Communication and Dementia Helen Crouch Speech and Language Therapist Older Adults Mental Health Milford Hospital [e-mail]

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Communication and DementiaHelen
CrouchSpeech and Language TherapistOlder Adults
Mental HealthMilford Hospitalhelen.crouch_at_surrey
communityhealth.nhs.uk
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Communication and Dementia

• All dementias have some form of communication
  difficulty.Some dementias present with
  communication difficulty as their first feature.

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Dementias

• Alzheimers Disease
• Vascular Dementia
• Dementia Lewy Body
• Semantic Dementia
• Primary Progressive Aphasia
• Parkinsons
• Huntingtons
• Picks
• MND

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• Language in Alzheimers Disease
• Early word finding difficulties
• Memory restricts comprehension
• Progressively fluent empty speech
• Language reflects underlying confusion

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Semantic Dementia

• Fluent empty speech
• Impaired naming and comprehension
• Semantic paraphasias
• Idiosyncratic word usage
• Loss of word meaning in speech and understanding
• Well preserved repertoire of speech
• Intact grammar

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Progressive Non Fluent Aphasia

• Non fluent hesitant speech
• Impaired word retrieval
• Errors of sounds and words
• Comprehension relatively preserved

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Vascular Dementia

• Pattern of language deficit is determined by area
  of damage
• Stepwise progression
• May be improvement of function during the course
  of the disease

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Impact on Functional Communication

• Difficulty with
• Following conversations
• Following the television
• Understanding humour or sarcasm
• Sticking to one train of thought
• Remembering the names of things
• Understanding book/newspaper even though still
  able to read aloud
• Writing

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• Insensitivity to other peoples communication
  needs
• Does not take turns in conversation
• Does not initiate conversation
• Says things which arent true or real
• Speech doesnt convey any meaning
• Asks the same questions repeatedly
• Mispronounces words
• Repeats things already said
• Slowness at responding

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Risk to individual

• Decrease in quality of life and sense of well
  being.
• Reduced access to and benefit from services.
• Social exclusion
• Increased level of dependence at an earlier
  stage.
• Challenging behaviour not managed effectively.

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Philosophy of Care

• All people have something to communicate
• Behaviour is an attempt to communicate an
  unfulfilled need.
• Optimising communication skills of person with
  dementia and caregivers is a central theme.

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Aims of intervention

• Maximise and maintain communication skills e.g.
  for decision making.
• Enhance coping skills and self efficacy.
• Reduce the impact of a communication disorder.
• Reduce stress on caregivers by providing
  management strategies.

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How?

• Assessment
• Providing advice, training and support.
• Introducing specific approaches
• Life story work
• Talking Mats
• SENSES framework

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Strategies to support conversation

• Observe and listen.
• Check for hearing aid and glasses.
• Attract attention first (name).
• Speak slowly.
• Short sentence length.
• Key words.
• Gesture and pointing (pictures/objects).
• Repeat/rephrase (dinners ready/food) .

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• Use names not pronouns
• ?Content of speech eg sudden change in topic,
  relying on memory, abstract
• Avoid questions
• Offer choices
• Validate rather than challenge
• Provide a reason for communication
• Respond to emotion
• Use preserved skills (assessment based)
• Communication aid

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• Be calm and still
• Think about your posture/body language
• Eye contact
• Minimise competing noises/conflicting stimuli
• Provide time

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Useful references

• Speech and Language Therapy
• Provision for People with Dementia
• www.rcslt.org
• Information on Semantic Dementia and
• Primary Progressive Aphasia.
• http//www.cerebralfunctionunit.co.uk/
• Talking Mats. Dementia effectiveness.
• www.talkingmats.com

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Questions