Three years ago Luis was diagnosed with Alzheimer's disease. His daughter Amelia goes for walks with him every afternoon. Sometimes he gets a bit stuck talking about his siblings.
- He worked in a a a ... in a ...
- In a factory, dad?
- Yes ... He is an engineer and does ... Mmmm ... [mueve las manos a un lado y a otro]
- What kind of factory?
- He makes ... well he, I don't know, he used to work there and they make ... cement.
- So, did you work in a cement factory, Dad?
Encode and decode messages. That is the basic capacity on which any attempt at human communication is based. Conversation is the most common way of exchanging messages and to be effective it requires the interlocutors to follow a complex collaborative process, adapted to the demands of each situation.
The reality is that we are not aware of this complexity until we face aging or certain degenerative diseases. In both cases, neurophysiological impairment makes it difficult to process mental operations, including simple conversation.
Why with Alzheimer's we express ourselves worse
Alzheimer's dementia triggers a neurodegenerative process in the central nervous system characterized by progressive neuronal death in certain areas of the brain. This gives rise to a diverse symptomatology that includes disorders in recent memory or working memory, depression, sudden changes in mood and significant alterations in linguistic function and, as a consequence, in communication.
Among these communicative obstacles, there are limitations to understand the context, difficulties in accessing the lexicon and in the motor programming of speech. In addition, chewing and swallowing functions can be affected (dysphagia), as can the ability to read and write.
The worst thing is that the linguistic deficit of Alzheimer's patients is related to the deterioration of its general executive functioning. Due, both expression and understanding of language are compromised due to alterations in the processes related to memory, concentration, reasoning capacity and the Theory of Mind. The patient ends up being unable to produce oral and written texts with adequate coherence and cohesion. What's more, he can't even understand them.
The deterioration of cognitive abilities causes difficulties to appear in the different executive functions such as access to the vocabulary, inhibition, impulsivity or emotional control.
They also involve a reduction in the ability to adjust or regulate behavior. Thus, planning and building communication exchanges becomes an odyssey, especially in the context of face-to-face conversation.
Redefining the role of speech therapists
Those who engage in conversations with Alzheimer's patients notice it. Your healthy interlocutors must deal with the problems they show to understand the context and adjust to shift changes or theme variations.
In addition, both the number and the duration of the pauses on the part of patients increases, as we saw in the initial conversation of this article. It is mainly due to the fact that there are problems of access to the lexicon. Sometimes, patients compensate by resorting to gestures.
Unfortunately, the diagnosis of Alzheimer's grows exponentially with the increase in the older adult population. The situation has forced speech therapists to redefine their work objectives to adjust to an inescapable reality: the world's population will gradually lose cognitive, linguistic, emotional and motor functions.
The significant reduction in the functionality, autonomy and quality of life of the elderly is causing an increase in the use of social and health services. So things, include the speech therapist in the comprehensive care of the affected population it is more relevant than ever.
In addition, within this interdisciplinary clinical intervention model, it is convenient to include both pharmacological and non-pharmacological care programs. In the specific case of the speech therapist, their objective should be to design assessment and direct care strategies aimed at intervening in the linguistic-communicative symptoms of the person with Alzheimer's.
Ultimately, it is about respecting their rights and recognizing that when caring for a person with dementia, the goal is not to “repair” or eliminate the effects of cognitive decline. It is also about achieving the best possible well-being for the person with dementia, their family members and caregivers. Achieving this requires stimulating and maintaining adequate interpersonal communication.
** This article was originally published on The Conversation by Beatriz Valles-González and Alejandro Cano, Director of the Degree in Speech Therapy at the International University of Valencia and Speech therapist and Psychologist, you can read it in full here.