Communication is an essential part of dementia management

When talking to people with dementia a number of factors need to be considered, each of which influences the communication process. Hearing difficulties, cognitive impairments and language deterioration may make it difficult for them to engage in a conversation, regardless on which side of the communication channel they are.

General recommendations for communicating with people with dementia

• Adjust the style of your communication to the level of cognitive impairments and take into account the cultural background, previous habits and individual manners of the person with dementia.
• Avoid critique and dispute, don’t criticise, accept their point of view and work from there.
• Match your verbal and non-verbal communication. Posture, tone of voice, facial expressions and body language are as much a message as are your words. 
• Avoid high-pitched voice and rapid speech, as it may create discomfort, impair understanding, and cause emotional distress.
• Respect personal space, avoid rapid movements, keep eye contact and use reassuring gestures.
• Create a calm environment and remove visual as well as acoustic distractors.

Speech and language impairment at different stages of dementia

Language and speech difficulty varies by type and stage of dementia. As dementia progresses the ability of verbal expression and understanding deteriorates significantly. At the initial stages of dementia people are still able to engage in meaningful conversations. However, subtle changes of spontaneous speech may already be present, e.g., delayed responses, pauses between words, slow verbal output, slowed speech due to word finding difficulty, and reduced content of communication. At the stage of severe dementia, a person with dementia may only be able to produce single words or sounds. At this stage, non-verbal communication can still be a way of communicating. Decline of semantic memory (knowledge of the meaning of words) also impacts on speaking, understanding, writing and reading.

Speech and language impairment in different forms of dementia

In dementia due to Alzheimer’s disease, work finding difficult is the most conspicuous early language symptoms. At later stages, the ability to understand words also deteriorates. There are two variants of dementia due to Frontotemporal degeneration where impairment of language is the earliest and leading symptom. In the variant “Primary non-fluent aphasia” the problem is producing verbal output. In the variant “Semantic dementia” the meaning of words, objects and faces is gradually lost.

The role of speech and language therapists

Speech and language therapists assess the nature and extent of impaired communication. They offer tools and exercises that take advantage of preserved communication skills or apply compensatory strategies. Speech and language therapists can also help with swallowing problems, which may arise at an advanced stage of dementia and are a particular problem in frontotemporal dementia.

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