Communication is a critical component of our life; it enables us to express who we are and allows us to relate to one another. When we communicate, we convey messages or exchange information to share information, needs, opinions, ideas, beliefs, feelings, emotions, experiences and values. Communication is more than talking and listening; it involves understanding and interpreting.
Information is conveyed in many ways:
- Verbal: words we use and understand
- Non-verbal: body language (facial expression, posture and gesture)
- Written: words we read and write
- Para-verbal: tone, pacing and volume of our voice
How does dementia affect communication?
Dementia creates distinct challenges in how people express themselves and understand what is being communicated to them.
The following communication changes are common among people with dementia:
- Difficulty finding a word
- Creating new words for ones that are forgotten
- Repeating a word or phrase (perseveration)
- Difficulty organizing words into logical sentences
- Cursing or using other offensive language
- Reverting a first language
- Talking less than usual
Although each person is unique, dementia has a profound effect on the language abilities of people living with the disease and therefore on the way they communicate. This language degeneration is known as aphasia.
People with aphasia have difficulty expressing themselves, finding the right words, understanding the words they hear, reading and writing. As the disease progresses, communication can become increasingly challenging. Recognizing those changes will help the person with the disease, and her family and friends, find ways to communicate more effectively.
Communication challenges during each stage of Alzheimer’s disease
People with dementia lose particular communication abilities during the early, middle and late stages of the disease. As the illness progresses, they experience a gradual deterioration of their ability to express themselves clearly and understand what others say. However, some form of communication does remain possible at every stage of the disease.
As the disease progresses, delusions — namely paranoid beliefs or false accusations — may occur. It is common for people with dementia to believe that their food is poisoned or that their belongings have been stolen. Others may believe that someone is spying on them or trying to hurt them. And some may even accuse their partner of having an affair. Remember that these accusations are the result of the disease; they are not willful or intentional. And although they can be hurtful, try not to take them personally. It is important not to argue with a person with dementia or try to convince him that his perception is not real. His perception is part of his own reality; try to accept it and meet him where he is.
In the early stage, the person often cannot find the right words − particularly the names of objects. The person may substitute an incorrect word, or may not find any word at all.
At this stage, the person may:
- Have difficulty understanding humour, jokes, and fast talk
- Have difficulty following multiple-step instructions
- Require increased concentration to follow conversations
- Have trouble staying on topic
- Need more time to respond to questions
- Experience increased frustration
- Have trouble finding the right word
- Lose train of thought more often
In the middle stage, more and more words become lost, and the person needs to think longer before expressing thoughts. The person loses spontaneity, vocabulary is more and more limited and sometimes the person repeats the same word over and over again.
At this stage, the person may:
- Have mild trouble understanding everyday conversation
- Often ask the speaker to repeat simple sentences
- Find it difficult to follow long conversations
- Have difficulty understanding reading materials
- Repeat the same word or information over and over (perseveration)
- Not be able to interpret facial expressions (like a wink or the nod of the head)
- Have trouble explaining or understanding abstract concepts (e.g. “I feel blue”)
- Lose interest in talking/speak less
- Have difficulty raising or lowering the voice
- Have difficulty finishing sentences
- Speak in vague and rambling sentences
In the late stage, individuals appear to lose the capacity for recognizable speech, although words or phrases may occasionally be uttered.
Non-verbal communication will become increasingly important as, at this stage, the person may:
- Be unable to understand the meaning of most words
- Lose the capacity for recognizable speech, although words or phrases may occasionally be uttered. Language often does not make sense to others.
- Become totally mute in some cases.
Person-centred approach to communication
A person-centred philosophy views people with dementia first and foremost as individuals, with unique attributes, personal values and history.
A successful person-centred approach to communication is based on:
- Learning about dementia, its progression, and how it affects individuals
- Believing that communication is possible
- Focusing on the person’s abilities and skills
- Reassuring the individual with dementia and being positive
- Meeting people with dementia where they are and accepting their reality
Quality of life for people with dementia is largely dependent on their connection with others. Maintaining a relationship can be a complex and challenging process, especially when verbal communication is affected.
Last Updated: 07/16/12
© Alzheimer Society of Canada 2011.