If you have a family member who has been diagnosed with dementia, you may not have noticed yet any particular difficulties with communication or behaviour. However, these areas are linked, and they are commonly a challenge for carers, families, and the individuals directly affected. This is the second article in a short series of three that we have produced on the subject of dementia and communication, for Mental Health Awareness Week 2017.
Most people who get dementia do eventually find communication difficult. However, the ways in which they experience the difficulties will be slightly different, depending on which part of their brain has been affected by the illness.
Why does dementia affect communication?
Different forms of dementia affect different parts of the person’s brain, particularly the cerebrum. The cerebrum is split up into sections, and these are called ‘lobes’. The main lobes that affect communication directly are the frontal lobe, the parietal lobe, and the temporal lobe. The occipital lobe tends to affect vision.
The frontal lobe tends to affect organisational and planning activities, including judgement, and decision making. While it may not seem like an obvious problem for communication, in fact the way we choose the right words in the right order so we can make sense is very much related to the frontal lobe. Not only that, it also makes it very difficult to find the right word to match an object, person, animal, and so on. This latter problem is known as aphasia.
The parietal lobe is divided into two main areas, right and left . Most people are right handed, and this means the left side of their parietal lobe is dominant.
The dominant side of the parietal lobe structures information in our minds, and affects reading and writing, using words, calculations, the person’s attention, their concentration, and perception.
This means the person’s communication options may become more narrow, as even writing things down, or reading what someone else has written may prove to be too hard.
The temporal lobe most often affects memory. Memory is a multi-faceted function of the brain, and there are several types we use on a daily basis.
The memory type most affected by damage to the temporal lobe is episodic memory. Episodic memory recalls events, for example, remembering a wedding, a discussion, or where you put your keys. Episodic memory functions in several concurrent ways, including the ‘encoding’ - how we learn and retain information – and the ‘retrieval’ - how we get the information back again.
The way episodic memory relates to difficulties in communication can be around remembering words — the right word for the circumstances — the order in which they should be spoken, and the sound of them. It doesn’t affect their understanding of the meaning of the words, however.
Semantic memoryis about how a person remembers the meaning of words. Also caused by problems in the temporal lobe, this is characterised by not understanding what other people or the person themselves have said, and not understanding things through reading. Problems with the semantic memory, therefore, can result in especial difficulties in expressing and receiving information.
Different types of dementia and the parts of the brain they affect
Alzheimer’s disease is one of the more widely affecting, common dementias, and most often causes damage to the parietal, frontal, and temporal lobes. Damage to the temporal lobe can make it hard to remember who people are, recalling words just when they need them, or getting them into the right order. It can also mean they don’t know what words mean when they hear or see them, and can make reading and writing slow and increasingly difficult. Don’t forget, however, because everyone is different, their illnesses can manifest in different ways, so even if two people have Alzheimer’s, that doesn’t mean they will both display exactly the same problems.
Another type of dementia is known as Frontotemporal dementia, and sometimes as ‘Pick’s disease’; this causes problems with the frontal lobe and the temporal lobe most often. This means finding the right words, putting them into usable sentences and reading and writing may become more and more difficult as the person’s illness progresses.
Vascular dementia is caused by one or more strokes — where a loss of blood flow, often as a result of a blood clot in the brain causes brain damage. Vascular dementia can affect any of the lobes or the limbic system of the brain, depending on where the damage has been done. If a blood clot formed in the area of the frontal lobe, they might find it difficult to make full sentences when they speak, or they might find it difficult to find the right words to describe items or people.
Dementia with Lewy Bodies (DLB) affects the parts of the brain that have the presence of the proteins known as Lewy bodies. Again, like vascular dementia, the effects on the person’s communication will depend on the location of the problem in the brain.
How you can help understanding and communication for someone with dementia
By understanding the exact form of the disease of the person you care for, which parts of their brain are most affected, and how that is likely to manifest for them as their illness progresses, you will be able to plan ahead. Coming up with useful and interesting adaptations to improve communication can be a creative and interesting exercise, and you will find some ideas in the final part of this three-part series.
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