One of the most vexatious, frustrating and emotion-provoking situations for caregivers is the loss of effective speech communication from the person living with dementia, and the loss of their reliable answers to concrete care questions, even to “yes-no” questions.
Like hearing ancient Latin or Greek, some things might sound familiar, but coherent communication is lost on the listener. Attentive caregivers and family members might be able to discern and interpret some basic needs, many times through non-verbal communication.
Like Alzheimer’s dementia itself, the communication problem is progressive. Previous fluency, maybe even in several languages, seems to disappear (review, 2015); speech output might be reduced to sing-song syllables with little apparent connection to the situation at hand. To hear the occasional well pronounced “YUCK!” is almost a welcome relief.
But does the vocal output from people with dementia, all but unrecognizable for understanding even by close family members, still contain specific, subtle and sophisticated meanings? Is it meaningless self-soothing babble, or are there messages of happiness and joy, or sadness and regret that might be interpreted?
[BTW, Cross-cultural medicine prefers the term “interpreting” for real-time live listening and speech, incorporating non-verbal clues, while the term “translating” is usually used for the written word and communication.]
In contrast, for healthy young children, language acquisition is a world wide phenomenon, no matter what the language, including sign language; even through “babytalk,” the process seems rapid and magical. The linguist Chomsky used the concept of a universal grammar in discussing language acquisition.
Diseases may give us a different peek at the language machinery; many conditions, like strokes, have associated communication problems. Some younger-onset dementias may be associated with Primary Progressive Aphasia (2021 review is nicely comprehensive), where receptive language (input) in general might be better preserved than expressive language (output).
Impairments observed by CareGivingOldGuy seem patchy and inconsistent, almost like a person’s “innate universal grammar” is dissolving. An alternative might be that the deep structure of meaning remains intact, but it has a frayed, fuzzy, erratic connection to linked vocal outputs (some neuroscientists have even tried testing Chomsky’s universal grammar idea).
Neuropsychologists and neurolinguists use terms like “language loss” and “language impairment,” but for Wales (2006), they are not synonyms. He basically states that it’s hard, if not impossible, to prove true “language loss”, with so many steps between thought and the production of speech. Using “language impairment” might be conceptually more helpful. He uses Alzheimer’s as an example.
“Retrogenesis” is the related concept that Reisberg published, contrasting the gain of skills in childhood with the inability to demonstrate those skills in Alzheimer’s and related dementias. The observation is that many functions, like language development, seem like they’re going in reverse, in chronological order.
Reisberg’s 2002 retrogenesis paper about its implications is an interesting read, because it’s almost a manifesto, with platform statements that might lead to a dementia approach policy. The paper features:
Axioms (“Axiom VIII: All human beings have the capacity for happiness if basic needs are fulfilled” ), Postulates (“Postulate V: The emotional level of the AD patient is dependent on the DA [Developmental Age”]), and Caveats (“Caveat VIII: AD patients appear to be less fascinated by the world and less inquisitive than infants and children at a corresponding DA [Developmental Age”]).
The paper is an overview; it’s a little shy on specific language issues. A few authors (2015 review above) have pointed out that anomia, problems in word finding, is a common issue in early dementia. Is anomia the reverse of an older child learning new vocabulary? Others refute the retrogenesis hypothesis (2015).
[BTW, near the Conclusion, the Reisberg paper has this jarring statement: “antineoplastic agents [i.e. cancer drugs] may have relevance for the treatment of AD.” This surprised an old oncologist like CareGivingOldGuy!]
Theoretical frameworks are important, but is there anything more practical and concrete that would help the communication process for everyday caregiving? The Dementia Care Central website has some common sense approaches.
Speech and Language Pathologists and therapists do have specialty approaches, including caregiving training, but it remains unclear how effective they are. The AHRQ 2020 document on dementia care interventions did not find anything with strong evidence of effectiveness, including cognitive / language programs.
Google Translate doesn’t seem to be the right application, but how about other cutting edge technologies or research ? For decades, communication boards have been used for other conditions, ever more sophisticated, in a field called Augmentative and Alternative Communication (AAC).
So watch for the next blog post, Part 2, about using artificial intelligence (AI) to do research in dementia speech communications, with links to discussions of AAC using AI and machine learning!
CC0 pixaline@pixabay
