This chapter discusses the perceptions of the person with dementia and the resulting communication. It examines the much-needed, intensive presence of the carer suggests a sort of intimacy. The chapter examines the ideas that carers have about old age and sexuality. The gradual decrease in the cognitive abilities of persons with dementia makes communication more difficult. Non-verbal communications are just as prone to being misunderstood as are verbal communications. Every gesture, touch or physical contact made by the person with dementia is more likely to be experienced by the carer as 'undesired intimacy'. Masturbation occurs in women for all of the same reasons mentioned, but in addition it is also sometimes done to keep warm. Obscene language is often used as a compensation for loss of status and feelings of inferiority. Male persons with dementia are not usually as self-conscious in the presence of female carers. Emotional abandonment occurred in some large families and in some very intellectual environments.