Speech Pathology Involvement in Alzheimer’s Disease
Alzheimer’s disease (AD) is a syndrome that includes multiple deficits, not limited to memory impairment. Word finding difficulties, and reading or writing difficulties may occur. Disturbances in executive function including planning, organizing, and completing tasks are common symptoms of the disease. These deficits may affect a person’s social skills and occupational success. The early signs of dementia include frequent pauses mid-sentence to retrieve words or memories, forgetting recent events, mood swings and personality changes, difficulty performing simple, routine tasks like paying bills and dressing, getting lost in familiar places, and repeating the same conversation over and over.
Early signs of AD often involve speech, language and possibly eating and swallowing.
Word finding problems, difficulty reading and/or writing, understanding, maintaining back and forth dialogue during the conversation, repeating ideas over and over again may occur. The person with AD may begin a thought and not complete it. There may be a change in talkativeness (less or more). Often there is a very literal interpretation of things said and a failure to recognize humor. Eating and swallowing impairment can occur in Alzheimer’s disease.
Speech Pathology Involvement in AD
At the beginning and throughout the course of treatment, speech-language pathologists (SLPs) share information about dementia with the individual and their family/caregivers. Treatment should be focused on the person’s individual’s needs and on maximizing the individual’s ability to participate in meaningful activities (e.g., Bourgeois, 2015; Chapey et al., 2000; Hickey, Khayum, & Bourgeois, 2018).
Person-centered communication goals can make it easier for the person with AD to understand and express themselves as it relates to their activities and in their familiar environments. Visual memory aids such as memory wallets or memory books, and schedule or reminder boards are often helpful tools to use.
SLPs can help the family put memory books together. Planning and organizing an activity, like cooking can be a challenge for a person with AD. The goal is to make learning effortless so that instructions are clear and materials and visual aids are provided to eliminate any guesswork on the part of the person with AD.
Technology can be a very helpful tool to use. Siri or other voice command apps can help by quickly providing picture cues. Photo album apps can be used to create memory books. Electronic memory aids/timers can be used to help with schedule management, medication management, and cooking. If needed, the use of alternative and/or augmentative methods to support communication can be introduced.
Family members and those who care for individuals with dementia are faced with challenges that can affect their own health and well-being (Gilhooly et al., 2016; Raggi, Tasca, Panerai, Neri, & Ferri, 2015; Snyder et al., 2015). Changes in communication functioning due to cognitive decline, together with behavioral changes, can have a significant impact on day-to-day interactions and can result in considerable frustration.
SLPs work with families and caregivers to help them understand and manage these changes, minimize stress and frustration and provide a supportive environment for the individual with dementia.
Some helpful tips for communicating with a person with Alzheimer’s disease include:
Maintaining routines or roles in the individual’s living community.
Don’t interrupt while they are speaking, and avoid criticizing, correcting, or arguing.
Give simple explanations.
Start up a conversation about something the person can see or touch.
Maintain good eye contact and allow plenty of time for the person to reply.
The best thing that you can do to help the person with Alzheimer’s disease express himself or herself is to provide compassion and understanding, respect the individual, and honor their world.
Some individuals with AD may experience behavioral challenges at mealtime, such as forgetting to eat or wandering away. Swallowing problems such as coughing and choking may occur.
Feeding problems such as forgetting to swallow or difficulty using utensils are common. These problems can have an impact on the person’s health.
A speech pathologist can make suggestions and offer modifications and interventions, working with the family and team, taking into consideration the potential health risks as well as the quality of life.
These are helpful speech-language terms to understand. You may hear your doctor or SLP use these when speaking about language symptoms in AD:
Aphasia. This involves problems speaking, understanding, reading, writing, telling time, and/or using numbers. Often misunderstood, aphasia does not affect a person’s intelligence. The most common cause of aphasia is a stroke.
Agnosia. A neurological disorder that results in an inability to recognize objects (such as an apple or a key), persons, smells, or sounds despite normally functioning senses (such as visual or auditory).
Apraxia of speech. Speech difficulties arise from problems planning motor movements. It is caused by damage to the parts of the brain that are involved in speaking.
Dysphagia. A swallowing disorder that may occur as a result of various medical conditions.
Executive function. A set of processes that all have to do with managing oneself and one's resources in order to achieve a goal. Executive functions help you manage life tasks of all types. For example, executive functions let you organize a trip, a research project, or a paper for school.
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About the Author
Allison Geller is a speech-language pathologist (SLP) and the owner of Connected Speech Pathology. She obtained her Bachelor’s and Master’s degrees from the University of Florida in Speech-Language Pathology. Allison has practiced speech therapy in a number of settings including telepractice, acute care, outpatient rehabilitation, and private practice. She has worked extensively with individuals across the lifespan including toddlers, preschoolers, school-aged children, and adults. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including receptive/expressive language disorders, articulation disorders, voice disorders, fluency disorders, brain injury, and swallowing disorders.
Allison served as the clinical coordinator of research in aphasia in the Neurological Institute at Columbia University Medical Center in New York. She is on the Board of Directors for the Corporate Speech Pathology Network (CORSPAN), a Lee Silverman Voice Treatment (LSVT) certified clinician, and a proud Family Empowerment Scholarship/Step-Up For Students provider. Allison is passionate about delivering high quality-effective treatment remotely because it’s convenient and easy to access. What sets us apart from other online speech therapy options is—Allison takes great care to hire the very best SLPs from all over the country.
