Alzheimer’s Disease From The Scope Of An SLP
Written by: Kendra Wormald / Medical Rehabilitation / April 19, 2023 / 10 minutes read
This piece serves as a contribution to the series investigating neurodegenerative conditions from the perspective and scope of a Speech-Language Pathologist.
Table of Contents
Definition
There is often confusion surrounding the concepts of cognitive decline, with the terms Dementia and Alzheimer’s frequently being used incorrectly.
The Alzheimer Society provides clarification between the two:
“Dementia refers to a set of symptoms and signs associated with a progressive deterioration of cognitive functions that affects daily activities. It is caused by various brain diseases and injuries. Alzheimer's disease is the most common cause of dementia” (2023).
The Science
Alzheimer's disease is thought to be caused by a build-up of proteins in and around brain cells. Plaques in the brain are formed from the overproduction of beta-amyloid protein. These plaques wedge between neurons and interfere with cell function. Cells are injured and subsequently die throughout the brain and areas of the brain begin to shrink. Also, neurofibrillary tangles, which are made of the accumulation of tau protein, collect inside the neuron. These proteins, that normally bind to and stabilize microtubules, link to other tau molecules - causing tangles. These tangles block the movement and communication of neurons.
Cause and Prevalence
Over 747,000 Canadians are living with Alzheimer's or another dementia. Worldwide at least 44 million people live with this disease.
One risk factor alone may not lead to Alzheimer’s but rather a combination of factors related to genetics, environment, age, changes in the brain and lifestyle. The impact each factor may have on each person may vastly differ.
Age is one of the greatest risks for Alzheimer’s, typically occurring in those ages 65 and older. Following 65, the risk doubles every five years (Alzheimer’s Association, 2023)
Genetics and family history may increase the risk of acquiring this disease. If you have a parent, brother or sister with Alzheimer’s, you are more likely to develop the disease. Research shows that there are two genes that influence whether a person develops this disease - risk and deterministic genes (Alzheimer’s Association, 2023)
Your health history such as head injuries, conditions that damage the heart and blood vessels such as diabetes, heart disease, stroke, and high cholesterol or blood pressure (Alzheimer’s Association, 2023)
Symptomatology
Symptoms of Alzheimer’s can vary from person to person. Often memory challenges present as an initial sign of the presence of the disease. Different stages of the disease may express symptoms differently and more intensely. Someone may be aware and frustrated by the changes while others may not have the same level of awareness.
Often symptoms present as:
Overall challenges with memory
Losing track of dates or not knowing where you are
Increase in the time it takes to complete tasks
Losing track of where you left items
Misplacing items
Forgetting names and faces
Forgetting newly learned information
Forgetting familiar routines
Challenges with reasoning and thinking through steps
Making irrational and impulsive decisions
Increase is the presence and severity of psychological conditions such as anxiety and depression
Trouble understanding visual images and spatial relationships
Difficulty with completing familiar tasks
Forgetting common words in speaking and writing
Changes in mood and personality
Challenges with organizing and expressing thoughts
(Mayo Clinic, 2023, Alzheimer’s Association, 2023, National Institute of Aging, 2017)
Symptoms of Alzheimer’s can vary from person to person. Different stages of the disease may express symptoms differently and more intensely.
Stages
Mild Alzheimer’s Dementia: Most people are able to function independently in many areas of life but often require support with various activities, particularly with finances and needing more time to complete tasks.
Moderate Alzheimer’s Dementia: Often the longest stage, where people often experience increased challenges with memory and language, confusion and difficulty recognizing familiar people, and completing multi-step tasks. Behavior and mood changes may also occur at this time.
Severe Alzheimer’s Dementia: Verbal communication will likely be significantly challenging and often will require full time support. Swallowing may also become difficult due to damages to the brain involved with movement.
Impact On Communication
Withdrawal from social activities and communication
Increase in saying repetitive statements
Challenges with word finding and forgetting word meaning
Challenges with reading, writing and working with numbers
Reduced attention during longer conversation
Difficulty following along or joining in on conversation
Reduced ability to remember what you had just said
Sensitivities to tone and loudness of voices
Increased use of inappropriate language
Reverting to first language learned
Mixing unrelated ideas together
Difficulty with accurately being able to express yourself
All of these challenges may lead to a breakdown in the forward flow of communication.
The symptoms of Alzheimer’s disease typically become more frequent and severe as you age. It’s important for these individuals to continue to have the right to the highest level of care, consideration and quality of life. The Alzheimer Society communities this effectively;
“ . . . each person with dementia is an individual, regardless of the stage of the disease, and that care should be individually tailored to their unique needs, interests, habits and desires.” (2020)
How to Support Communication
Communicate in brief and direct statements
Use keywording to express main ideas and important concepts
Don’t ask too many questions at a time
Don’t provide too much information or directions at a time
Use photos, visual schedule or other reminders to support memory
Offer corrections as suggestions
Reduce distractions
Support the use of nonverbal communication
Direct your face towards them
Ensure you make eye contact
Avoid open ended questions
Speak clearly and slowly
Give them time to respond
Encourage and welcome them into conversation
Provide simple options to support decision making
(Alzheimer Society, 2023, Mayo Clinic 2021, Leisure Care, 2022)
Our Masterclass on Communication Wellness can be found here.
Impact on Caregivers and Close Others
Alzheimer’s Disease can evidently be overwhelming not only for those living with it, but also for their caregivers, friends and families. Be sure to take care of yourself and intentionally reflect on your thoughts, behavior, tone and mood. Speaking to a psychotherapist may be a supportive avenue to consider.
A Speech-Language Pathologist can provide clinical perspective and support for those living with and affected by Alzheimer’s Disease. Together or individually, you will work with the clinician to address topics such as understanding the breakdown of communication abilities, strategies, supportive technology and communication partner training. As Alzheimer’s Disease is a progressive neurodegenerative disease, different amounts and types of support throughout the process may be necessary.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
