Your loved one picks up a pencil, and instead of calling it a pencil, they call it a cup. Or a fork. Or a notebook. They just can’t get the right word out.
Language difficulties are one of the most frustrating symptoms that can happen in dementia, for the person with dementia and for you as the caregiver. One of them is something called aphasia.
What Is Aphasia in Dementia?
Aphasia is a condition that affects a person’s ability to communicate. It can be pretty common in dementia, because dementia impacts the part of the brain responsible for language. Usually, aphasia is caused by damage to the left hemisphere of the brain, which houses our language abilities.
To break it down on a very basic level, there are two broad categories:
- Receptive aphasia, trouble understanding language
- Expressive aphasia, trouble expressing it
Somebody can have one or the other. Or they can have both.
Receptive Aphasia: When They Can’t Understand What You’re Saying
Receptive aphasia, sometimes called comprehension aphasia, is about comprehending. It affects a person’s ability to understand language.
Your loved one can hear your words. They just aren’t understanding what you’re saying.
You might notice it when:
- You ask a simple question, and they can’t respond appropriately.
- They can’t follow simple instructions.
Either one could be a sign they’re having a hard time comprehending the words you’re saying.
Expressive Aphasia: Trouble Finding and Saying the Right Words
Expressive aphasia is where the person has difficulty expressing their words. Trouble finding words is how a lot of caregivers first describe it. It’s sometimes called Broca’s aphasia, because it primarily involves an area of the brain called Broca’s area.
One easy way to remember it: expressive aphasia affects their ability to express themselves, and with Broca’s aphasia, their speech can sound broken.
They might not use the correct words. Speaking can be very effortful, and putting sentences together can be so difficult that you have a hard time understanding what they’re trying to say. That’s the pencil that comes out as a cup or a fork. Other times, instead of complete sentences, they speak in fragmented ones.
What Aphasia Feels Like, for Both of You
Can you imagine knowing exactly what you want to say, knowing what you’re trying to communicate, and when you open your mouth, you just cannot say it? That’s expressive aphasia.
Or can you imagine someone is talking to you, very clearly trying to get you to do something, and you’re trying with all your might to understand them… and you can’t? That’s receptive aphasia.
Both can be incredibly frustrating for the person with dementia. And for you.
How to Communicate With Someone Who Has Aphasia
If either type is present, one thing you can try is working in more nonverbal communication:
- Gestures
- Body cues
- Facial expressions
- Written words or images
That kind of communication can work well for people who have aphasia.
Ask for a Speech Therapy Evaluation
But my biggest recommendation is to request an evaluation with a speech therapist. Sometimes they’re called a speech pathologist (or speech-language pathologist). It’s the same thing.
A full, comprehensive evaluation isn’t just about seeing the level of impairment in their speech and what they’re still able to do. I’ve worked with some amazing speech therapists, and one of the greatest things they can do is take what your loved one is struggling with and develop the best ways for the two of you to communicate, based on their level of impairment.
That’s priceless, quite honestly.
Trouble With Words Doesn’t Always Mean Aphasia
People with dementia can have problems with language or understanding from time to time, and it doesn’t necessarily mean they have aphasia. They could be:
- Having a bad day
- Sleep deprived
- Seeing a visual hallucination, which makes it hard to focus on what you’re saying
- Having a hard time hearing
Whenever we talk about any symptom, it’s really important not to hang on to one thing and lump it all together as “oh, it must be this.” That’s why a thorough evaluation is always important.
I go through another reason answers can come slowly in why people with dementia take longer to respond.
You May Have to Ask for the Referral Yourself
So, do you think your loved one might have aphasia? If so, would you consider talking to their medical provider about a speech therapy evaluation?
From personal experience, specialty appointments like this one are often something the family member has to initiate and ask about, rather than waiting for the health care provider to recommend it. Sometimes they’re just not thinking about it as a possibility.
If you’d like help getting ready for that conversation, I go through how to prepare for the next doctor’s appointment.
It can absolutely help reduce frustration and stress in your home when communication is better.
If you’d like help with what to do in these really difficult moments, how to manage the stress, and how to build a better relationship with your loved one while making the best decisions you can for both of you, that’s what we work on together inside the Care Collective. I get to know you personally there. You can learn more here.
