On the long and distressing journey that is dementia, one of the key issues is keeping communication going. Over time, all communication skills learned over a lifetime are lost.
People forget the names of things, lose their understanding of words and sentences, and gradually lose their ability to understand concepts and what they hear. You cannot assume that their understanding has been accurate even if they appear to respond appropriately.
People with dementia have increasing difficulty getting their message across when they talk. Even when they still understand words, they can have difficulty finding the word they want to use. They can find it more and more difficult to put coherent sentences together. They can even become confused with “crossed wires”. Responses to conversation and questions can appear unrelated. Eventually even their speech articulation can suffer so that they come across as hesitant, mumbling or repetitive.
Executive function skills deteriorate. Executive functions are those higher order thinking skills that regulate the other thought processes. Maintaining focus can be hard, as well as being able to shift focus so that people appear more rigid in their thoughts and get stuck on ideas or words and are less able to be flexible with daily life changes. Working memory suffers so that they can no longer multitask or take more information into account. Emotional control can be more difficult, and so less appropriate to situations. People with progressing dementia lose their ability to self-monitor as well as their insight. Even noticing when there is a breakdown in communication, and being able to fix it, or clarify the issue, becomes hard.
Impulse control, or inhibiting, is lost, so that people can say and do things that they would never have done in the past.
Especially difficult is the ability to use the social aspects, or pragmatics, of language. When people lose their ability to use and understand appropriate pragmatics it often seems like they have had a personality change. When we communicate, the words are only part of the story. We also regulate our body language, facial expressions, tone of voice and intonation. We orient our listener, thinking about how much someone needs to know. We answer questions giving just the right amount of information, and appropriate to the atmosphere of the situation. All of these become increasingly difficult to manage with dementia.
A lot of what we say is not meant to be taken literally. We use idioms, colloquialisms, sayings and pepper our speech with all sorts of word pictures and imagery. It becomes harder and harder for people with dementia to negotiate these conversations.
To help people with dementia understand, you can:
- Get close and get their attention
- Reduce background noise and distractions
- Say less words
- Use simple sentence structure
- Say exactly what you mean
- Don’t take too long to say it – they may remember for only a very short time
- Exaggerate the tune in your voice
- Uses pauses to make the key words stand out
To help people with dementia express themselves:
- Reduce questioning
- If you have to ask a question, avoid open questions – ask for specific or limited information
- Limit choices
- If they are stuck telling you something, break it down to yes/no questions like, “Do you mean x or y?”
- Start the sentence for them, using rising intonation in your voice, like, “You want your…?”
- If they can’t remember the name of the object they want, ask what they want to do with it
- Allow them time to say what they want to say
- Listen to the general message – it may give you clues to the specific
- Listen for any emotion in their voice – this may give you a clue as to how they are feeling
- If you can’t understand, acknowledge the emotion then distract, and, if necessary come back to it later
- Comfort and reassure rather than argue
A researcher, Brooker (2003) put it very succinctly, suggesting “warm, accepting human contact through non-verbal channels”.
Speech Pathologists can help you along the journey, both helping to keep the neural pathways as active as possible, and in guiding you to facilitate as meaningful communication as possible.