Dementia and communication
Dementia is when an underlying disease causes changes in the brain.
People living with dementia experience symptoms that affect their daily life. These include changes in:
- memory
- perception
- problem-solving
- language
Alzheimer’s disease is the most common and well-known type of dementia.
Other types of dementia include vascular dementia, frontotemporal dementia (FTD) and dementia with Lewy Bodies.
Dementia can also develop in medical conditions like Parkinson’s disease.
People can have risk factors for dementia, and in some cases, dementia occurs without any known cause.
All people with dementia experience changes in communication.
How dementia affects communication
Changes in communication are among the earliest features of dementia. These changes depend on the type of dementia and the person’s unique symptoms.
Alzheimer’s disease (AD)
People with Alzheimer’s disease may have ‘episodic memory loss’, or difficulties creating new memories. This means they have more difficulty with their short-term memory, though long-term memory may be good.
Memory changes can affect communication in different ways, such as making it difficult to remember people’s names or the details of a recent event in conversation. This can make it harder to have conversations with others.
The person may ask the same questions repeatedly, lose their train of thought, or struggle to follow long instructions or quick changes of topics in group conversations. They may use more “empty speech” with fewer specific content words, leading to others having more difficulty understanding their message. They may experience changes to their reading and spelling abilities.
Fronto-Temporal Dementia (FTD) – behavioural variant
In FTD (behavioural variant), the person’s personality and behaviour can change, which affects their communication, including their social skills
For example, they might interrupt others or make inappropriate comments. They might also be less sensitive to the emotions of others.
Primary Progressive Aphasia (FTD -semantic, FTD- progressive nonfluent, AD- logopaenic)
In primary progressive aphasia (PPA), changes in language are the initial and most significant symptoms.
The person may have difficulty finding words, understanding what words mean, putting sentences together, and reading and spelling.
For some people with PPA, speech becomes halting, slow and effortful, which makes it harder for them to express themselves.
Other Dementias
People with a range of other, or more rare dementias such as progressive supranuclear palsy, corticobasal degeneration etc also experience changes to their communication including changes to speech production or language skills.
How communication changes affect daily life
Having meaningful conversations with family and friends is one of the most important aspects of living well with dementia. Independently navigating written information such as reading forms, websites and emails is essential for independence and decision making. We use communication throughout our daily life whether to order a coffee, text a friend, read the newspaper or chat with friends.
However, when communication changes occur, these activities can become challenging.
Communication changes can be puzzling and frustrating for both the person living with dementia and their family and friends. The person’s family and friends may not know what to do to help them communicate.
Because of this, people with dementia may withdraw from social events and interactions.
Other daily activities that rely on communication can also be affected.
This includes:
- making appointments
- answering telephone calls
- writing shopping lists
- calling for help
- having conversations about health care
How a speech pathologist can help
Speech pathologists help people with dementia with communication and independence.
They use assessment, diagnosis, intervention and education to provide therapy, strategies and aids to help navigate communication changes.
This might include word finding therapy to assist in recalling important words or creating communication aids such as life story books and memory wallets to support conversation or use of technology to aid communication
Speech pathologists can also help family members and friends to help maintain connection and relationships.
Speech pathologists can make communities more dementia-friendly by providing communication partner training, accessible written information and signage, or promoting use of aids or technology like iPads to optimise communication.
Find a speech pathologist
Five tips for communicating with people with dementia
1. Understand the person’s experience
Understand their personal experience with dementia so you can tailor your communication to their symptoms.
For example, if they have memory difficulties, use shorter sentences, write down key words, or repeat information.
A speech pathologists can help with this tailoring.
2. Create a supportive environment
This could include finding a quiet corner of a café and bringing along photographs to stimulate conversation.
Give the person time to respond or react. Support them through non-verbal communication, such as your tone of voice, facial expression and body language.
3. Actively include the person living with dementia in the conversation
Talk to the person directly and watch for verbal and non-verbal responses.
Ask the person what things they find most helpful to support their communication.
For example, if they are having trouble recalling a word, would they like you to suggest a word?
4. Conversations should be enjoyable and uplifting
Use the person’s lifetime of experience to identify positive and engaging topics of conversation.
Avoid ‘testing’ the memory of the person with dementia. Instead, give names or other details freely to help the conversation flow.
5. Promote conversation and connection through shared activities
Doing things together like going out for dinner, to an art gallery, or for a walk in the park will create opportunities for conversation.
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