Communication is a means of verbal and nonverbal expression that allows us to interact with others, this being an extremely important resource in the relationship between the patient with dementia and his primary caregiver. Usually, due to the lack of knowledge about how to approach and communicate with people with dementia, caregivers and people close to them often choose to restrict them from social situations and contact with others, thinking that they do not need to interact and integrate into the environment around them.

Due to inefficient communication, caregivers may limit their performance, as well as affect the emotional state of the patient with dementia. Thus, we need to know the alterations in language that people with dementia may manifest, in order to develop communication strategies and create an assertive connection between the patient and us. This is because we need to communicate with them daily to identify their needs and interests, and through language we encourage them to cooperate in the performance of daily activities. Derived from the above, we will address several language impairments that patients with dementia may present, as well as strategies to establish a better interaction.

What is dementia?

It is the term that refers to the presence of progressive cognitive impairment, characterized by alterations in cognitive processes such as: orientation, attention, concentration, short and long term memory, as well as behavioral and mood disorders that limit the autonomy and independence of patients with with this neurodegenerative disease. Leading them to require individual assistance from specialists such as physical therapists, nurses, geriatricians, cognitive psychologists and family members called primary caregivers.

Language impairment in patients with dementia

There are several types of dementia; on this occasion, Alzheimer’s dementia, vascular dementia, frontotemporal dementia and semantic dementia will be discussed.

Alzheimer’s dementia

Patients with Alzheimer’s dementia usually have a slowly progressive evolution, so that at the beginning of the disease they show alterations that are regularly associated with immediate memory, which makes it difficult to consolidate new information. Episodic, semantic and working memory are also affected, in addition to the appearance of behavioral alterations, as well as deficits in visuospatial processes and anomias that can directly affect language and communication with the environment.

Vascular dementia

The affectations in vascular dementia may derive from a single infarct that damages different cortical regions, triggering serious repercussions in some areas such as: dorsolateral prefrontal cortex, parietal, temporal neocortex of the transmodal node or Wernicke’s area, to mention a few. This is a negative aspect since it could affect language comprehension, presenting also alterations in the evocation of semantic and episodic memory, just to name a few.

Frontotemporal dementia

With respect to frontotemporal dementia, these patients are regularly affected in grammatical and syntactic fluency, thus causing them to dispense with the use of conjunctions and prepositions, using only verbs and nouns in their communication. Interaction with these patients is usually terribly affected in more advanced stages of the disease, since they tend to become disinhibited to such an extent that they manifest behaviors that are socially unacceptable, such as shouting, taking off their clothes, cursing, among others, which causes distancing by the primary caregivers and social rejection.

Semantic dementia

Finally, the symptoms of semantic dementia are similar to some presented in Alzheimer’s dementia, since one of the first alterations is in language. In this particular condition the most impaired process is the semantic memory which affects the retrieval of information related to content, topics, concepts and data that have been stored throughout the patient’s life, being these alterations a major impediment that can restrict their language and verbal expression to others.

Communicating with the patient with dementia

After learning about some of the language and cognitive processes that patients with dementia suffer, our job as specialists and primary caregivers is to carry out efficient strategies that allow us to communicate optimally and assertively with our family member or patient, thus having the objective of helping them in the daily performance of their activities, to contribute to the achievement of a better quality of life and finally develop positive emotional ties that generate peace of mind and above all security.

15 strategies for communicating with our relative or patient

Here are 15 strategies that facilitate communication with people suffering from dementia.

1. Use a tone of voice according to their hearing needs, consider if the patient has hearing deficits or uses hearing devices. The use of soft tones of voice may not be useful for all patients. We must identify the characteristics of our patients and family members to determine the tone that will allow them to hear us clearly.
2. Speak clearly and slowly so that the patient or family member is able to capture the information provided. Avoid using unusual words or speaking quickly.
3. Provide concrete instructions, one instruction at a time, for example: “close the cupboard, open the window, wash the dishes”. Do not overload with complex instructions.
4. Establish eye contact at all times, e.g., when giving an instruction, when talking or asking a question.
5. In advanced stages, use and encourage the use of gestures to complement communication. For example: “the gesture of brushing the teeth, going to sleep, saying yes and no.
6. Make physical contact with the patient, gently press his hand or shoulder while giving an instruction or while speaking appreciatively.
7. Call him/her by name, or ask him/her how he/she would like to be called, do not infantilize with diminutives or incorrect terms such as little old man, gramps, etc.
8. Help him/her to retrieve information, give him/her phonological or semantic clues about how the word starts or the concept he/she wants to tell us. For example: name of a common red fruit (aaap) = apple.
9. In advanced stages of dementia use visual support through signs, pictograms, physical or digital photo album.
10. Validate the patient’s speech. Do not confront information, encourage him/her to answer new questions instead of continually reiterating that he/she told us about the subject several times. Example: he told us three times that he went to the park, instead of confronting him let’s ask him: What did he see in the park? When did he go there? How did he feel? What other parks does he know?
11. Encourage the patient to write short sentences on a notepad, blackboard or refrigerator.
12. Encourage the patient to communicate with others by telephone or virtually.
13. Make him/her part of a familiar conversation, ask him/her to address a topic he/she is passionate about, ask him/her questions about it.
14. Make pertinent repetitions, repeat instructions or information that the patient needs.
15. Establish roles and quality time with the patient. The primary caregiver also requires rest to be in optimal physical and emotional condition with the patient.

Conclusions

The patient with dementia suffers from various language and communication impairments during the progression of the disease. Therefore, our goal as caregivers and specialists is to provide them with tools and strategies that allow them to integrate as much as possible to their social environment and be in contact with it.

It is a daily challenge that is often difficult, but with the help of specialists, support networks and information, we can overcome the complications of this disease. It is extremely important to remember that even though they suffer from a neurocognitive disorder, they are human beings who deserve our attention, patience, empathy, care and above all, a lot of love.

References

Aguilar, V., Martínez, R., Sosa, O. (2016). Diagnóstico diferencial de las demencias [Differential diagnosis of dementias]. Instituto Nacional de Neurología y Neurocirugía. http://repositorio.inger.gob.mx/jspui/handle/20.500.12100/17226

Nilton, C., Montesinos, R. (2015) Enfermedad de Alzheimer. Conociendo a la enfermedad, que llegó para quedarse [Alzheimer’s disease. Getting to know the disease, that’s here to stay].

Brooker, D., & Surr, C. (2005). Dementia care mapping. Bradford: Bradford Dementia Group.

Mace, N., & Rabins, P. (1997). Cuando El Dia Tiene 36 horas [When the Day has 36 Hours]. México: Editorial Pax México.