The 7 A’s of dementia: aphasia

The 7A’s tool was developed to help understand the way a person living with dementia is experiencing their world and how we can learn to support that person. Each of the 7A’s represents damage to a particular part of the brain associated with cognitive losses. It is worth noting that each of the “A” words are stand alone medical terms often relating to other brain disorders.

Here are the 7A’s:

1. Anosognosia                                                   loss insight
2. Amnesia                                                          loss of memory
3. Aphasia                                                           loss of language
4. Agnosia                                                           loss of recognition
5. Apraxia                                                           loss of purposeful movement
6. Altered perception                                         loss of perceptual acuity
7. Apathy                                                             loss of initiation

Aphasia is not a disease but a symptom of brain damage which causes loss of language. Aphasia is the term used to describe someone who has difficulty with language and speech, including problems with reading, listening, speaking and writing. As dementia progresses, the communication skills of a person with dementia gradually decline and they have increasingly more difficulty expressing thoughts and emotions.

Types of aphasia

Generally, aphasia can be divided into four broad categories:

(1) Expressive aphasia involves difficulty in conveying thoughts through speech or writing. The person knows what she/he wants to say, but cannot find the words they need.

(2) Receptive aphasia involves difficulty understanding spoken or written language. The individual hears the voice or sees the print but cannot make sense of the words.

(3) Global aphasia results from severe and extensive damage to the language areas of the brain.  People lose almost all language function, both comprehension and expression. They cannot     speak or understand speech, nor can they read or write.

(4) Individuals with anomic or amnesia aphasia, the least severe form of aphasia, have difficulty in using the correct names for particular objects, people, places, or events.

It is worth mentioning that there is a specific type of aphasia called Primary Progressive Aphasia  associated with Frontotemporal Dementia (FTD) where aphasia may be the first noticeable symptom.

What aphasia in dementia may look like:

• difficulty following conversations, especially more than one
• word substitution or using the wrong word
• difficulty organizing words into sentences
• repeating or getting stuck on a word or a phrase
• not understanding what is being said
• reverting to a first language (even if not used for number of years)
• talking less and less
• social withdrawal

Communication Tips

Dementia Friends offers the following tips:

Speak to someone with dementia as you would with anyone else and keep an eye out for cues that they’re having trouble following the conversation. If the person is obviously struggling, here are some approaches you can try:

• Speak slowly and calmly
• Keep sentences short and simple
• Ask “yes” and “no” questions
• Leave lots of time for answers
• Listen very carefully, and watch for non-verbal communication
• Use pen and paper to communicate with single words or short phrases

And don’t forget to use actions as well as words to help them understand what you’re saying. For example, you could get the person’s coat and indicate with your hands the way outside.

Learning to be a good communication partner in the early stages to someone with aphasia will help you better connect with each other. The Alzheimer Society of Canada offers an info sheet on strategies to support communication at every stage of dementia.

Also, studies have shown that using pictures (on a mobile device or picture board) can help communication after speech becomes difficult. You can create your own picture board using searchable pictographic images to facilitate conversation.  This is essentially giving the person with aphasia a way to communicate.

 Jo gets the final word

Jo Huey is an author, advocate and family caregiver to her Mom who lived with dementia. For Jo, communication is about connection and not correction. From her personal experiences, Jo created and shares her top 10 list of communication tips:

Agree…never Argue

Redirect…never Reason

Distract…never Shame

Reassure…never Lecture

Reminisce…never say “Remember”

Repeat…never say “I already told you”

Say “Do what you can”…never say “You can’t”

Ask…never Command

Encourage and Praise…never Condescend

Reinforce…never Force

What communication tips have you tried with someone who has aphasia?