Communication and Alzheimer's ~ ~ Dr. Domenico Pratico', MD, FCPP

Alzheimer’s disease is a progressive neurodegenerative disorder that profoundly impacts the brain structure and function resulting in pathological cognitive decline and memory loss. Contrary to popular belief, Alzheimer's disease encompasses more than just memory loss.

In fact, while memory impairment is a commonly recognized symptom, Alzheimer’s can manifest in various signs and symptoms that go beyond memory-related issues.

Among them, diminishing communication skills is one of the most common symptoms caused by the disease, and caregivers, friends and family members often have difficulty creating meaningful interactions with these patients.

Beside memory loss, Alzheimer's patients may have difficulty in communicating with us.

In fact, people with Alzheimer may struggle to find the right word when speaking and forget what they are saying very easily.

For this reason, the disease can make communication difficult for both caregivers and the person with the disease itself. It is important to note that, however, depending on the stage of the disease, the ability to communicate could be very different. Thus, if a patient is in the early stage of Alzheimer’s, it is quite possible that he or she will be able to hold a conversation and engage in social activities. When the disease enters the middle stage, most probably it will create some type of communication difficulties both in expressing as well as understanding and processing receiving information. Finally, when the disease reaches the late or advanced  stage, the patient may become totally nonverbal with only some facial movements as way of interaction. 

While talking we could hold the hand of our loved one.

Here are some communication tips for each of the different phases of the disease.

Early stage

Include the person in conversation and speak directly to him/her, not just to the caregiver.

Listen to the person when he/she expresses feelings, inner thoughts and fears by always keeping eye contact.

Have a conversation about what kind of communication is most comfortable, for example, face-to-face, email or text.

Middle stage

Speak slowly and clearly in an environment that has minimum level of noise and stimuli.

Allow the person the time to think and respond before interjecting with another question, topic or even repeating the question.

When possible, try to interact with yes and no type of questions. For example, “Did it rain today?” instead of “How was the weather today?”.

Avoid asking too many questions, as it can feel overwhelming for your loved one to think of all the different responses.

Late stage

Use nonverbal communication, such as facial expressions and pointing.

Consider the emotional impact of words when you speak, for example, saying “I love you” and sharing a happy memory with the person will resonate better than talking about any generic topic.

Avoid acting or speaking in a way that makes the person feel like he/she is invisible. Our physical presence matters to our loved one, even if he/she does not remember who we are.

Below are some general communication tips for everyone who cares or deals with an individual with clinical signs of dementia:

• Make eye contact and use the person’s name.

• Be warm and open in our tone and manners.

• Avoid interruption.

• Do not use baby talk or a baby voice when speaking.

• Use methods other than speaking to help the person, such as gentle touching to guide them. If possible, hold the person’s hand while you talk.

• Allow more time for the person to respond. Be patient.

• Try to be specific in the questions and instructions.

• Do not point out mistakes or memory lapses by saying things  like “Don’t you remember?”

• If the person does not understand what we say the first time, try rephrasing what we just said with different words.

Eye contacts together with gentle touch can also be a way to facilitate communication wth our loved one who has Alzheimer.

It is easy to get frustrated in front of our loved one’s inability to respond, or to take offense to an angry outburst or to his/her forgetting a conversation we recently had.

We must keep in mind that Alzheimer’s affects not only communication styles and ways, but also a person’s “filter” and behavior.

Let’s remind ourselves that our loved one would have responded properly before Alzheimer’s. Let’s all take a moment to remind ourselves of who he or she really is to stay grounded in our relationship.

While it can feel awkward and sometimes frustrating when communicating with someone who has Alzheimer’s disease, it is always extremely important to keep trying to communicate and engage with our loved one.

It is not the quantity of communication or engagement that matters but the quality of it.

If you are interested in reading more of my blogs:

Check out my recent blog: The 4 Cardinal Points of Behavior Domenico Pratico', MD, FCPP 

Dr. Domenico Pratico' , MD, FCPP

Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor at the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.

For more information on the research conducted by Dr. Domenico Pratico, please visit this link.

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Stay updated with the work happening at Dr. Domenico Pratico's lab by visiting the Pratico Lab website.