March 1, 2018 Elaine C. Pereira

Alzheimer’s is a progressive neurological disease that impacts a person’s memory, judgement, life care, and communication. One of the first indications of Alzheimer’s is often language decay.

Language requires a very complex set of neurological skills. When people engage in conversation, the brain hears what is said, processes the meaning, encodes the message and executes an appropriate verbal response. This reciprocal dialogue loop literally occurs in nanoseconds.

In children, language acquisition takes six years to fully mature, whereas gross and fine motor skills develop faster. Conversely, changes in language are often the first signs of dementia.



It’s through words directed by the brain that a person communicates effectively. But when the words are directed by a brain experiencing dementia, they are wrought with unreliability.



As the brain slowly deteriorates, dialogue becomes warped. The changes are insidious at first. A person might hesitate for a moment trying to recall a familiar name or substitute one common noun for another (spoon for cup) but not self-correct. Illogical thinking leads to irrational remarks. Eventually the subtle errors mushroom into verbal disasters often accompanied by an edgy attitude.

How Dementia’s Impact on Communication Can Cause Problems



Communicating with dementia patients can be devastating for family members when their loved one can’t say “Hello,” answer a question, or share memories. Unfortunately, caregivers utilize a plethora of misguided efforts trying to stimulate awareness through questions that can’t be answered.



The most frequent unwitting mistakes are probing, prodding and praying for the correct response to: “What’s my name Mom?” or “Do you remember this?”



Of course they don’t remember! Not remembering is the hallmark of Alzheimer’s.



It’s understandable that adult children expect their parent to always know them. Recognition is validated by language such as saying their name, especially spontaneously. As all words become increasingly more difficult to retrieve, the parent with dementia stumbles and can’t express aloud the right word, in this case the precious name of their son or daughter.



The ensuing chain reaction can further undermine an already possibly fragile relationship between ailing parent and adult child. I hear it all the time: “Mom has no idea who I am.” Disheartened, families sometimes curtail visits to their loved ones, citing “Dad doesn’t know me anyway, so why go?”



The Importance of Dementia Communication Strategies



Despite these frustrating interactions, researchers maintain, however, that for the most part our loved ones with dementia are still in there and it’s up to us to learn how to talk to someone with dementia and find the connection that “speaks” to them.



In lieu of setting your parent up for failure, provide them with the support they need. “Hi Mom. I’m your daughter Carol.” or “These are pictures from your trip to David’s house.” Establish a calm atmosphere, not a challenging one.



Many with Alzheimer’s drift back in time referencing events from the past as if in the present. My mother saw my (deceased) dad. “Wayne’s in the parking lot. Please let him in.”



Do not correct the misstatements. Although Mom’s reality was anything but real, it was her reality at that moment. I left Mom’s room for a few minutes. When I returned, she had completely forgotten seeing my dad.



Validate what they say or what they are asking cautiously. It’s uncomfortable for caregivers and families to feel they are outright lying, but creative responses in a gentle voice can help to communicate with dementia patients effectively.



Just months before my mother died from Alzheimer’s, she experienced brief moments of amazing lucidity. Her verbalizations were infrequent and mostly incoherent, except for a few rare, well composed remarks.



“Have you seen Wayne today?” Mom asked. “He’s dead, isn’t he? I haven’t seen him in a while.”



Cautiously I responded, “Yes.”



“I thought so. How is it that you know that, but I don’t know that?”



I told Mom that she had known that once, but her memory was not always reliable.



How to Communicate Effectively through the Five Senses



When words fail, and they will, foster connections through the five incredible senses.



Touch. Our skin is our largest organ and sensory vehicle! Touching someone or being touched in a positive manner instantly launches a cascade of becalming endorphins known as the brain’s morphine. For all people, but especially those with Alzheimer’s, touch is everything when words fall short.



Mom was hospitalized twice for lung surgery in the two months before she died. She never opened her eyes, didn’t eat, didn’t speak until on one visit, I massaged her face and hands with lotion.



“That feels good,” she mumbled in a raspy voice.



Those were literally the only words she had uttered in weeks triggered, I have no doubt, by tender touch.



Smell. Research shows we associate smells especially from our childhood experiences with past events. The enchanting fragrance of lilies triggers memories of playing in my grandfather’s yard. The aroma of pies and cookies baking, simmering stew, cinnamon, even coffee can be soothing. Whatever bouquets were once relevant likely remain important avenues for continued connections.



Taste. As with smell, we have taste memories also. Reliving a taste from one’s past can trigger positive sensations. There are five separate and distinct tastes; sweet, sour, salty, bitter and umami/savory. Most with Alzheimer’s gravitate toward sweets probably because sweet is the longest sustaining on our palate.



Sound. Communicate with the one you love less with jabbered words and more with soothing sounds. Music, especially familiar songs, is well documented as relatable. If they seem agitated, try white noise such as a whirling fan, ocean waves, ticking clock. Other appealing sounds are wind chimes and birds singing.



Sight. Although all five senses function at birth, it’s through our eyes that our very first and most influential bond is formed. The smile! Without a single spoken word, smiling speaks volumes. Our facial expressions convey emotions and feelings that transcend language. Regardless of where you’re from or what language you speak, a smile is universally understood.



Visual connections bathed in familiar history like photo albums and meaningful objects, can trigger comforting nostalgia. Visual hallucinations are not uncommon in Alzheimer’s patients. My mother experienced a few including a stunning vision of her mother. Since my mom’s visions were not discomforting to her, I smiled along with her as she smiled having experienced them.



Our elderly experience many health issues, but as the brain is the master control center, neurological impairments play havoc with every function. Losing language is perhaps the hardest, but if we learn how to communicate with dementia patients more effectively, it can ease this hardship.



Elaine C. Pereira, MA OTR/L CDP CDC is an author, speaker, certified dementia practitioner and caregiver. Contact her at elainep@iwillneverforgetbook.com.