Speaking Alzheimer’s

The loss of language ability is one of the profoundest losses experienced in Alzheimer’s disease–both for a person living with the disease as well as the caregiver. Frustration easily boils over when someone is not able to make themselves understood.

In the very earliest stages of Alzheimer’s disease, language problems usually present as difficulty with word finding, that sensation of feeling like the right word is on the tip of the tongue. That happens to all of us at times, but becomes much more frequent and severe in patients with Alzheimer’s disease. Typically, it involves difficulty in naming objects. Eventually, a person may substitute a wrong word, or talk around it. For example, instead of “I want to put on a sweater,” they may say, “I want to put on a squirrel.” They usually know that they’ve said something wrong and can laugh about it. An example of talking around a word would be substituting “that thing you sit on” for “chair.”

Over time, speech can become jumbled and less fluent. This has been called “word salad,” a mix of real words that together have lost some meaning. Sounds within words can become mixed up. For example, Harvey once said “sibling” instead of “blessing.”

Just like babies before they learn to speak real words, gibberish might make an appearance. Harvey and I could carry on “conversations” this way–all the sounds and inflections of a normal conversation, just without any actual words. It was delightful! We were communicating.

Eventually, in late-stage Alzheimer’s disease, the person is left with just a handful of meaningful words, then one, then none.

Conversation, the verbal interchange between two or more people, becomes harder and harder as the disease progresses. There are several reasons for this beyond the difficulties mentioned in the preceding paragraphs. Mainly, because their comprehension slows as well, it takes the person with Alzheimer’s disease longer to respond because they have to process what is said to them, and then process their own response. It also becomes difficult for the person with dementia to keep a train of thought straight in their minds, and they might jump from topic to topic. Too, a person with dementia will find it nearly impossible to remember a conversation topic if it’s interrupted

Because comprehension is so compromised, patients with dementia may have particular difficulties understanding someone speaking with an accent, or very rapidly, or with complex sentence structure and multi-syllable words. It’s just hard for them to follow.

Other language skills, such as reading and writing, deteriorate over time as well. I could see a definite decline in Harvey’s reading. He started off reading normally, then dropped books in favor of newspaper articles, then stopped that altogether. If I tried to have a conversation about something I knew he had read in the paper, he either had a hard time explaining what he had read, or else couldn’t remember reading it. Once, early on in his dementia, Harvey asked me to look over a Sunday school lesson he had written out. There was a logic and a flow, but the writing was sketchy and full of holes.

Next week, I’ll start to explore ways you can more effectively communicate with someone experiencing Alzheimer’s disease.