COMMUNICATION AND ALZHEIMER’S DISEASE
What is communication?
Communication is the essence of human interaction and learning.
The nature of communication is dependent on interaction between two or more individuals and understanding is constructed through that interaction.
Communication is a basic human right and essential to our quality of life as a social species. As human beings, we use communication to: relate to others, socially connect, greet, call attention, share feelings, express an opinion, agree, disagree, explain, share information, question, answer, tease, bargain, negotiate, argue, manipulate, compliment, comment, protest, complain, describe, encourage, instruct, provide feedback, show humor, discuss interests, be polite, make friends, express interest or disinterest, etc.
As Alzheimer’s disease progresses it slowly robs the person from being able to communicate. This becomes exceedingly difficult for both the caregiver as well as the person. Alzheimer’s disease affects the person’s speech, reading and writing abilities. The deficits in all of these become more pronounced as the disease progresses. In clinical terms
Aphasia: This is the term used to describe a difficulty or loss of the ability to speak or understand spoken, written or sign language as a result of damage to the corresponding nervous centre. Because speaking, writing, reading, and understanding speech involve different areas of the brain and different nerve networks, aphasia can be uneven, with some skills retained longer than others. For example, a person may be able to recognize written words flawlessly and yet fail to comprehend their meanings.
Difficulties with speech: Persons with Alzheimer’s disease have difficulties in naming objects rather than state the name of the object they may substitute what the object does. The person may have not find the right word. Persons may use the wrong word or one with the wrong sound or even nonsense words. They can use a beat around the bush means known as circumlocution to express themselves. The person cannot find the word so rather they describe. I need a pencil becomes I need one of those things you write with; without ink. As the disease progresses the person will ramble and repeat themselves. In most severe stages of the disorder persons become mute.
Understanding speech: In the early stages the Alzheimer’s patient is capable of understanding speech but this diminishes as the disease progresses. They have problems understanding humor and flowing multiple step instructions. The person has difficulties in particular of understanding long sentences. Therefore to communicate it is recommended to use short sentences with simple grammar. In the middle stages the person may request that the speaker repeat sentences.
Reading: Persons with Alzheimer ‘s disease gradually loose the ability to understand the written word. They may be able to read the words aloud but not understand the meaning.
Writing: The ability to write becomes increasingly difficult. They may begin by making writing the wrong words or misspell them. Eventually they are no longer able to write short notes or to take messages.
Agnosia: This is the term for the lost of ability to recognize what objects are and their use. They may use a fork instead of spoon a knife instead of pencil. As for people they may confuse a spouse for an intruder. This is not because they are not remembering the person but because their brain is not working out the identity of the person. They may not even recognize their own reflection in a mirror.
Apraxia: This is the term to indicate that a person can no longer carry out a motor skill. This is different from paralysis associated with stroke because in Alzheimer’s disease the person forgets how to carry these motor skills. Usually this includes the inability to tie shoelaces, turn off the tap, fasten buttons, turn on a radio or TV. This is usually gradual but as the disease advances the ability to chew, walk or sit up become affected.
Decline in cognitive abilities:
These are the “thinking” activities of reasoning—solving problems, making decisions, exercising judgment, and so on. Impairments of cognitive function can begin subtly as poor performance in an activity the person once did well. Poor judgment and lack of insight can lead to accidents.
Early in the disease, individuals may easily lose track of time; later, their disorientation becomes more pronounced and extends to places and people. The sense of time becomes more distorted as the disease progresses, and people may insist it’s time to leave immediately after arriving at a place or may complain of not having been fed as soon as a meal has ended.
Personality changes: Relatives may notice that the person is displaying out of character behavior. Such examples include withdrawing, irritability or even hostility. Mood swings are also commonly noticed.
Behavior problems: The person may wander during night and day. Other problems include :being stubborn, refusing care, handwringing, pacing, incontinence, aggressive behavior, getting lost, using obscenities and other verbal abuse, inappropriate amount of clothes for the climate.
Sundowning: This is a situation where behavior problems are worse in the late afternoon and evening. The reason are not fully understood however less light may contribute to the person’s inability to interrupt visual information. The person ‘s tolerance for stress also declines and a seemingly minor problem generates a major reaction.
There are some excellent guidelines provided in the following links to learn how to better communicate with a person with Alzheimer’s disease.