next page) and supply pictures representing the
decision, and then let the person place pictures (or actual objects) on the page to
show their choice or decision. For example, if you wanted to have them decide about
playing cards, you could provide them with the template on page 11 and have them
place the playing cards in the “I like” or “I do not like” box.
11
I would like...
I like... I do not like...
4. Leisure Time Memory Book

To have interesting materials for leisure time, design pages about the person’s
hobby or special interest. It is important to think about what they enjoyed doing
before they developed dementia and include that information in the book. It is also
important to remember that many activities can be adjusted for the individual’s
current needs. The pages can help support conversations about their favorite things
and remind them about specific interests.
My
Myinterests
interests My interests
I enjoy swimming in the pool. I love afternoon tea. The scones

are my favorite.
12
Choosing the Appropriate Format for
the Memory Book
The size and format of the memory aid have to match the person’s physical and
sensory needs.
Is the person mobile or wheelchair-bound?
Does the person have difficulty with actions that require manual dexterity, such
as turning pages?
How is the person’s vision? Are glasses needed for reading?
For the person who is still ambulatory (able to walk), a small book that they can
carry with them is best. This “memory wallet” can be a small notebook that fits in a
purse or in a pocket. It should contain information that the person might need for
identification (for instance, address or phone numbers). It should have some blank
pages for writing down something the person wants to remember, such as the name
of a new friend.
If the person is non-ambulatory, a larger three-ring binder book is best. With larger
pages and font size, this type of book is quite versatile. It allows for bigger pictures
and more text. The pages are often easier to manipulate.
13
Helpful Tips and Tricks
Portable Aids
Use a plastic photo album for a mini-memory book.
Use a wallet card insert to assist with retrieval of specific facts when the
person is away from home. You can write on the business-sized cards.
Stationary Aids
Place the pages in clear inserts or laminate the pages.

Note: You can write with a dry-erase marker on the pages to direct the
person’s attention to specific items within the photo. It's a great way to
increase interaction during a conversation, and the marker wipes off
afterward.
14
Determining the Features for the Book
The next step in the process is figuring out the appropriate font size for easy
reading. You can use a simple reading assessment to decide the best font size. Type a
list of sentences in different font sizes, and then have the person read them. Notice
how easy or difficult each one seems to be. If the person stumbles over the words or
makes reading errors, then a larger size is better. Choose the font size that the
person reads most quickly without mistakes.
Next, consider the length of the captions. Some people can read entire sentences
and others do better with only a couple of words. Consider the following example
that shows four levels of decreasing complexity:
When writing captions for the memory book, type up the list in the font you think is
best, and then ask the person to read them. You will notice if any of the sentences
are too long or complex, if there are reading mistakes, or if the person struggles to
read the sentence. Adjust the sentences until they are easily read. An example is on
the next page.
15
Finally, it is important to personalize the text using first-person pronouns.
Statement Correction
Your money is safe in the bank. My money is safe in the bank.
You are going to church today. I am going to church today.
Choosing the Pictures and Writing the Captions

Now it’s time to find the pictures you want to include in the memory book, if you
haven’t already. Some people find it faster to choose the pictures first and then
write the captions. Others prefer to write captions and then choose the pictures.
Both strategies work. Photos of people are best; label each person in group photos.
One or two pictures per page is best for focusing the conversation on one topic.
Strategies
Choose the pictures first: OR Choose the labels first:
I live in Rhode Island.
My cat's name is Luca.
My dog is 90 pounds.
We celebrate Christmas.
Kristen and Alyssa are sisters.
16
It is always important to have a family and self-identification page within the book.
If the person has trouble recognizing someone, place the recognized picture next to
the current one.
My name is Meredith.
This is me
This is me
when I was
now.
young.
Helpful tips:
Make the first couple of pages and then ask the person to read them.
Modify as needed.
It could be helpful to put each page in a plastic page protector.
17
Using the Memory Book
How to have a satisfying conversation
Becoming a STAR-GUIDE Communicator
S Smile during the conversation and act interested while the

person is talking.
T Thank them for sharing their story and having a conversation.
A Ask them to join in conversation:

“Would you mind if I sat beside you? I would enjoy talking
with you.”
R Reassure them if they are struggling, and provide help if needed.

“Don’t worry, Mary. What can you tell me about your childhood?”
Guide the conversation topics and always redirect when needed.

“I recently got married. Please tell me about your wedding.”
Talking Tips
Try not to quiz the person by asking many questions.
Examples: “Who is this person?” “Is this your friend?”

“Are you related?”
Solution: “Tell me about this person.”
Try not to correct something that was stated as a fact.
Example: “No, that is not Sarah. That’s Michelle,

remember, your daughter?”
Solution: “Michelle looks like Sarah, doesn’t she?”
18
Technology Options
Feasibility
If your loved one lives far away, consider using one of the many online sources for
creating personalized photo books. Some computers even come with a tool for
creating a photo album. Once the book is developed, it can be shipped to the
individual's home. Online websites provide a quick and easy way to organize and
develop a memory book with electronic copies of photos.
Examples of websites:
https://www.shutterfly.com/
https://www.snapfish.com/photo-gift/photo-book
https://photos3.walmart.com/about/photo-books
https://www.picaboo.com/photo-books/classic/
Helpful tip: Be careful when designing your book

online:
Decorative backgrounds can be distracting.
Too many pictures may be overwhelming.
Font sizes may be too small.
Online programs may not crop your photos correctly.
19
High-Tech
Memory books can also be made so they can be viewed electronically on a tablet or
smartphone. This may be an appropriate option if your family member is familiar
with technology or has sensory limitations. Below are some examples of common
limitations and high-tech solutions.
Limitations Technical features
Visual Photos can be enlarged using the zoom feature

Fine motor Pages can be turned with a tap or swipe rather than flipping
Reading Phrases can be audio-recorded and embedded in the program
Examples of Electronic Tools:

Story Creator™ (Apple’s app store)
Pictello™ (Apple's app store)
PowerPoint™ (Microsoft Office)
Sensory Modifications to Memory Books
Talking Photo Albums

Talking photo albums are a great style of memory book for individuals who have
poor vision or difficulty reading. Instead of writing the message, you can record a
unique message for every page in the book. The individual can then play the message
when viewing the page.
20
Sensory Pages
Sensory pages are wonderful to include in a memory book for individuals with poor
vision. The pages incorporate different textures for the person to touch. These are
especially great for specific careers, hobbies, and interests (e.g., sewing,
construction, and interior design).
Reminder Cards
In addition to memory books, reminder cards are another great way to support
impaired language and memory skills. The purpose of a reminder card is to help the
person remember a specific fact that is often forgotten. This information is specific
to an event that occurs frequently and causes the individual to be frustrated when
they can't recall facts or details independently.
Reminder cards are most commonly used when an individual repeats a question
moments after you answered the question. The card saves you from repeating an
answer many times and helps the person recall the information independently.
Follow these easy steps when creating and using a reminder card:
1. State the answer to the question asked.
2. Write the answer on an index card.
3. Give the card to the individual or place it within their range of vision.
4. Instruct the person to "read the card aloud" to make sure it "sounds right" to
them.
5. If the question is asked again, instead of answering the question, say, “Isn’t the
answer to that question on that card? Read it.”
6. Repeat step 5 each time the question is asked.
21
Example
Question: Where is my paycheck?
1. Answer: Your money is safe in the bank.
2. Write on card: My money is safe in the bank.
3. Place the card in the hand of the individual.
4. Instruct the individual to read the card.
Additional examples:
Question: When am I going home?
Written on card: I live here now and enjoy it.
Question: When is my family visiting?
Written on card: My sister visits every day after dinner.
Reminder cards can also be used to assist with challenging behaviors or safety
concerns. Follow the same steps as above, and then instruct the individual to read
the card when the behavior occurs.
Example:
If an individual continues to stand when positioned in front of a wheelchair, a
reminder card can be used to encourage them to sit down.
On the card you should write: I sit in my chair to not fall down.
22
Additional examples:
Problem: Individual does not cooperate during washing.
Written on card: I enjoy getting clean in the shower.
Problem: Individual does not drink water throughout the day.
Written on card: I drink water to stay energized.
Make the message simple and clear

Use large print (not cursive) and just a few simple, positive words
(e.g., enjoy).
Personalize the message

Use personal pronouns (e.g., I, my, we) within the message.
Read the message aloud
If there are errors, write a new card. Cross-outs will be confusing.
Consider the location of the reminder card

Tie the card to a string, or attach it to a wheelchair with Velcro.
Fold the card for it to stand up.
Put the card in a simple photo frame.
Use a small portable dry-erase board.
23
Sensory Modifications to Reminder Cards
If an individual has decreased reading ability, pictures can be used to support the
statement written on the card. This is especially useful with recurring problematic
behaviors.
If a person has poor vision, an audio recording of the message can be used. Portable
tape recorders or the recording device on electronic phones can be useful. Instead of
saying "Read the card," you would say "Press the button" to play the audio message.
24
In Closing
We hope you have found this guide helpful. Although the design options for these
memory supports are endless, what is most important is that you tailor the supports
to meet the needs of your loved one. To do that, we encourage you to be creative,
listen to your family member, and design the supports one step at a time as
presented in this guide. If one option does not work, we encourage you to try
another. Throughout the process, please keep in mind that dementia does not define
your loved one.
Through using memory books and reminder cards, we hope that you and your loved
one can engage in positive and meaningful conversations.
25
About the Authors
Alyssa M. Lanzi, Ph.D., CCC-SLP, is a speech-
language pathologist and Research Assistant
Professor in the Department of Communication
Sciences and Disorders at the University of
Delaware. She has received grants from the National
Institutes of Health to investigate the effects of an
intervention designed to improve the independence
of older adults at risk for dementia and to develop a
database to study the language and cognitive skills
of individuals with dementia. She has published
numerous research articles investigating person-
centered approaches for individuals with mild
cognitive impairment and dementia, and has
presented at several conferences to teach speech-
language pathologists how to deliver those
approaches. Dr. Lanzi is also on the executive
committee for the Delaware Center for Cognitive
Aging Research, a partnership between the
University of Delaware and the Swank Center for
Memory Care and Geriatric Consultation.
Michelle S. Bourgeois, Ph.D., CCC-SLP, ASHA

Fellow, has received numerous grants from the
National Institute on Aging (NIA) and the
Alzheimer’s Association to investigate interventions
for spousal and nursing home caregivers designed to
improve the quality and quantity of communicative
interactions with residents with dementia, to
evaluate memory aids and interventions for persons
with dementia and traumatic brain injury, and to
develop training programs for institutional
caregivers. As a clinical researcher, Dr. Bourgeois
has published numerous research articles, training
manuals and CDs, and books. She was the recipient
of the 2007 Barry Reisberg Award for Non-
Pharmacologic Research, Theory, and Clinical
Practice and an Erskine Fellowship at the University
of Canterbury, New Zealand.
26

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Caregiver’s Guide to

Creating Memory and

Alyssa M. Lanzi, Ph.D., CCC-SLP

Copyright © 2022 by Health Professions Press, Inc.

iStock: Pages 3 (CasarsaGuru), 4 (SilviaJansen), 6 (bottom right—tea, Eva-Katalin), 6 (bottom right—scones,

About This Guide 4

Purposes of Memory Books 6

Choosing the Appropriate 13

Using the Memory Book 18

About the Authors 26

Individuals with dementia can have meaningful conversations if provided the

Researchers have repeatedly documented that people at all stages of dementia

Memory books have four common uses:

1. Conversation 2. Specific Facts

My granddaughter got married last I live in room number 43.

3. Decision Making 4. Leisure

Our great-nieces used to visit us over

I worked as a lobster fisherman for

1. My name is ___________________________________________________ (full name or nickname)

2. I was born on ______________ (date) in _____________________________________ (city, state)

3. My parents were __________________________________________________________ (names)

4. I spent most of my career working for ________________________________________________

5. My wife’s/husband’s name is _______________________________________________________

6. Our wedding was on __________________(date) in ___________________________ (city, state)

7. My children’s names are

a) ____________ b) ____________ c) ____________ d) ____________ e) __________

a) ____________ b) ____________ c) ____________ d) ____________ e) __________

9. My grandchildren’s names are

a) ____________ b) ____________ c) ____________ d) ____________ e) __________

10. My ________________ (type of pet)’s name is ______________________________________

11. I went to college/high school at ________________________ in _______________ (city, state)

12. I earned a living ___________________________________________________ (my occupation)

13. Now that I am retired, I enjoy _____________________________________________________

14. I used to play ___________________________________________________ (sport/instrument)

15. My favorite pastime is/was _________________________________________________ (hobby)

16. When I was younger, I used to ____________________________________________ (anything)

17. I attend (went to) __________________________________________________(church/temple)

18. One of my most memorable vacations was ________________________________ (where), on

_______________________(when), with _____________________________ (whom)

Anything else that is particularly important or memorable:

My morning schedule: I live in room number 43

Question: Where is my husband?

My husband rests peacefully here.

Music Knitting Eggs French Toast

Poker Crafts Pancakes Cereal

4. Leisure Time Memory Book

I enjoy swimming in the pool. I love afternoon tea. The scones

Use a plastic photo album for a mini-memory book.

Place the pages in clear inserts or laminate the pages.

Your money is safe in the bank. My money is safe in the bank.

You are going to church today. I am going to church today.

Choosing the Pictures and Writing the Captions

Choose the pictures first: OR Choose the labels first:

I live in Rhode Island.

My cat's name is Luca.

Kristen and Alyssa are sisters.

It could be helpful to put each page in a plastic page protector.

S Smile during the conversation and act interested while the

2. I was born on (date) in _______________________ (city, state)

6. Our wedding was on (date) in _________ (city, state)

a) __ b) c) d) e)

a) __ b) c) d) e)

a) __ b) c) d) e)

10. My (type of pet)’s name is ______________________

11. I went to college/high school at __________ in _ (city, state)

_(when), with _______ (whom)