Dementia affects the chemical and physical structure of the brain as the disease progresses. Memory loss is often the most associated symptom of dementia; however, every level of functioning is affected by dementia.
The area of the brain responsible for language and communication is affected by the cell and nerve damage that occurs in the brain from the formation of plaques and tangles, nerve and cellular damage and brain inflammation. These changes affect the individual’s ability of speech, including difficulty finding the correct words to use, vagueness of speech, very limited language ability, and garbled speech. In the final stage of dementia, an individual will often lose all ability to communicate verbally.
Dementia can affect communication in two major ways. It affects the way the person with dementia interprets information and it affects the way the person expresses him / herself. Difficulties with speech are often one of the first noticeable symptoms in people with dementia, particularly those with Frontotemporal Dementia.
In the early stages of dementia, persons may carry on normal conversations, but simply forget a word, use the wrong word, substitute a word that sounds familiar, or have difficulty resuming a conversation after an interruption. However, in people with dementia, language problems eventually become more noticeable. Communication problems that were initially just minor inconveniences become much more severe and difficult in the later stages of dementia, as language and conversation become more greatly compromised. It becomes harder for individuals with dementia to remember or to learn new phrases, slang, or expressions It is also more difficult for people with dementia to hold several ideas in their heads at once. Therefore, they may jump from topic to topic without completing a coherent sentence.
It also becomes increasingly difficult for persons with dementia to understand what others are saying. In addition to not understanding certain words, rapid speech, high-pitched speech, and complex speech all become difficult to follow.
Communication Skills Loss Through the Stages of Dementia
Early dementia / Alzheimer’s:
Some difficulty concentrating and following conversation; difficulty finding the right words when speaking or writing; losing train of thought when speaking; repeating oneself. Usually the person with dementia is aware of these problems and may try to hide or overcompensate for them.
Moderate or mid-stage dementia / Alzheimer’s:
Difficulty following along with group and one-on-one conversations; losing train of thought when speaking; increased difficulty finding the right words when speaking or writing; loss of vocabulary, like proper nouns and slang terms; substituting words that sound the same or inventing new words; difficulty following storylines in books, TV shows, or movies; difficulty following directions; poor recall when telling others’ about recent events; increased used of gestures to communicate.
Severe or late-stage dementia / Alzheimer’s:
Inability to follow along with anything other than simple conversations and instructions; increased loss of vocabulary, including personal information and loved ones’ names; inability to follow storylines in books, TV shows, or movies; tendency to talk about nothing, rambling, or babbling.
End-stage dementia / Alzheimer’s
Inability to speak or otherwise respond verbally; difficulty or inability to understand when spoken to; all communication may be done non-verbally.
What to Expect as Communication Problems Increase:
As dementia progresses, people with dementia may use a set of common phrases or words more frequently, In later stages of dementia, this small set of repetitive language may turn into a babble of language to the point that the individual with dementia can no longer express what they want or need with words.
Many people who have trouble communicating and have memory problems can remember songs from their youth or years past, since music and melodies are stored in a different part of the brain’s memory center than words. Therefore, singing songs with loved ones with dementia might serve as another way to connect.
In the later stages of dementia, barriers to communication become greater and the ability to communicate may decrease until there is minimal to no communication. Individuals with dementia might use curse words (a strange quirk of diseases that sap language skills) or grunting may replace words. As the ability to form and understand language fades, recognition of the person’s own name may linger longer than understanding of other words. That said, a caregiver’s physical presence may be appreciated long after words no longer make sense or even after the person with dementia no longer recognizes people around him / her. In addition, the person might still be able to understand one’s tone of voice at this point.
Effectively Communicating with Someone with Dementia
As dementia progresses and the ability to communicate decreases, effective communication becomes increasingly more important for both the caregiver and the individual with dementia. Touch is an important means of communication. If the person can tolerate it (and some people cannot), caregivers can give a kiss, hold hands, give a very gentle massage, or lightly brush hair.
If a loved one is not carrying on conversations as he / she once did, it does not mean that he / she isn’t listening or doesn’t want to engage. Often, the individual with dementia cannot recall the word he / she wants to use. Fortunately, there are several strategies that can effectively help with communication:
- Speak slowly, with proper pronunciation and grammar.
- Avoid lengthy streams of conversation and going off on tangents. Instead, try focusing on one idea or short story at a time.
- follow the other aspects of a loved one’s conversation to figure out what the individual is trying to say. Don’t be afraid to ask him / her if he / she really meant another word but avoid over-correcting.
- Be patient. The person may just need more time to respond. Do not fill the silence by asking the question again or asking another question, it adds more confusion and restarts the processing time again.
- Identify yourself before starting the conversation and refer to the person by name. This will get the person’s attention and help to bring awareness of who you are.
- Keep it simple. Use basic language and keep stories brief. Try to talk about only one topic at a time. Avoid slang, nicknames, and idioms. Give simple explanations. Reminiscing can be healthy, but avoid asking, “Do you remember when…?”
- Minimize distractions. Turn the radio or television off and remove things from sight that are visually distracting. If possible, sit down face-to-face in a quiet, calm place. Be mindful of the tone, pitch, and speed of your voice. Keep your voice friendly, low, and slow.
The Importance of Non-Verbal Communication:
Communication is more than just language and speech. Non-verbal communication is increasingly important as an individual’s dementia progresses. This may include hand gestures, body language, facial expressions, eye contact, touch, and even actions. For people with dementia who get frustrated or angry when having a conversation or can no longer find the words to express themselves, non-verbal communication can still be an efficient way to connect with others.
Use non-verbal communication to reinforce a message. For instance, ask a person if they want something to eat and then point to the refrigerator to help clarify the question. Convey agreement or disagreement. Nodding “yes” or shaking your head “no” will help the person with dementia understand how you feel. A warm smile or hug conveys a message just as strongly as words can.
Heidi Lohre RN