Memory and Communication
It was difficult to know what was upsetting my husband. He wasn’t able to say. Then at bed-time I noticed his toe was badly swollen. “Another beautiful day,” my mother would say on coming down for breakfast often with the rain lashing down! And I would simply say, “You’re feeling good then?”
People with Alzheimer’s disease develop communication problems, which tend to become increasingly severe as time goes on. The term “aphasia” is sometimes used to describe the difficulty or loss of the ability to understand spoken or written language as a result of damage to the corresponding nervous centre (the parts of the brain responsible for communication). People communicate with each other by speaking, through body language, using signs, pictures or symbols and in writing.
For this reason, this section is divided into the following three sections :
- verbal communication
- non-verbal communication and physical contact
- reading, writing and pictures/symbols
How to facilitate verbal communication
Due to a gradual evolution of language impairment, communication difficulties may arise which may lead to frustration, confusion and even anger at times. The needs and wishes of the person with dementia may not be met, their behaviour may be misunderstood by others and they may start to feel increasingly isolated. The inability to communicate properly can cause embarrassment, especially if attention is drawn to mistakes. In fact, it is not uncommon for people with dementia to start to use a less complex style of speech (shorter sentences and/or a limited vocabulary), to initiate less conversation, become withdrawn and even to stop speaking altogether.
You might also get frustrated at not being able to help the person with dementia, feel perplexed by their behaviour and miss the times when you used to have long conversations together. There are a number of practical solutions that you can adopt, which might improve communication, but you should not concentrate so much on them that you sound forced. Your attitude and encouragement is much more important.
Try to adopt a positive approach
By being patient, adopting a non-critical attitude and remaining calm, the person with dementia is more likely to persist in trying to communicate and be less inclined to feel embarrassed and ashamed. It is best to take the initiative yourself, to talk to the person about something that he or she finds interesting. You could also try to involve the person in conversations with other people. Although people with dementia may start to use a more simple style of language and shorter sentences, it is important not to treat them like children, adopt a condescending manner or talk about them as if they were not there. The «Ten Commandments for approaching and communicating with someone with dementia»1 provides a few simple guidelines.
Approaching the person with dementia
- Close to the person thou shalt stand
- The person’s name thou shalt use regularly
- The person’s body thou shalt touch
- At the person’s height and face to face thou shalt stand
- Eye-to-eye contact thou shalt establish
Communicating with the person with dementia
- Slowly and clearly thou shalt speak
- Short, simple, clearly and concrete words and sentences thou shalt use
- With gestures and touch thy words thou shalt complete
- One message at a time thou shalt give
- Affirmative sentences thou shalt use
Therefore, don’t focus on mistakes, but rather try to understand and respond to what you think the person with dementia means and how they feel.
Try to provide support and adapt your style of language
As many of the communication problems encountered by people with dementia are in some way linked to memory loss, you can help by repeating what was said, recapping and giving reminders about something that was said earlier, prompting when someone is waiting for an answer and using people’s names more. If you notice that the person has not understood something, you could repeat what was said in a different way. But, if your sentence was simple and specific, do not repeat it in a different way as it could lead to frustration. Wait and repeat the same sentence again. If they seem to be stuck for a word, you could make a suggestion. Sometimes someone with dementia uses just one word inappropriately in a sentence. The clue to what they are trying to say can often be found in this word, e.g. clock instead of time, boat instead of coat or rain instead of water. However, it is important to ensure that you do not draw attention to or emphasise the person’s problems. Also, you should be careful not to provide assistance before it is needed or take over as this may reduce the incentive to try. The person may simply need more time to take in what has been said and to respond. Try to keep questions simple, preferably requiring a yes or no answer.
Make sure that there are no physical problems affecting communication
The person with dementia may have difficulties with communication as a result of faulty eyesight, hearing or badly fitting dentures. For example, they might not be able to see who is speaking or simply not hear what someone is saying. Alternatively, badly fitting dentures might make it painful to speak or embarrassing if they are too loose. It is very important that you check whether there are any physical problems which might interfere with communication, so that you can take the necessary measures. Please refer to the relevant chapters in the section on medical and physical issues.
1 The Ten Commandments have been adapted from "Les dix commandements" of our Belgian member organisation Ligue Alzheimer: http://www.alzheimer.be/index.php?option=com_content&view=article&id=11&Itemid=15
How to use non-verbal communication
As verbal communication becomes increasingly difficult, you might find that you rely more on non-verbal communication, i.e. tone and pitch of voice, eye contact, facial expression, posture, sign language and physical contact. People with dementia are usually good at interpreting such signs, but often have difficulty interpreting the more subtle signs that people use to signal when it is someone’s turn to speak in a conversation. Consequently, people with dementia might butt in and then fail to respond at the appropriate time in a conversation, which could perplex people who were unaware of the problem.
The tone and pitch of your voice are extremely important. The person with dementia may concentrate on this as well as on your facial expression and even body posture in order to understand. This can be extremely useful, but it can also lead to misunderstandings, particularly when what you say does not correspond with your non-verbal language. For example, you might say, “It’s all right. It’s not your fault”, whereas the tone of your voice and your facial expression might indicate that it is not all right and that you are annoyed about it. However, non-verbal language can also help you to understand how the person with dementia feels when words fail them and you can communicate a good deal through a look or a smile, as well as with your gestures. Many people appreciate physical contact and it can be an effective means of communication for people with dementia. It has been noted that even in the most severe stages of dementia, people still tend to respond well to soft, familiar voices and touch. So, even when the person with dementia can no longer understand, you can still take hold of their hand or put your arm around them. This can communicate a great deal and provide reassurance.
How to use reading, writing and pictures/symbols
You may have found that the person with dementia sometimes understands a written message, but has difficulty understanding what you say or can read something correctly without understanding the meaning. You may have been surprised to find that they can sign their name long after they have lost the ability to write. Many people understand pictures and symbols, although the same symbol might not be as effective for different people. These different forms of communication all involve different skills and abilities, which may change over time and are different for different people. It is important to make the most of different forms of communication for as long as they are effective.
How to make the most of reading, writing and pictures/symbols
Strategically placed self-adhesive stickers, sheets of paper, white wipe clean slates and small blackboards are all useful means to leave messages, e.g. “Don’t forget to lock the door”. In order to avoid confusion, it is best to leave two notes rather than put two messages on the same note and not to have too many notes. The person’s abilities are likely to change over time so it would be a good idea to occasionally check that the person with dementia can still read and that they understand what the words mean. You could also label drawers, cupboards and doors to indicate what they contain e.g. socks, food cupboard or which room they lead to, e.g. bathroom or kitchen. Such labels could be combined with images (e.g. symbols, photos or drawings etc.). For example, on the toilet door you could have a picture or symbolic representation of a toilet with the word “toilet” written below. This can be particularly helpful in situations where there are several people with dementia living together. However, it is important to remember that some symbols might be too abstract to be useful. It is therefore best to avoid modern looking abstract symbols or pictograms as people with dementia may have difficulty interpreting them.
Last Updated: Friday 11 September 2009