Most individuals with Alzheimer's disease are cared for at home by family members, particularly spouses. As language impairment progresses, communication between spouses becomes difficult and caregivers are likely to be unprepared for this challenge. The purpose of this study is to describe spouse caregivers’ knowledge of communication in AD and to determine their learning needs regarding effective communication strategies. A measure of knowledge about declining language skills and appropriate communication strategies was developed and pilot tested. Participants included 16 spouses caring for a partner with AD at home. Care recipients were generally mildly impaired. Caregivers were aware of at least some of the decline in language but were less knowledgeable about communication strategies. They were experiencing numerous communication problems, but reported minimal difficulty in communicating. Nurses in acute and long-term care settings are challenged to assess spouses’ knowledge and awareness about communication in AD and provide information about effective communication strategies to decrease misunderstandings and frustration, which often lead to behavior problems. Recommendations for further development of the AD Communication Knowledge Test are offered.