Last month I wrote about Agnosia…the inability of the brain to interpret vision correctly. Agnosia is often seen in patients with Alzheimer’s disease or some of the other dementias. This month I will share with you some information on one of the other “A’s” of Alzheimer’s disease: Aphasia.
Aphasia is partial or complete loss of the ability to express or understand spoken or written language. It results from damage to the areas of the brain that control language. Aphasia is not exclusive to Alzheimer’s disease. It can be the result of other illnesses or injuries that cause damage to the speech centers of the brain, such as a stroke or traumatic brain injury.
The extent of the aphasia associated with Alzheimer’s can vary, depending on the progression of the disease. In earlier stages, there may be word finding difficulties and occasional word substitutions. Someone may be looking at your watch and call it a clock or the timer. They may use vague word substitutions like “the thing” or “you know”. As the disease progresses, the word finding problems can increase, substitutions may increase, and speech can be come less fluent and grammatically correct. We call this word salad…a string of words that have no meaning together. In late stages of the disease, repetition of sounds can occur in place of actual words, “like ya ya ya ya ya”. Along with a decline in the expression of language, there can also be a decline in the comprehension of both written and spoken language. You may be talking quite clearly, but your loved one simply can’t make sense of the words to know what you are asking.
It can be frustrating to communicate with a person who can not make their needs well known or who can’t comprehend what you are saying. They can get easily agitated that you don’t understand them, and you, in turn can get easily agitated that they don’t understand you. As with all of the manifestations of dementia, it becomes your responsibility as the caregiver to adapt; your loved one isn’t able to change or control the changes that are happening inside his or her brain.
There are some strategies that you can try that will help the two of you to communicate. Remember, each person with dementia is different. Though there are similarities and common trends, each person presents in a unique way. The one absolute: just when you figure out how they are presenting, they will change.
First and foremost, remain patient. Know your tipping point and avoid getting there. When your frustration is mounting, take a breath and take a break. Come back to the issue at hand in a different way after you have recollected yourself.
Speak in clear, uncomplicated sentences. Break tasks in to simple steps. No need to speak loudly (unless they have a hearing problem). Yelling the instruction won’t help them comprehend it any better and always remember that you are speaking to an adult. Though you may have to adjust words to be sure they are familiar (ie using the word “pee” if that is what your loved one calls it), be careful not to use condescending words.
Avoid unnecessary chatter when you are trying to convey or accomplish a particular task. Talking about the weather while you are trying to get Mom to eat isn’t going to be helpful. Background noise can also be distracting. Pay attention to the sounds around you, like the tv, kids arguing, music from the radio, etc. You want your loved one to hear your instruction. Their brain can’t clear out the other distractions, so you must.
Keep a smile on your face. Your loved one can pick up on your non-verbal clues. A smile lets them know that you love them, aren’t angry at them, and have it all under control (even though you may not J).
Give your loved one time to express him or herself and try to avoid correcting them. This can be hard, but gets easier with practice.
Be a “creative listener”. Pay attention to body clues. Your loved one may be saying that they need to go home, but if they are also pulling at their belt buckle, they may saying they need to use the bathroom.
Encourage conversation and keep your loved one included, but avoid open ended questions or questions meant to test. “What did you do at Daybreak today?” is a set-up for failure. “Did you have fun playing bingo today?” is less frustrating. And if they say they didn’t play bingo, even if they brought you home the prize, go with it, don’t argue it.
I know, easier said than done. Trust me when I tell you that your interactions will be less stressful for you and more enjoyable for your loved one if you are ale to get comfortable with some of these strategies. And when all else fails, a smile and a hug that says “I love you no matter what” can say it all.
Christina Forbes, LGSW from the Daybreak Newsletter 3/2010