How does dementia affect communication?
As we have seen, dementia progressively affects how the brain functions.
Dementia can affect a person’s ability to remember and understand basic everyday facts, such as names, dates and places. The ability to process information may deteriorate over time, so a person’s response to questions can be delayed. Eventually, they may struggle to convey what they want to say, or to understand others.
Communication problems may arise because of impaired speech, comprehension, hearing, vision, or physical sensation. Different types of dementia will affect communication in different ways.
- difficulty remembering events or situations
- difficulty acquiring or remembering recently received information
- difficulty finding words (known as aphasia)
- limited ideas or use of words in conversation
- taking longer to process information
- being easily distracted
- difficulty following multi-step commands
- difficulty forming or understanding complex sentences
- filling in gaps in memory or understanding (known as ‘confabulation’)
- take a long time to respond, e.g. providing an answer to a question asked some time ago
- weakness of voice or difficulty articulating (dysarthria)
- difficulty planning or making decisions
- lack of inhibition
- inability to read facial expression or complex social cues
Someone with Alzheimer’s disease will have difficulty remembering, may become ‘time-shifted’ as their ability to recall recent events diminish, so that they rely more heavily on earlier memories. They may also experience low volume speech, or be without speech in later stages.
A person with fronto-temporal dementia (or Pick’s disease) may experience aphasia and also what is known as ‘perserveration’ (repetition of words or phrases).
In Dementia with Lewy bodies, people can experience fluctuating attention and articulation ability, reduced volume control and monotonous intonation, difficulty with initiation and turn-taking in conversations, repetition of topics and their emotions may be difficult for carers to interpret. There are also particular communication challenges such as visual hallucinations, which we will explore in the next section.
The extent and type of communication challenge will vary from person to person.