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The 5 A's of Alzheimer's Disease: Aphasia

Posted by on 5/13/2015

Anomia, Apraxia, Agnosia, Amnesia, and Aphasia are the five A symptoms seen with patients with Alzheimer's disease. This article discusses the last of the five symptoms, aphasia. There are different types of aphasia and more clear-cut "definitions" when the term is used in relation to other conditions.  For simplicity reasons of this article, the nutshell definition of aphasia is the inability to effectively communicate.  Note that other deficits, not related to language ability, also contribute to the language difficulties in Alzheimer's disease, such as the cognitive deficits of decreased attention and memory, but those nuances of aphasia are beyond the scope of this article!

Aphasia - Explaining Why Mom with Alzheimer's Can't Communicate Her Words

The communication difficulty, or aphasia, seen in Alzheimer's disease can affect both the  person's abilities to talk (expressive language) and receive language (process what is heard). It is important to know that it is not the person's hearing that is affected. When the person does not answer you or answers incorrectly, talking louder to the person will not help!

Expressive Aphasia in People with Dementia

Examples of expressive language difficulty include:
  • Pausing or hesitating as the person searches for the right word, called anomia (see below to read more about this other 'A' symptom of Alzheimer's)
  • A word substitution, such as calling a coffee pot a "drink machine"
  • Using general terms instead of specific words. For instance, asking for that "thing" when looking to watch tv or saying my sweater is "over there", rather than asking for the tv remote or saying the sweater is "on the couch".
  • Switching sounds in a word, such as "wish dasher" for "dishwasher"
  • Use made-up words, creating their own sort of language, common in later stages
  • Repeating sounds or words over and over

Receptive Aphasia in People with Dementia

Examples of receptive language difficulty include:
  • Misunderstanding what other people say or hearing only parts of the messages
  • Not answering a question or answering incorrectly. This can be due to the person not understanding the question in the first place. Sometimes patients with Alzheimer's will just nod their head to cover up the fact that they do not understand or to give a response in the only way then know how.
  • Answering "I don't know", "I don't care", or "You Choose" when asked what they want.  Again, the problem is in understanding what the question is.
  • Increased anxiety in settings with lots of people, as the person cannot correctly filter the many sounds and words that they hear.

Strategies to Help Aphasia in Earlier Stages of Dementia

Patients in the earlier stages of dementia and their support team can use strategies to help minimize the effects of aphasia. Some strategies to try include:

  • Give the person time to process what was said and to form a response. This can take twice as long or longer for the person with Alzheimer's disease. Be patient and wait before you start talking again.
  • LESS IS MORE! Cut your messages from 3 or more sentences to 1. Skip the whole background story and just get to the point!
  • Carry a card that says "Be patient, my Alzheimer's brain takes longer to communicate" that the person or caregiver can show at restaurants or stores.
  • Focus on the person when they are trying to get a message across.  Often you can figure out what they mean from the context of conversation or with their gestures (i.e. if they point to something).
  • Do not use open-ended questions but rather give multiple verbal choices for the person to choose from. For example, instead of "What do you want for lunch?", say "Do you want a sandwich or soup?".

Strategies to Help Aphasia in Later Stages of Dementia

  • Use more non-verbal communication both to tell the person things and to help understand what they might want.  Words are barely needed (or effective, at this point). For example,
    • Show the person their 2 choices when offering lunch options - the sandwich meat and the can of soup (or pictures of the items).
    • Watch the person for non-verbal things like gestures, facial expressions, or tone of voice when the person is trying to communicate something.  And be a detective. Might the person be hungry when they are hollering and grabbing their stomach?
    • Use gestures and demonstrate!: Point to where you want the person to go; reach out hands and pull them to you when you want the person to stand up; take your own drink of water when you want them to take a drink.
There is a lot to learn when dealing with the symptom of aphasia in Alzheimer's disease, but with practice, caregivers can get better.  And when caregivers are better able to manage aphasia, the more competent they will feel as a caregiver and the less frustrated, anxious, or even embarrassed, the person with dementia will feel.  Questions? Feel free to ask in the comment section below.

Read about the first 'A' symptom of Alzheimer's disease: Anomia

Read about the second 'A' symptom of Alzheimer's disease: Apraxia

Read about the third 'A' symptom of Alzheimer's disease: Agnosia

Read about the fourth 'A' symptom of Alzheimer's disease: Amnesia

Reference: Aphasia definition from the American Speech-Language-Hearing Association

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