3. How does dementia affect communication?

People with dementia experience several difficulties in communication. Changes in production and comprehension abilities differ in their extent and nature depending on the type of dementia and the stage of the disease. While the exact progression of the disease is different for each person, there are some steps which are common among different conditions and stages.

Initially, people with dementia often have troubles in finding the right word at the right time (“anomie”) and often makes use of one word for another, basing on phonological similarity (regarding sound) or semantic similarity (regarding meaning). At times, speech appears to be confused and contains false starts (sudden stops or topic shifts). This arises from the difficulty of keeping in mind what the person wants to communicate while his conscious thought elaborates him linguistically. The person may experience increased frustration. Furthermore, the person might have troubles in following fast and complex dialogues between several people, especially if there is background noise. There may also be some difficulties in writing (reduplications and /or omissions of letters, overlapping and/or spacing of letters within of the same word, etc.).

As dementia progresses, speech problems become greater, and language becomes unclear. The difficulties at the pragmatic and semantic level increase considerably. At this stage the vocabulary becomes more and more limited. The person needs more time before speaking and sometimes they repeat the same word over and over again. The person might resort to passe-partout words (“the thing”) or to pronouns (“it”), leaving no lead way for someone else to guess what it is they are trying to communicate, which might cause great frustration in both the person and his caregivers. The person has trouble understanding everyday conversation and following complex orders (e.g. “Before coming to the table, go wash your hands.”), or even simpler ones. Understanding of figurative language (e.g. “I feel blue”) is also compromised as well as understanding of written messages. Even the expressive side of non-verbal communication deteriorates: the gestures that accompany the words are not always congruous, the prosody becomes monotonous or sometimes it does not match the emotional content of the message. However, the decoding of gestures, affective prosody and facial expressions of his interlocutor is still relatively well preserved.

At later stages, people appear to lose the capacity for recognizable speech. The person becomes increasingly laconic and speaks only if stimulated, with often stereotyped answers. The person repeats the sentences she heard or that she has pronounced herself (“echolalia”). Sometimes the person whispers only one or two syllables. Finally, the person might only moan or scream and then become totally mute. Oral comprehension is seriously compromised and writing and reading are no longer possible. Even non-verbal communication is noticeably reduced: there is motor inertia, the face is devoid of expression, and affective, visual contact with the interlocutor is difficult.