By Tina Kad

Specialist Speech & Language Therapist at Speech Therapy Interactive

Hello, my name is Tina and I am a Specialist Speech & Language Therapist at Speech Therapy Interactive. I work with adults with communication and swallowing difficulties, as a result of an acquired or progressive neurological conditions. My job also includes educating and raising awareness supporting health professionals and families in the community to provide the best care for their clients/loved ones.

Today I am here to talk to you about the impact of communication for someone with Dementia, and how you can help…

Let’s look at the different types of communication difficulties a person with dementia may experience:

1. Aphasia

People with dementia very often experience symptoms of aphasia (generally people with Alzheimer’s or vascular dementia). This includes word finding difficulties, not being able to remember names of people or places they’ve known their whole lives, making errors in their speech, whether that’s grammatical or semantic. They may have difficulties understanding language. Primary Progressive Aphasia has a significant impact on a person’s language abilities. Symptoms include these difficulties: They may have difficulties with comprehending spoken or written language, particularly single words, difficulties with comprehending word meanings, naming objects, difficulty retrieving words,frequently pausing in speech while searching for words or have difficulty repeating phrases or sentences.

2. Cognitive Communication difficulties

People with dementia encounter many cognitive impairments. This includes a decline in memory, difficulties with planning, organising and sequencing thoughts, difficulties with attention where they may be easily distracted making it difficult to stay on topic or even distracted by their environment.. These cognitive difficulties can impact their ability to communicate their thoughts effectively and be understood by others.

3. Apraxia

Apraxia is one of the most common cognitive difficulties in those with dementia. It can affect their ability to move their muscles. It is important to remember that the muscles themselves are not damaged, it is the pathway from the brain to those muscles that are damaged. Apraxia is the inability of the body to respond to messages that are normally sent from the brain, such as the brain telling the hand to move a fork to the mouth. Generally, a person with apraxia as a result of dementia will not be able to connect the two ideas until someone physically moves the fork to the person’s mouth. People with dementia may experience difficulty when eating – as they are unable to plan and sequence their mouth muscles in order to chew their food and may pouch their food in their mouth..

Strategies that you can use to facilitate communication

Supported conversation strategies

  • Reduce distractions and background noise
  • Ensure you are in the person’s line of vision, maintaining eye contact, sitting face to face, so they know you wish to communicate
  • Keep your messages short and simple e.g. starting with the main topic then add the details later
  • Make sure that the order of your comments follow the actual time sequence e.g. “I went to the shop, and then I met Sarah”.
  • Use a total communication approach to supplement what you are saying e.g. using natural gestures, referring to objects and pictures nearby e.g. pointing to the clock when talking about the time, pointing to a photograph of a family member you are talking about.
  • Emphasise key words.
  • Try to use key terms that link to personal events/ scenarios in their lives to provide familiarity for more effective comprehension.
  • Repeat or Rephrase information if the person indicates that they have not understood you. You can also use closed ended (YES/NO) questions to clarify.
  • Simplify your questions as necessary to avoid frustration. Ask questions one at a time
  • As dementia progresses, the person may become less able to initiate conversation; you may have to start taking this initiative.

Communication passport

Communication passports are a great tool to build rapport and  initiate conversations with a person with dementia. It is also a great way to support them when they enter an unfamiliar environment e.g. hospital. Communication passports consist of the key information about the individuals. This includes things such as their likes and dislikes, the best ways to communicate with them and how to communicate with them. It can be in the form of a book or cards and just generally assist someone new to get to know the individual and how to communicate effectively with them. This will make communication for the individual easier with new people they encounter as it provides the new conversation partner with some background information of the person.

Memory box

Memory boxes are boxes that contain an item or items that are meaningful in some way to the individual.  This may be a treasured personal item, or an object that they can associate with their past. Memory boxes work on the principles of reminiscence or ‘life story’ therapy. Because the oldest memories are the ones that people may retain the best. It can give great comfort to see and talk about items that trigger those memories. Not only do they promote reassurance and familiarity, but they can also help with the practical issue of wayfinding – may help the individual locate their own space.

The Benefits of a Memory Box:

–          Offer familiarity

–          Offer comfort

–          Help with wayfinding

–          Trigger memories

–          Provide opportunities for communication

Reminiscence therapy

In collaboration with the individual, create a life story book. This would include people and events from the past

–          This works on the individual’s functional communication, recognition and self-esteem by providing them with opportunities for communication and social contact. This will enable the individual to build links between past and present. Include photographs and annotate them using the individual’s own words.

–          Use prompts to initiate conversation – this could include photos, newspapers, music and you could also incorporate smells and textures.

–          Arrange the book in chronological order from her childhood to her present using themes such as family, friends, early years, school days, interests, work, achievements, special places and things.

–          All of this will improve cognition, recall, communication, and improve mood.

–          It will reinforce a sense of identity and regain a sense of happiness through nostalgia.

If you have any questions and want to have a chat, you can contact Tina directly –