5.5 - Cognitive symptoms and communication difficulties

Cognitive symptoms and communication difficulties

A person who has suffered from a dementia disease sooner or later also suffers from various cognitive symptoms which, individually or together, lead to communication difficulties. Such things as memory, language and other abilities connected to our intellect are affected and deteriorated, and the further into the dementia the person is, the more pronounced these symptoms also become. Memory problems and forgetfulness are among the symptoms that people generally associate with dementia. Here is a brief description of some of the most common cognitive symptoms that usually affect people with dementia and that make communication more difficult.

Aphasia stands for linguistic inability and means that the persons has problems with either expressing themselves, understanding spoken language, or a combination of these two. It can manifest itself in various ways, for example as amnesia or anomie, which are summarized below.

By amnesia is meant memory loss, which for people with dementia means that the ability to remember and create new memories gradually deteriorates and eventually disappears completely. The most common is that short-term memory is affected first, while experiences and memories from early childhood often remain intact.

Anomie expresses forgetfulness and is something that usually occurs relatively early in the course of the disease. The affected person often forgets the words for ordinary objects and events, which often leads to attempts to use paraphrases to express what is meant. For example, if the person forgets the word for “toothbrush”, they can instead try to describe in other words what the toothbrush should be used for.

Agnosia involves problems with interpreting different sensory impressions. It can affect all our senses, such as taste, smell, sight, hearing and touch. A person who suffers from agnosia thus finds it difficult to interpret the sensory impressions, even if, for example, sight, hearing or feeling itself is not affected. In concrete terms, this means, for example, that the sufferer has difficulty understanding what he sees even if the eye functions as usual, that the food may taste and smell different, and if the hearing is affected, the sufferer finds it difficult to understand, for example, spoken words or other sounds.

Apraxia means no longer remembering how to perform previously learned activities and daily chores. For example, a person suffering from apraxia may forget how to use a knife and fork at a meal, how to use a toothbrush, or how to put on clothes in the right way and in the right order. Since the different abilities are maintained longer the more they are used, it is important that the staff at a home does not take over but both encourages and supports the sufferer in coping with things on their own. This may, for example, involve presenting one garment at a time when dressing, or helping the person at the meal by guiding the hand to the mouth to initiate the movement. At meals, it is also good to eat with others because the victim can then see and imitate movements and behaviors.

In addition to this, there are a number of more or less common symptoms such as ekolalia (a compulsive and unintentional repetition of other people's words), palilalia (a repetition of one's own phrases and utterances, not infrequently with an increased speed towards the end of the utterance), mutism (inability to speak) and confabulation (if the person does not remember what happened, he creates his own pictures and stories about the event). Some people may exhibit a so-called screaming behavior at the end of the disease, which means that the person with a loud and desperate voice screams or shouts often or almost all the time. The reason for the behavior is unclear, but it is believed that it is probably due to a feeling of existential anxiety and the experience of being in a fragmented and incomprehensible world.

The above-mentioned symptoms can occur to varying degrees both due to the type of dementia the person has suffered from as well as how far along the disease is. Therefore, not everyone suffers from all the symptoms and it is important to try to understand and interpret the expressions of each individual person.

The video below shows a situation where an assistant nurse leaves a patient with dementia, Berta, alone with her evening toilet.

Reflective questions

* Reflect on the situation: what's going on with Berta?

* What consequences does it have for Berta that the assistant nurse left her alone?

* Give suggestions on how the assistant nurse could have done instead.

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