Enhancing Communication Skills

Adapted from ADVANCE for Speech-Language Pathologists and Audiologists

Knowing what skills are retained as a person progresses through the stages of dementia can help clinicians stabilize patients and maximize their communication. In very early stages, changes are often undetectable but increase as the dementia progresses. Due to the decline in memory, individuals in moderate stages may repeat themselves frequently. Abstract language also begins to decline. Patients will still be able to recall the immediate past, but may have difficulty staying on topic in conversations.

Individuals at the mild level may be able to answer open-ended questions. When this is no longer possible, multiple-choice questions can be employed. People with mild dementia can still follow one-to-two directions. They are able to provide information about familiar objects and they initiate conversation. Many continue to experience lucid moments and express a desire for control over their environment.

With moderate to severe dementia, critical areas of functionality are affected. The visual system remains intact for a while, but the motor system seems to fail in their ability to write and feed themselves. At this time, a switch to finger food would be appropriate. Patients with end-moderate to severe dementia may still introduce themselves, but are unable to follow anything more than a one-step direction.

At the very late stages of dementia, patients might understand pictures but they will probably not know the day and year. They might still answer yes/no questions and some may be able to understand the printed word, but many are no longer verbal. In addition, many experience difficulty in swallowing. Seventy percent of patients with advanced dementia will need a swallowing evaluation. In the final stage of dementia, patients have typically lost almost all independent function.

According to Susan Rowe, MS, CCC-SLP, the best way to reach people in end-stage dementia is through sensory input in terms of touch, taste and hearing. "Make sure their hearing is adequate, and try to be soothing."

Oral care is crucial at the end stage. "Studies have shown a direct correlation between being a dependent feeder, having poor oral care and being at extreme risk for aspiration pneumonia," says Rowe.

Procedural memory often is retained for a longer period than other types of memory. Procedural memories are ingrained routines that are learned throughout life. For example, an individual with late-stage memory loss may not be able to independently brush his or her teeth, but if a caregiver hands the individual a toothbrush with toothpaste applied, he or she may be able to perform the activity. Singing songs is another function of procedural memory that can be used to increase communication.