A few weeks ago, I made a presentation about Alzheimer’s disease to a group of notaries public. I had been asked to present information that could help them recognize when a signatory might have cognitive issues. I wasn’t there to tell them how to do their jobs, just present the information. That entailed details about the staggering numbers of people expected to be affected in the near future, definitions of dementia and Alzheimer’s, a simple framework for what happens in the brain, the stages of Alzheimer’s disease, and ten warning signs of cognitive decline as opposed to normal aging.
A notary is tasked with ascertaining whether a potential signatory is capable of understanding the document that they are being asked to sign, and my presentation gave them some clues to look for, and pitfalls to avoid. Information such as, “Just because someone carries a diagnosis of dementia doesn’t mean they cannot understand the document.”
They seemed to be most interested in the warning symptom of language difficulties. This would be the most obvious aspect of the disease that a complete stranger might pick up on. So we spent a good deal of time here.
Word finding problems, or anomia, is the most obvious deficit. We have all experienced this—the word we want is on the tip of our tongues. For me, when the word finally comes to me, I blurt it out, usually after saying, “You know, it’s one syllable, starts with ‘M.’” Names are notoriously hard as we age. With Alzheimer’s and other dementias, this word finding issue is just more persistent, and the person doesn’t usually even remember that they had forgotten a word or a name.
A person living with dementia may learn to talk around the forgotten word, and can be so skilled at it that the person in conversation with them doesn’t even notice. This is termed circumlocution. When it’s obvious, it can be quite humorous. “Zebra” may become “the horse with stripes.”
I noticed that Harvey would always respond, “Yes,” to any yes or no question. I think it was just easier. Other persons with dementia will default to “No.” The notaries public I addressed knew to ask open-ended questions because of this. Later in the disease process, open ended questions would be too difficult, so simple yes or no questions may be your default.
Another language quirk sometimes seen is echolalia, when the person repeats what you’ve said verbatim. It can make it seem that they completely understand you, but if you ask them to explain or put it in their own words, it might be impossible for them.
A person living with dementia may substitute a related word for the one they want, such as “computer” instead of “television.” Sometime the substituted word sounds similar, but has a completely different meaning. “Floor” becomes “flower.”
Sometime, they may blank on the word altogether, and conversation stops. Sometimes a nonsense word comes out, one with jumbled sounds. Sometimes the jumbling can result in a real word, but is inappropriate. Harvey once said “sibling” when he meant “blessing.” All of the elements of the word were there, just mixed up.
Another aspect of language difficulty is losing track of a conversation. Because they cannot hold onto a thought for long, their discourses can be disjointed, jumping from topic to topic.
Comprehension of verbal and written language is almost always affected at some point.
Many persons living with dementia know that their language skills have deteriorated and choose to keep quiet, perhaps letting their care partner do all the talking. It might make the affected person appear aloof, indifferent, or unfriendly.
Talking to the group of notaries public reminded me that we all encounter persons living with Alzheimer’s disease or another dementia in our daily or our working lives. Because we don’t know a person’s cognitive abilities, patience and kindness will go a long way in our conversations, even with strangers.