As per data from Mayo Clinic, 2022, Alzheimer's disease (AD) is the most common neurodegenerative cause of dementia, accounting for approximately 60–80% of all dementia cases worldwide. AD is a progressive degenerative condition, primarily affects older adults, with advancing age representing its strongest risk factor and it is among one of the most feared conditions of aging.
A diagnosis of AD often leads to shock and inability to accept the condition. There is a significant gender difference in the incidence of AD. As women have more longevity and increase in age is a risk factor for developing AD, reports indicate a higher prevalence of AD among women across all regions of the world.
AD begins long before symptoms are noticed. Early signs of dementia include subtle changes in memory, thinking, language and behavior, which tend to worsen over time. It progresses through three broad phases-early, middle and late stages.
During the early phases, a person may have memory lapses and may lose track of time and place. They may also have difficulty finding words during speech. However, individuals in this phase are able to carry out their daily routines independently. During the middle phase, the symptoms will start progressing. They may forget recent events and personal history.
Persons at this stage may also present with mood changes. During this phase, the person may need occasional assistance from others for complex routine tasks. Behavioral changes become evident at this phase and individuals start getting agitated. They may also develop unfounded suspicions.
In the late-stage, individuals' overall physical and mental functions continue to deteriorate and participation in mainstream society becomes impaired. Verbal communication becomes more challenging and they may have difficulty following conversations. They may require total assistance with eating, dressing and all other daily self-care tasks.
Individuals being diagnosed with AD is on the rise and according to WHO, current projections estimate that the global prevalence of AD will nearly triple by 2050, making it one of the greatest public health challenges of the twenty-first century. This necessitates the need for early identification and timely management of symptoms in AD.
Early diagnosis gives patients and families valuable time to understand the condition and prepare emotionally. This leads to better access to the right services and support which helps provide an increased quality of life. A good quality in the early phase of AD can be maintained for several years. Early management helps to preserve the patient's level of function for longer. Identifying individuals at risk can help healthcare professionals recommend lifestyle changes that can delay or slow down the onset of AD.
Communication is central to independence and quality of life. Difficulty expressing a need can make it harder to communicate with family members, doctors, caregivers and other service providers. A person who cannot easily find the right words may become frustrated, withdraw from conversations or avoid social situations.
As Alzheimer's disease progresses, communication difficulties can also affect the ability to participate in healthcare decisions, manage everyday activities and maintain social relationships. Therefore, communication should be considered an important component of dementia care rather than an issue secondary to memory loss. Language difficulties may emerge early in the course of AD, with declining performance on naming and word-retrieval tasks being commonly observed.
As the disease progresses, higher-level or macro-linguistic language abilities may also become increasingly impaired. These include the comprehension and use of non-literal language, such as metaphors and sarcasm, as well as the ability to maintain thematic coherence during discourse.
Individuals may demonstrate reduced global coherence in structured interview tasks, reflecting difficulties in maintaining a central topic, organizing information, and conveying ideas in a logically connected manner. These changes can significantly affect functional communication and participation in everyday social interactions.
A speech-language pathologist (SLP) plays an important role in the process of early identification, assessment and management of communication difficulties associated with Alzheimer's disease (AD). The SLP may evaluate a range of language and communication abilities, including object naming, word retrieval, comprehension of increasingly complex information, organization and description of events, conversational skills, ability to follow instructions, and effective communication in everyday situations.
Such assessment provides valuable information about an individual's current communication profile, identifies areas of impairment, and helps determine appropriate intervention and support.
Speech-language intervention in Alzheimer's disease is primarily aimed at maintaining communication and participation for as long as possible. Depending on the individual's abilities and stage of the condition, intervention may include structured language activities, word-retrieval strategies, conversational practice, memory and communication supports, and activities designed to strengthen the use of remaining abilities.
Therapy may also incorporate external support, such as written cues, photographs, calendars, communication books and familiar environmental prompts. These strategies can help the individual communicate more effectively even when some cognitive abilities have declined. An equally important part of intervention is caregiver training. Family members can learn how to communicate more effectively by using short and clear sentences, allowing additional time for responses, reducing unnecessary distractions, offering appropriate cues, and avoiding repeated correction when it causes frustration.
A diagnosis of Alzheimer's disease does not mean that communication suddenly loses its value. Even when verbal communication becomes limited, people can continue to express emotions, preferences and needs through facial expressions, gestures, tone of voice, familiar routines and other forms of non-verbal communication.
The goal should therefore not be simply to measure how many words a person can remember. It is to help the individual remain connected with other people and participate in meaningful activities for as long as possible. Family members also play a crucial role. Instead of completing every sentence or answering on behalf of the person, caregivers can give sufficient time for the individual to respond.
Asking one question at a time, using familiar topics, maintaining eye contact and acknowledging the person's message can make communication more successful.
There is understandable fear surrounding a diagnosis of Alzheimer's disease. However, knowing what is happening can allow individuals and families to make informed decisions, plan care, address communication difficulties and seek appropriate professional support.
Alzheimer's disease may progressively change memory and communication, but appropriate support can help preserve connection, dignity, participation and quality of life. When memory changes, listen to the language too. Sometimes, the earliest clues are not only in what a person forgets, but in how they communicate.
Girija PC, Professor and Head, Dept of Audiology and Speech Language Pathology, AWH Special College, Kozhikode
Hana Basheer, Asst Professor, Dept of Audiology and Speech Language Pathology, AWH Special College, Kozhikode