1. Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

2. What is Alzheimers Disease? Alzheimers Disease is a progressive neurological disorder with a slow onset that causes large numbers of nerve cells within the brain to die (Daly, 1999). Alzheimers disease is the most prevalent form of dementia.

3. What is Dementia? Dementia is a syndrome characterized by loss of cognitive functioning sufficient enough to interfere with performing normal daily activities (Daly, 1999). To have dementia, the patient must have deficits in at least 3 of these 5 areas: 1.Language 2.Memory 3.Visuospatial skills 4.Personality 5.Cognition (Glickstein & Neustadt, 1993)

4. The Alzheimers Brain The atrophy of cells within the cerebrum causes the brain to shrink (Ferrand & Bloom, 1997). The picture at the right, provided by the Alzheimers Association (2006), depicts an advanced Alzheimers brain in comparison to a healthy brain. Image by Jannis Productions and retrieved from http://www.alz.org/brain/09.asp

5. The Alzheimers Brain Several anatomical changes occur within the brain: – Gryi (or the ridges) thin, sulci (or the grooves) widen, and the cortex shrinks, damaging areas involved in thinking, remembering, and planning (Alzheimers Association, 2006). –The hippocampus, which is the area of the brain responsible for the formation of new memories, is also severely affected by the shriveling of cells. – Ventricles (fluid filled spaces) grow larger.

6. The Alzheimers Brain Image retrieved from the American Health Assistance Foundation (2006) at http://www.ahaf.org/alzdis/about/BrainAlzheimer.htm

7. The Alzheimers Brain Changes in the brain occur progressively over time. The illustration at the left shows deterioration of the brain throughout the course of the disease. As the areas for speech and language deteriorate, so do speech and language skills. Image retrieved from the American Health Assistance Foundation (2006) at http://www.ahaf.org/alzdis/about/Brain_Neurons_AD_ Normal.htm

8. Who is affected? Approximately 10% of persons over the age of 65 are affected by Alzheimers Disease (Daly, 1999). While Alzheimers is more prevalent in the elderly, it can affect the middle-aged (40+) and on rare occasions, even the young (25+) (Glickstein & Neustadt, 1993).

9. What is the life expectancy? Alzheimers patients have the outward appearance of wellness, but cognitive decline makes the average life expectancy 8-10 years after diagnosis, but it can be anywhere from 3- 20 years (Daly, 1999). Even if the individual with Alzheimers disease has no other serious illness, the loss of brain function itself will eventually cause death.

10. How is Alzheimers classified? The Global Deterioration Scale is a seven-point rating scale that assesses cognitive and functional capabilities of Alzheimers patients from normal aging to severe dementia (Ferrand & Bloom, 1997). Images by Jannis Productions and retrieved from the Alzheimers Association (2006) at http://www.alz.org/brain/08.asp

11. Stages 1 and 2: Within the Limits of Normal Aging Stage 1: No Cognitive Decline Stage 2: Very Mild Cognitive Decline Some memory lapses, usually forget familiar words and names or the location of glasses, keys, etc. Problems are not obvious to family members, friends, and medical professionals.

12. Stages 3 and 4: Early-stage Alzheimers Stage 3: Mild Cognitive Decline Earliest clear-cut deficits, though still may go undiagnosed. Word and name finding problems become obvious to family members and friends Performance issues in social and/or work situations Mild to moderate anxiety Stage 4: Moderate Cognitive Decline Clear-cut deficits upon clinical interview Decreased knowledge of recent events Trouble remembering personal history Decreased ability to travel to familiar locations Inability to complete complex mental tasks Individual may become subdued and withdrawn, especially in social situations Denial (Reisberg, Ferris, Leon, & Crook, 1982)

13. Stages 5 and 6: Mid-stage Alzheimers Stage 5: Moderately-Severe Cognitive Decline Patient can no longer live alone Unable to recall important aspects of current lives, such as telephone number, address, names of grandchildren, etc. Frequent disorientation to time and place May need help choosing proper clothing Stage 6: Severe Cognitive Decline Most awareness of recent experiences is lost Often forget name of spouse or caregiver Disruptions in sleep/waking cycles Tend to wander off and become lost Significant behavioral and personality changes like delusions and hallucinations

14. Stage 7: Late-stage Alzheimers Stage 7: Very Severe Cognitive Decline Frequently, all verbal abilities appear to be lost. There is usually only grunting but occasionally, but a few words or phrases may be uttered. Require help with feeding and toileting (Alzheimers Association, 2006) Cannot walk without assistance or sit up without support Abnormal reflexes Rigid muscles Impaired swallowing (Reisberg, Ferris, Leon, & Crook, 1982)

15. Communication and Alzheimers As a person progresses through the stages of Alzheimers Disease, the ability to communicate (including speech and language) deteriorates. Image retrieved from Historical Documents at http://www.historicaldocuments.com/RonaldReaganSpeeches.htm

16. Communication and Alzheimers Changes in communication abilities are unique and specific to each person. Individuals with Alzheimers may exhibit: Circumlocutions (word finding difficulties) Repetitions Verbal perseverations (repetition of a particular word or phrase) Deficits in pragmatic skills like turn-taking and topic maintenance (Bourgeois, 1991) Diminished vocabulary and reading comprehension Faulty linguistic reasoning (Bourgeois, 1991) Simplification of syntax (sentence structure) (Glickstein & Neustadt, 1993) Irrelevant speech

17. Communication and Alzheimers In the early stages of Alzheimers, communication difficulties are primarily related to short term memory loss, a reduced attention span and ability to concentrate, and a lack in the ability to take in information (Touzinksy, 1998). These individuals are typically aware of their problems but often refuse to acknowledge their impairments and try to cover up their difficulties. Denial begins to manifest itself.

18. Communication and Alzheimers Individuals in the middle stages of Alzheimers disease have more visible communication difficulties. They will engage in repetitive questioning and may also produce statements that make little or no sense. These patients suffer from more severe word finding problems and declined verbal communication. For these reasons, they may have difficulty maintaining a conversation and will often retreat in social situations (Touzinksy, 1998).

19. Communication and Alzheimers In the later stages of Alzheimers, verbal communication may be almost completely nonexistent. Individuals in these stages have little comprehension skills left and frequently babble. Verbal expression may be limited to a few words or phrases (Touzinsky, 1998). Individuals in late-stage Alzheimers often only retain residual knowledge of the past, a time when life made sense (Touzinky, 1998).

20. What can you (the caregiver) do to help communication? Enroll your loved one in speech therapy Be patient and supportive Show your interest by maintaining eye contact Give the person time to speak without interruption Dont criticize or correct Encourage the use of nonverbal communication like gestures Limit distractions Avoid arguments (Alzheimers Association, 2006)

21. Why speech therapy? An SLP can also teach communication strategies that will be useful as the disease progresses and more communication abilities are lost. A speech language pathologist (SLP) can provide the individual with Alzheimers with techniques to help maintain communication at their current level for as long as possible.

22. Why speech therapy? Because the caregiver and close family members are the individuals primary communication partners, the SLP will hold counseling sessions where you can voice your concerns and also teach useful strategies for maintaining communication at home. Image copyright of Mike Moreland (1993). Retrieved from http://www.faqs.org/health/Healthy-Living- V2/Health-Care-Careers.html

23. Why speech therapy? Speech therapy for individuals with Alzheimers disease is important because it helps to improve communication which will improve the individuals overall quality of life. That is the most important goal.

24. References Alzheimers Assocation. (2006). Communication: Best ways to interact with the person with dementia. Retrieved October 19, 2006, from http://www.alz.org/Resources/factsheets/Communications10_5.pdf Alzheimers Association. (2006). Stages of Alzheimers disease. Retrieved October 19, 2006, from http://www.alz.org/Resources/FactSheets/FSstages.pdf Alzheimers Association. (2006). What is Alzheimers disease? Retrieved November 5, 2006, from http://www.alz.org/AboutAD/WhatIsAD.asp Bourgeois, M.S. (1991). Communication treatment for adults with dementia. Journal of Speech and Hearing Research, 34(4), 831-844. Retrieved October 16, 2006, from the MEDLINE database. Daly, M.P. (1999). Diagnosis and management of Alzheimer Disease. The Journal of the American Board of Family Practice, 12(5), 375-385. Retrieved November 1, 2006, from the MEDLINE database.

25. References Ferrand, C.T., & Bloom, R.L. (1997). Introduction to organic and neurogenic disorders of communication. Needham Heights, MA: Allyn & Bacon. Glickstein, J.K., & Neustadt, G.K. (1993). Speech-language interventions in Alzheimer's disease: A functional communication approach. Clinics in Communication Disorders, 3(1), 15-30. Retrieved September 29, 2006, from the MEDLINE database. Reisberg, B., Ferris, S.H., Leon, J.J., & Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136-1139. Touzinsky, L. (1998). Validation therapy: Restoring communication between persons with Alzheimers disease and their families. American Journal of Alzheimers Disease, 13(2), 196-201. Retrieved November 1, 2006, from the PsychINFO database.