Lost for words: Communication breakdown in dementia

Sep 24, 2018

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Lost for words: Communication breakdown in dementia

Lost for words: Communication breakdown in dementia

Posted in : All, Dementia Care, Living with dementia on by : Giulia Melchiorre

What is communication?

When we think of communication we may believe it is the same as language or speech. However, it is much more than that. Communication combines language, attitude, tone of voice, facial expressions and body language to pass on messages to others. Language on the other hand is a tool of communication. It may be written, spoken or expressed using gestures and body language. Speech involves using muscles to produce the sounds that make up language.

Communication is key for us; we use it to express ourselves, and to share our needs, desires, opinions, knowledge and feelings with each other. It allows us to connect with other people and maintain relationships. In different types of dementia, a person’s communication abilities can gradually decline as the disease progresses. This can lead to frustration and  a decrease in quality of life.

Why do communication abilities decline in people with dementia?

There are many reasons why communication declines in people with dementia, and the extent to which and how it changes will depend on the type of dementia and stage of disease progression. Some of the factors that affect the ability of a person with dementia to communicate include:

  • Memory problems
  • Difficulties with attention
  • Difficulties concentrating
  • Slower information processing resulting in delayed responses
  • Changes in behaviour, such as disinhibition
  • Damage to brain areas that are key for language processing

What changes occur?

The changes in communication that occur depend not only on the type of dementia, but also on the stage of the disease and the affected individual, as each person with dementia is unique. Below is a short summary of some of the most common changes that we can observe across different types of dementia:

  • Word-finding difficulties
  • Fluent, but empty speech (i.e. what is being said makes no sense)
  • Difficulties understanding what is being said
  • Problems with writing and reading
  • Loss of normal social conventions of conversations (e.g. interrupt or ignore a speaker, or fail to respond when spoken to)
  • Difficulties expressing emotions appropriately

Select the type of dementia below to find out more specific information about communication loss and relevant advice:

Alzheimer’s Disease (AD) 

Frontotemporal Dementia (FTD), including behavioural variant and primary progressive aphasias

Parkinson’s Disease (PD) 

Vascular Dementia (VD)  

Dementia with Lewy Bodies (LBD)

What does this mean for day-to-day life?

As mentioned above social conventions of conversations may be lost. This may result in the person with dementia talking too loudly, repeating ideas, speaking too much at inappropriate time or digressing from the topic.

Severe language decline can also mean that the person with dementia is no longer able to express their needs, which affects quality of life, prognosis and social relationship. For example, a person with dementia may find it difficult to maintain existing friendships, resulting in withdrawal from social contact.

At the same time activities of daily living that depend on communication abilities will be affected, which can result in a loss of autonomy, increasing caregiver burden.

Loss of communication is also associated with behavioural problems, such as agitation, restlessness and wandering.

What can you do?

It is important to bear in mind that communication is much more than just spoken language. In fact, research has shown that 55% of communication is conveyed through our body language, including facial expressions, posture and gestures. 38% is conveyed through the tone and pitch of our voice, and only 7% through the words we use. This means that how you say something may be much more important than the content of the message.

1. Encourage communication by starting conversations & making it easy to communicate:

  • Speak clearly and slowly, using short sentences
  • Make eye contact when they’re talking or asking questions
  • Give them time to respond so they do not feel pressured
  • Give simple choices & use closed questions. For example, ask “Would you like tea?” instead of asking “Would you like tea or coffee?
  • Encourage them to join in conversations with others, where possible
  • Try not to patronise them or make fun of what they say
  • Acknowledge what they have said, even if they don’t answer your question or what they say seems out of context. Show that you have heard them and encourage them to say more about their answer

2. Use body language & physical contact: Communication is more than just talking

  • Be patient & remain calm
  • Keep your tone of voice positive and friendly, whenever possible
  • Keep a respectful distance while talking to them, e.g. be at the same level or lower when they are sitting down
  • Pat or hold the person’s hand while talking to them to help reassure them and make you feel closer- watch their body language and listen to what they say to see whether they’re comfortable with you doing this

3. Listen carefully & be aware of non-verbal messages, i.e. facial expressions & body language

  • Make eye contact
  • Do not interrupt, even if you think you know what they’re saying
  • Give them your full attention; stop what you’re doing while they speak
  • Try to minimise distractions, such as TV or radio playing too loudly
  • Repeat back to them what they said and check if it is accurate

 

This article is based on research publications and information from well-known organisations in the dementia space. Sources include:

Scientific Paper: Language impairment in AD And benefits of acetylcholinesterase inhibitors

Scientific Paper: The brain basis of language processing: from structure to function 

Scientific Paper: Life with communication changes in Parkinson’s disease 

Scientific Paper: The Language Profile of Behavioural Variant Frontotemporal Dementia 

NHS guide: Communicating with someone with dementia 

FCA guide: Communication (for dementia)

Alzheimer’s Association leaflet: Communication 

Parkinson Society British Columbia leaflet: Communicating effectively with a Person with Parkinson’s who has cognitive impairments 

Dementia Australia: Managing changes in communication

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