How dementia changes communication
Often among the first changes families notice, alongside memory problems:
- Searching for words, or using vague ones (“the thing,” “that place”)
- Losing the thread mid-story or mid-conversation
- Repeating a question or story within minutes
- Struggling to follow group conversations, instructions or a TV plot
- Withdrawing from conversation, or becoming frustrated or quiet
- Difficulty reading, writing, or handling calls and messages
Changes vary by person and type of dementia. A clinical evaluation helps sort out what comes from memory, attention or language, since each needs a different approach.
Types of dementia
Dementia is an umbrella term for many different conditions, and the type shapes what changes first. The following are the types we see most often, and an individual may have features of more than one:
- Alzheimer’s disease
- Often begins with memory changes, with word-finding and following conversation getting harder over time.
- Vascular dementia
- Caused by reduced blood flow to the brain, from large strokes or many small ones. Planning, judgment and attention are often affected early, and some people have trouble finding words. Changes can appear suddenly after a stroke or build gradually.
- Frontotemporal dementia
- Often begins earlier in life. The behavioral variant changes personality, judgment and social behavior, and people may not recognize it themselves. Language variants (primary progressive aphasia, below) affect speaking and understanding words. Memory is often relatively preserved early on.
- Lewy body dementia
- Attention and alertness can shift from day to day, even within a day. Vivid visual hallucinations, movement and sleep changes are common, and some people develop a weak voice.
Mild cognitive impairment
Mild cognitive impairment (MCI) is a change in memory or thinking that is greater than expected for a person’s age, but does not significantly interfere with daily activities. We support the communication side, such as word-finding, following conversations and staying organized.
Primary progressive aphasia
Primary progressive aphasia (PPA) is a form of dementia in which language is the first and main thing to change, while memory may stay relatively strong at first. A neurologist diagnoses it, usually with brain imaging. There are three main types:
- Nonfluent / agrammatic
- Speech becomes slow and effortful, grammar is simplified, and sounds may come out distorted.
- Semantic
- Word meanings fade: names of objects and people are lost, and familiar words may stop making sense.
- Logopenic
- Long pauses to find words and trouble repeating longer sentences, while word meanings are kept.
How it works
- Comprehensive clinical evaluationWe talk with you both, review the medical history and any neurology, primary care or imaging reports, and assess word-finding, understanding, reading, writing, attention and memory as they affect communication. Goals are then set together, based on the results and what matters most to the person and family.
- Therapy sessionsCommunication work built around your goals, with family included whenever possible.
- Take-home strategiesMemory aids, routines and exercises the person and family can practice together at home, with a few key strategies covered briefly during sessions. Families who want more in-depth training can book separate caregiver education sessions.
- Ongoing updatesEach time a goal is met, we set a new one and check in with the family on progress, adjusting as abilities change. We coordinate with doctors and other therapists, and refer out when needed, for example to occupational therapy, counseling or other specialists.