How dementia can affect an individual's ability to understand written communication

People with Alzheimer’s disease and other types of dementia can find themselves gradually closed off from the world due to increasing cognitive dysfunction. According to the Alzheimer’s Association, this condition affects their ability to remember, speak and understand what they hear from others. Other challenges can include difficulties with writing and reading.

Your loved one may notice difficulty in finding the right words when speaking. He or she may describe a familiar object because they cannot recall its name—nouns are the first type of words to be affected. Trains of thought are frequently derailed, and logical word sequences become harder to summon up. People with dementia find it difficult to join a conversation, to understand a subtlety or a joke, or keep up with complex sentences that include two or more pieces of information. Unable to find the right word, a person may say the wrong or a made-up word. As dementia worsens, these mistakes increase.

Some people try to conceal their communication problems by pretending to understand more than they do when, in fact, they may completely misunderstand the conversation or situation. They may revert to silence, relying more on gestures than speech. The inability to speak coherently as they used to can cause individuals with dementia to feel frustrated and alone.

There are ways that loved ones and caregivers can make communication easier. In a study with professional caregivers, methods that were successful included providing a single direction or idea at a time, asking close-ended questions and making repetitions with paraphrasing.

Caregivers should use the person’s name to get their attention before talking. A gentle touch on the arm or shoulder can help; wait until the person looks at you, then begin to speak. Maintain eye contact, speak slowly, with pauses between sentences. Keep your sentences simple and short, choosing basic, easy words, and allow time for your loved one to respond. As verbal and cognitive abilities decline, both partners can rely more on the tone of the voice and body language. The caregiver can listen for and look for clues in communication from their loved one and react accordingly. It is helpful for the caregiver to minimize the number of words used and concentrate on his or her tone while simultaneously using gestures.

Watch the eyes of your loved one to see if he or she understands. Repeat what you heard back to the person and ask if it is accurate, or ask your loved one to repeat what he or she said. Try to be engaged by giving visual cues, and break instructions down into simple steps, conveying them slowly. At times, words can become jumbled and you may hear one or two clear words. Try repeating those words back to your loved one to let him or her know you are listening and understanding. Patience is key.

Communication is easiest for those with dementia when it is a quiet, peaceful place, where distractions, such as a television or other people’s conversations will not interfere. Also, they can communicate better when their physical needs are met first — thirst, hunger, pain, toileting, etc. — and should be attended to pro-actively.

The more advanced dementia becomes, the more important it is not to give up communication. Communication may come in many different forms; a bouquet of flowers, a card, a hug, a smile, working together or simply holding hands. Always convey a positive attitude, so as not to create anxiety. Interactions between loved ones and caregivers can help keep the affected person grounded and in the world, both receiving and giving love.