In everything we do we communicate. With and without words we connect and share information, experiences, and memories. Dementia is often a big game breaker in this process. It makes communication more difficult. Both Aphasia and Dementia are collective names for different types of disorders that occur in the brain. That a collective name is given to a group of disorders is because they generally have certain common denominators. Aphasia is purely a language disorder which affects a person’s ability to communicate. Other cognitive functions such as memory and spatial insight remain intact, while Dementia affects several cognitive functions.
But what is Aphasia and what is Dementia?
As is known, there are many different forms of Dementia. It is often thought that memory problems are among the first signs of Dementia. This is indeed the case with Alzheimer’s disease, which is the most common. But memory loss is not always part of the Dementia picture.
When we talk about Aphasia and Dementia, we talk about disorders that only occur from an adult age when the brain is fully grown. Aphasia is caused by sudden brain damage in an area that has to do with speaking, understanding, reading or writing a language. This may be due to a stroke, accident, brain tumor, inflammation or poisoning. As a result, part of the brain is damaged in one go, but the damage is limited to that area.
Dementia, on the other hand, is caused by a progressive disease, which affects brain cells and/or the connections between them bit by bit.
It is a gradual process: the affected pieces start small, but grow larger with time as more and more brain cells are eliminated. This happens in multiple places in the brain, including parts that contain language functions.
What are the characteristics?
- Memory problems
- Difficulty in talking and understanding language (Aphasia)
- Problems with performing complex actions (Apraxia )
- Having problems with recognizing objects (Agnosia)
- Problems with logical thinking, planning and organizing and executing activities
- Attention and concentration problems
- Understand and process information less quickly
- Disorders in thinking in images or drawing objects
Dementia only occurs if the above characteristics increase in seriousness and cannot be explained by another illness.
The language problems in Aphasia and Dementia sometimes resemble each other. This is because the problems that arise depend on the precise location of the affected brain cells, regardless of how they are affected. Compare it to a building: whether it breaks down here and there and shows cracks in time, or if a strong earthquake suddenly causes a crack; damaged is damaged.
So whether the area of Broca* is affected by Aphasia or Dementia, in both cases the person in question will have problems with the production of language.
Primary Progressive Aphasia
Dementia and Aphasia are two different diseases. How is it possible that this form of Dementia has the term Aphasia in its name?
Aphasia in the name refers in this case to the fact that this disease is a specific language disorder.
Language problems are the primary characteristic. But while the classic forms of Aphasia are characterized by sudden brain damage and language loss, Primary Progressive Aphasia is a relatively rare form of Dementia, because the disease causes increasing (progressive) brain damage. There is a gradual deterioration of the language pattern in patients with this disease, which starts mildly but becomes increasingly noticeable.
In Primary Progressive Aphasia, the problems, at least in the first 2 years of the disease and sometimes longer, are purely and only related to language.
Three forms of Primary Progressive Aphasia
More than 30 years ago, leading neurologist Dr. Marsel Mesulam described Primary Progressive Aphasia (PPA) for the first time. PPA, also called Mesulam disease, is a brain disease where nerve cells in and around the language center in the left temporal lobe.
Since then a subdivision has been made in three different forms, based on both the specific areas of the brain that are affected and the different language problems associated with each variant:
Primary non-fluent aphasia
In primary non-fluent Aphasia, as the name suggests, the production of language is disturbed and it is difficult to make successful sentences, but the understanding of language is still fairly good. The person with PPA can do everything independently for a long time: gardening en cooking. Memory, emotions, spatial insight and other functions remain intact for a long time.
Patients with Semantic Dementia, on the other hand, speak fluently, but have problems with understanding – they lose the meaning of words and often have no idea what everyday words mean (e.g. ‘brush’ or ‘dog’).
Logopenic progressive Aphasia
The patients mainly have word finding problems, slow speech and they have difficulty repeating words and sentences.
The course of PPA
In the first 2 years of the disease, and sometimes longer, Primary Progressive Aphasia only affects the language area in the brain. This means that a patient can continue to do all sorts of things independently (such as social activities, gardening, etc.) for a long time to come because the memory, emotions, spatial insight and other cognitive functions remain intact.
Eventually, after a few years, the disease gradually begins to affect other parts of the brain and patients may experience memory problems, personality changes and problems recognizing people, objects, sounds, and smells – features that often occur with Alzheimer’s disease.
It is important to discover where the problem lies for the person in question. Or better yet: what can he or she still do? When you know that, you can respond to that and there may suddenly be opportunities to talk to each other more easily.
Speech therapy helps
The substantive phenomena are very dependent on which area of the brain is affected and to what extent. However, typical is how the symptoms begin and how they develop.
Speech therapy can be very helpful in all three forms of PPA and a speech therapist can help devise alternative communication strategies. For some it helps to learn some sign language, others benefit from having laminated cards to communicate with.
In Aphasia, someone has difficulty speaking and/or understanding language from one moment to the next, but the situation is not getting worse and with appropriate therapy, language problems can even be reduced.
With Dementia, the language problems arise on a small scale, but gradually get worse and will not improve but will increase due to the progressive nature of the disorder.
But that does not mean that language therapy cannot help in communication with Dementia. Instead of focusing on improving the damaged parts of the language, speech therapy in Dementia becomes more focused on adapting the language and listening position, so that communication can proceed as smoothly as possible.
Because despite the crumbled bits and cracks, the building is still there and can certainly withstand some weather and wind.
Dealing with Aphasia
You can compensate for the lack of words by using pictures. Take photos or pictograms of common actions and objects.
In addition to using images on a laptop or tablet, your family member or patient may still be able to write, type or point out words. There are various apps that you can use.
The app SmallTalk Aphasia – Female is suitable for your loved one or patient if he or she has difficulty finding words, but can still read.
SmallTalk Common Phrases is designed for people with speech problems, but who can read.
If the person speaks hard, keep looking at him or her and take the time. In body language, gestures and sounds you can probably “read” what she means.
Almost all people with Aphasia can make understandable gestures for a number of words they cannot say.
It is important that conversation partners pay attention. Those gestures can help you better understand a conversation. The meaning of a gesture is not always immediately clear. That is why a conversation partner must ask good questions to understand what a gesture means.
Someone with Aphasia or Dementia and their family members will need the help and support of a doctor, counselor and speech pathologist. It’s a good idea for family, friends, and caregivers to:
- Be open about the problem so people can understand.
- Set up a daily routine for the person with Aphasia or Dementia that includes rest and time to practice skills.
- Use sentences that are short and to the point.
- Stand where the person with Aphasia or Dementia can see you.
- Treat the person as an adult, keeping him or her involved in all possible routines.
- No one likes to be ignored. Include the person in your conversation.
- Help the person with Aphasia cope with feelings of frustration and depression.
- Be patient. Give them the time they need to try to speak and get to their point
There are simple ways to keep distractions and noise down while communicating:
- Turn off background music, news or TV
- Move to a quieter room
- Always assume that the person with Aphasia is listening and understanding
- Talk in adult language, never make them feel like children
- Do not pretend to understand them if you don’t
- If they cannot understand you, do not shout. Unless the person also has a hearing problem, shouting will not help
- Make eye contact when talking to the person
There are simple ways to keep distractions and noise down when asking questions:
- Ask yes/no questions
- Give clear choices for possible answers. Do not offer too many choices
- Visual cues help
There are simple ways to keep distractions and noise down while giving instructions:
- Break them down into small, simple steps
- Allow time for the person to understand. Sometimes this can be a lot longer than you expect
- If frustrated, consider switching activities
- Encourage a person with Aphasia to communicate in other ways, such as pictures, pointing and hand gestures.
It may help everyone to have a book of pictures or words about common topics or people. This can make communication a lot easier.
Generally, it is a good idea to keep the person with Aphasia or Dementia involved in conversations. Make sure they understand, without pushing too hard or causing more frustration.
And most of all do not correct when they remember something incorrectly.
* The center of Broca is a part of the cerebral cortex that is involved in language. In particular, Broca takes care of the speech and of talking to himself in silence. The area is also active in thinking about and performing body movements. The Broca speech center is part of the frontal lobe, and for right-handed people, it is almost always on the left hemisphere. In a minority of cases, left-handed people are on the right hemisphere.
When you need more information or tips don’t hesitate to contact us.