Open Access. © 2020 Claudia Dinand, Margareta Halek, published by De Gruyter. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110677485-002 2 Challenges in interacting with people with dementia Claudia Dinand, Margareta Halek Abstract: Adequate and mutual interaction is a key factor for a good and stable rela- tionship between people with dementia and their carers and a prerequisite for living well with dementia. The dominant features of dementia include cognitive impairment and behavioral changes in people with dementia, often referred to as “challenging”. Whether communication is successful or not depends, on the one hand, on the type and degree of cognitive impairment and the skills and resources available to people with dementia and, on the other hand, on the ability of the environment to interpret and understand the utterances and the meaning of the behavior. In the first part of this essay we begin with a description of the different concepts of challenging behavior and their theoretical assumptions and backgrounds. We then describe the particularities of the nursing perspective and show the state of the art in caring for people with dementia with challenging behavior. We will also consider current evidence on the different views on the phenomenon facing the perspective of professionals, family carers and people with dementia themselves. In the second part, we alternately describe and reflect on a very short sequence of a micro interaction of a couple at home during a meal. With regard to current theoret- ical discussions, the example gives a first impression of the tiny, situational and com- plex interactional attunements and underlines the need for sensitive communication skills of people caring for people with dementia. 2.1 Introduction Dementia has an enormous impact on daily living of people with this disease and for all surrounding them. One of the most prominent challenges in dealing with demen- tia is the creation of an appropriate and effective interaction. The dementia process causes direct communication impairments due to pathological changes in particular brain regions (e. g. anomia, aphasia, impairments in motor performance of speech). But the major part of communication and interaction problems is a result of misad- justment between dementia related impairments, available capabilities of the person with dementia and the competency of the environment to deal with the communica- tion difficulties. One of a dominant characteristic associated with dementia are, along with cog- nitive impairments, the changes in behavior of people with dementia. The prevalence of behavioral symptoms of people with dementia living at home is 53 % in Germany (Teipel et al. 2015; Thyrian et al. 2015) and between 11–90 % international (Borsje et al. 2014). Behavioral changes are one of the first signs of dementia and they accompany