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How Alzheimer's Disease Affects Communication Ability What Is WINTER 2020 CareA PublicationTalk of Hope Hospice, Inc. How Alzheimer’s Disease Affects Communication Ability emory loss is one of the Mwidely known symptoms of Alzheimer’s Disease, but many other skills and abilities become impaired as well. Persons living with Alzheimer’s and other dementias experience changes in the brain’s temporal lobe that affect their ability to process language. Even in the disease’s early stages, caregivers may notice a decline in formal language (vocabulary, comprehension, and speech What is Sundowning? production), which all humans rely amily care partners and professional caregivers alike get frustrated upon to communicate verbally. with dementia-related behaviors that are barriers to providing care and Symptoms include word loss, F improving quality of life for the person in their care. Behaviors associated with confusion during the conversation, sundowning are particularly difficult. not being able to follow a storyline, Sundowning is a lay term that describes a state of increased confusion and and decreased speech. anxiety that presents itself in the late afternoon and continues through the Word loss and the brain’s evening; for some, it extends into nighttime. Signs include many forms of temporal lobe anxiety, aggression, pacing, confusion, wandering, and repetitive behaviors. As a child is learning a language, Some people experience hallucinations, delusions, and paranoia. nouns are stored in the left side According to the Alzheimer’s Association, sundowning occurs in as many of the temporal lobe. So, when as 20 percent of persons with Alzheimer’s Disease. Other dementia-related dementia problems begin in this illnesses such as Lewy Body Disease, Fronto-Temporal Dementia, and Vascular region of the brain, it is common Dementia also commonly present sundowning in middle and late stages. for the person to use the wrong The exact cause of sundowning is not known, but some experts believe it is word, even for a simple object, or related to disturbances of the circadian rhythm resulting from dementia-related forget a familiar person’s name. brain changes. When this happens, a caregiver Tips to cope with sundowning should respond both with curiosity Helping the person in your care cope with the effects of sundowning requires to learn what is meant and with great effort. Finding the right combination of environmental adjustments is compassion to allow the person specific to the individual. Try out these common tactics: to retain dignity in spite of the mistake. Similarly, the person with • Before the sun sets, close the blinds and turn on the interior house lights. dementia may altogether forget the For some, this needs to be as early as 3 p.m. word or name and struggle to finish • Assess the environment to be sure it is well lit; vision difficulties will (See “Communication” on page 2) worsen agitation. (See “Sundowning” on page 4) Hope Hospice, Inc. 6377 Clark Ave., Suite 100 Dublin, CA 94568-3024 (925) 829-8770 HopeHospice.com LEADERSHIP TEAM Jennifer Hansen Chief Executive Officer Jatinder Pal Singh Marwaha, MD, HMDC Medical Director, Hospice Epi DeLeon, MD Associate Medical Director Kuljeet Multani, MD, HMDC Associate Medical Director Communication (continued from page 1) the needs of the person in his or her Kathy Nouri, RN, BSN, MPH a sentence; for the same reason, care, which in the case of this example Chief of Quality Compliance Raul Perez, RN, BSN, PHN a caregiver should not resort to is simply to move more slowly and Chief of Patient Care Services language or tone that emphasizes the with greater care. Michael Sinclair Controller person’s forgetfulness and makes him Maria Iglesias feel foolish. The silver lining Director of Human Resources As the disease progresses, formal As with much of life, there is a silver Kathleen Brand, LMFT, ATR lining to the reality of dementia- Director of Bereavement Services language usually disappears, and Jennifer Pettley, MPA the person living dementia is left related language decline. The brain’s Director of Development temporal lobe is two-sided. The left Kari Rayford, LVN, CHPLN with little ability to communicate Director of Outreach his needs. He may stop talking side deteriorates while the right side Kendra Strey remains intact, often to the end of Director of Communications completely and rely solely on non- the dementia journey. The right side Elsei Ye-Arling, RN, BSN, CCM verbal cues such as facial expressions Director of Patient Care Services and emotional commotions. enables a person to engage in basic social chit-chat, clap or toe-tap to the Behavior as communication rhythm of music and poetry, and even At this stage, behaviors are often the dance. only way to communicate what is on A person living with dementia can the person’s mind. These are called find great comfort and joy in listening dementia-related behaviors. They are to his favorite music or singing messages about ideas, feelings, and along to songs from his past. It’s not needs, and he is uncommon for a telling you in the person to retain It’s not uncommon for a person to best way he can— the ability to recite retain the ability to recite favorite the only way he can. favorite scriptures scriptures or poems or to sing For instance, or poems, even along and clap to an old song. a caregiver who word for word. This provides personal can happen even care (bathing, toileting) too quickly in persons who are otherwise non- Community-based and non-profit, Hope causes frustration for the person verbal. Hospice is accredited by The Joint Commission, certified by Medicare and Medi-Cal, and is a living with dementia; he can’t process Care partners can learn new ways member of the National Hospice and Palliative Care Organization and National Partnership for what is happening. Frustration can to interact with their loved ones Hospice Innovation. turn to resistance, anger, and even who have dementia by engaging in © 2020 Hope Hospice, Inc. aggression, all of which may be activities that rely on the right side of avoided if the caregiver understands the temporal lobe. Page 2 QUICK QUIZ Vision Changes in the Patient With Dementia Read the issue and answer True or eople living with dementia commonly experience changes to their vision False to the questions below. Pbeyond what’s expected as part of the normal aging process. As dementia- related illnesses cause progressive brain deterioration, a person will experience 1. Sundowning is a term that describes certain sight deficits because the brain is no longer processing what the eyes an enhanced state of confusion. see in the same way. Some common problem areas include: True or False Depth perception: The patient may exhibit difficulty in navigating steps, 2. When a person living with grabbing objects, and distinguishing between dementia begins to struggle with word two- and three-dimensional scenes. With confusion, correcting him will help the the latter, for instance, the person may symptom subside. try to pick up flowers from a floral- True or False printed tablecloth. Reduced peripheral range: In 3. It’s common for a person to retain your youth, you likely enjoyed the ability to recite favorite scriptures 180 degrees of clarity in front or poems, even in persons who are of you. As we age, we naturally otherwise non-verbal. experience a narrowing of our True or False field of vision. For a person living 4. Declining depth perception is with dementia, this process is on the only vision issue that dementia overdrive and it may cause them to patients do not face. not see a caregiver approaching from the True or False side, or even a plate of food in front of them if they are not directly looking at it. 5. Persons living with dementia prefer Facial recognition: Dementia symptoms include confusion and memory dinner plates to be of a similar color to loss. But that may not be all that’s in play when a patient seems to not the food they are served. recognize a loved one or frequent visitor. Damage to certain parts of the brain True or False may cause misidentification of people, like thinking a man is one’s brother 6. If your patient exhibits symptoms of instead of husband. The problem similarly manifests itself in instances like sundowning, turning on the television seeing a red ball and calling it an apple. will help her focus and lower anxiety. Color and contrast decline: Problems detecting contrast are commonly True or False found in the bathroom, where the white toilet and seat disappear against a white tile floor. Mealtimes, already a challenge for some who struggle with 7. Sundowning is believed to be swallowing, is problematic when, for example, white mashed potatoes aren’t related to disturbances of the circadian noticed when served on a white dinner plate. Additionally, reduced ability to rhythm from brain changes. distinguish colors may result in a person picking out mismatched clothing. True or False 8. When a dementia patient insists on something that is not true, it’s best to correct her so that she is not confused. Problems distinguishing color True or False and contrast are commonly experienced among persons 9. Shutting the blinds before sunset living with late-stage is one way to alleviate sundowning- dementias. Caregiver tip: Serve food on a plate of a related anxiety and confusion. different color than the food True or False itself. The same rule applies to all areas of the home; it’s 10. Soft music is soothing to most difficult for the patient to dementia patients. see a white toilet seat on a white toilet in a bathroom True or False with white tile floor. Look for ways to improve contrast Find the quiz answers on the bottom throughout the home.
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