Dementia and language

Difficulty with speech and language (aphasia) is a common effect of dementia. Damage to the brain can make it difficult to absorb and understand what others are saying, it can feel like the words you’ve heard are swimming around your brain but not forming any meaning.

Likewise, finding the words you want to say can be much more challenging when you have memory problems. Many people with dementia need more time to listen and speak so can lose confidence when it comes to conversation.

Symptoms of communication problems in people with dementia

Symptoms you may notice include:

• Difficulty finding the right words (aphasia)
• Talking very slowly and needing others to speak slowly
• Aggressive language, such as swearing a lot or shouting
• Saying words in the wrong order or mixing up tenses
• Difficulty understanding what others say due to trouble grasping a sentence as a whole, instead understanding the individual words only
• Slurring words or other trouble physically pronouncing them
• Speaking very little or becoming entirely non-verbal
• Forgetting how to speak a second language and reverting back to mother tongue
• Speaking in an accent they had lost. For example, somebody who moved from Glasgow to the south of England as a child and lost their accent may revert back to their Glaswegian accent.

What causes speech and language impairment in people with dementia?

Different types of dementia can affect different parts of the brain in different ways. The main areas of the brain that are responsible for speech and language are the frontal and temporal lobes, and Broca’s area, which is in the left hemisphere of the brain. This is why language difficulties are particularly prevalent in people with frontotemporal dementia. However, damage to any part of the brain can affect its ability to function as neural pathways that send messages between different areas are damaged or blocked.

Causes of dementia, such as protein build-up or blocked blood vessels, can cause cells in areas of the brain to die. This can affect a person’s abilities in hearing and processing information, comprehension, vocabulary and grammar, and communicating their thoughts effectively.

Dementia and people who speak more than one language

For people living in the UK for whom English is not their first language, dementia can present a problem that others don’t face. As dementia progresses, some people can lose their ability to speak their second language and can only remember their mother tongue. This can present problems in finding care, as they need care workers who can communicate with them.

Jag’s mother has Alzheimer’s disease and vascular dementia. Due to this, she can now only communicate in her native Punjabi, which has made finding care during the COVID-19 pandemic extremely difficult.

She explained: “The council couldn’t help me. They couldn’t help me source any Punjabi-speaking carers. I was desperate. All I ever get from professionals is, ‘Put your mum in a home,’ but that can’t meet her religious, linguistic or other cultural needs.

“I’ve had to find Punjabi-speaking carers myself and provide my own Punjabi language resources. I’ve struggled at every juncture.”

Jag is calling for more support for people with dementia from BAME (Black, Asian and other Minority Ethnic) communities. You can find out more about her story here.

Communicating in different ways

It’s always essential to be patient when communicating with people with dementia. When speaking to a person with dementia, do your best to:

• Speak in clear, simple sentences. Some people with dementia have difficulty hearing while others can be sensitive to noise so adjust how loudly you speak accordingly.
• Do not speak to them as if they were a child. Being patronised can be distressing for anyone, with or without dementia.
• Allow them plenty of opportunity to speak and contribute.
• Avoid direct questions where possible, this can make them panic as they struggle to remember the answer. Instead, steer the conversation gently onto that topic.
• Pay attention to your body language, such as smiling, giving them personal space and sitting at a level with them. Holding hands can be reassuring if you are personally close to them.
• Never lose your temper when they are slow to respond, misunderstand you or repeat something that you know isn’t true. You don’t need to correct them on every mistake they make because they have remembered information wrongly.

As dementia progresses, it can be necessary to find different ways to communicate. Examples include:

• Gestures and facial expressions
• Drawing or communication cards
• Using music. Singing can be easier than speaking for people with dementia so using songs or rhymes to express how they feel can be helpful.
• A 2017 study published in the US National Library of Medicine found that it can be possible to create a ‘shared language’ with non-verbal people with dementia. This is done by imitating their communication methods then evolving that as a means for them to let you know how they feel. For example, whistling, tapping on the table or clapping
• Seeking a speech and language therapist. These therapists can help people with dementia and their loved ones to improve communication. They can also help with issues with swallowing, eating and drinking.