Communication disorders in patients with dementia are increasingly present as the disease progresses, due to language and behavioral disorders. Factors favoring communication include the bringing into play of emotions, the application of body care and a good relationship between the patient and those around him.

Language is affected

Dementia is a disease of communication and, above all, of verbal communication. Indeed, the progression of the disease inevitably impoverishes the capacities of verbal exchange of the patient with his entourage. The real communication difficulties will mainly arise in the severe stage of his illness.

Verbal communication with the patient suffering from a cognitive function deficit is all the more difficult as the extent of the cerebral lesions – in particular the language areas – is marked. This deficit concerns:

• comprehension disorders;
• oral expression disorders dominated by a lack of words;
• frequent paraphasias : words are distorted or substitute for others;
• a simplification of the syntax;
• in the most severe cases, the language becomes jargon with numerous neologisms.

Communication aggravating factors

Whether it is a family or medical environment, several factors can aggravate the exchange:

• lack of availability, attention and listening. For example caregivers, who during a treatment, have a personal conversation from which the patient is excluded;
• precipitation: the patient needs time to gather his ideas, find the right words and check that he has been understood. Otherwise, he will often prefer to be silent;
• the medical jargon sometimes used by caregivers;
• a statement by the patient considered uninteresting;
• a failure at the start of a relationship where too much is asked of him, where he feels devalued.

How to optimize communication

Any cognitive stimulation can be conducive to inducing speech, especially in the case of sessions with a speech therapist.
Other therapies (music therapy, relaxation techniques, art therapy) facilitate communication by strengthening self-esteem.
Pleasant body treatments such as massages or cosmetic treatments can encourage the patient to talk.

How to stimulate the patient’s attention and motivation

Communication should never be forced. Caregivers to create a climate of trust and stimulate attention and motivation. For this it is necessary to:

• go to a quiet place to create together a common space of exchange;
• face the sick at the same level as him;
• stimulate his attention by touch and gaze;
• make simple sentences containing only one idea at a time;
• say ‘I’ and avoid using ‘we’ which is too vague and impersonal;
• ask questions to elicit ‘yes’ or ‘no’ answers, not ask for choices;
• reformulate the patient’s words if necessary to check their content;
• possibly help him find the missing words.

Patients suffering from dementia have a verbal expression that becomes more and more difficult. However, until the advanced phase of the disease, before the stage of mutism, the majority of them seek communication to express their experience, to speak in pairs, etc.
When the verbal mode of communication disappears, the word is always possible, especially if a favorable climate favors it.
Furthermore, It is necessary that the entourage is convinced that exchanging with them makes sense and that their words make sense.