Communication problems begin early in Alzheimer’s disease and with most other forms of dementia.
Changes in communication do NOT follow a predictable path. Loss of skills can vary between individuals even in the same stage of the progressive dementia process and/or between people whom have similar areas of the brain traumatized by a single event. Sometimes, the same person may have difficulty with one part of the communication process and at another time it may be a different skill that is impaired. The individual may even perform better from one occasion to the next depending on mood, well-being, health, and/or environmental effects.
People with dementia have a difficult time both in expression and understanding of spoken and/or written language.
Memory loss usually causes the initial communication difficulties. An individual with dementia often recognizes the problem and “covers” the deficits with common socially appropriate responses in conversation such as: “Oh, I see” or “Well, how nice”. Confabulation which was mentioned briefly above is when a person “makes up” information or “tells a story” that is not true. Flattery and humor may also be used by the individual with dementia and used as a way to hide their deficit and keep it from being recognized or focused on. In early stages of dementia, the individual is usually very aware of their deficits and does make attempts to cover them up. Some people are often open to suggestions on how to deal with the problems. In conversations with people who have dementia, it is important to allow the individual time to think and process the information and then to respond. If a person is distracted or gets off topic, caregivers can gently give the person assistance to redirect them or supply a missing word in a sentence if the person is stuck
Complex vocabulary and less common words will begin to be forgotten and/or be more inappropriately used in the middle stages of dementia. Individuals will begin to use less proper names or specific words to identify people, places and things and will start to replace them with generic or simple words like he, she, it, that thingy or this here thingamabob. The individual may begin to repeat themselves or ask others to repeat what they have said. Following verbal and/or written directions becomes very difficult, especially if given too much information. The individual with dementia may continue to speak, however, what is said begins to make less sense or become less understandable to others. A person with dementia may show increasing signs that he/she is having difficulty concentrating, initiating conversation, understanding abstract/complex ideas, words, or slang terms. The person may also demonstrate behaviors that would appear as lack of awareness about common social manners such as standing too close to someone or frequently touching/reaching for someone.