Alzheimer’s Disease From The Scope Of An SLP

Written by: Kendra Wormald / Medical Rehabilitation / April 19, 2023 / 10 minutes read

This piece serves as a contribution to the series investigating neurodegenerative conditions from the perspective and scope of a Speech-Language Pathologist.

Definition

There is often confusion surrounding the concepts of cognitive decline, with the terms Dementia and Alzheimer’s frequently being used incorrectly. 

The Alzheimer Society provides clarification between the two: 
“Dementia refers to a set of symptoms and signs associated with a progressive deterioration of cognitive functions that affects daily activities. It is caused by various brain diseases and injuries. Alzheimer's disease is the most common cause of dementia” (2023).

The Science

Alzheimer's disease is thought to be caused by a build-up of proteins in and around brain cells. Plaques in the brain are formed from the overproduction of beta-amyloid protein. These plaques wedge between neurons and interfere with cell function. Cells are injured and subsequently die throughout the brain and areas of the brain begin to shrink. Also, neurofibrillary tangles, which are made of the accumulation of tau protein, collect inside the neuron. These proteins, that normally bind to and stabilize microtubules, link to other tau molecules - causing tangles. These tangles block the movement and communication of neurons. 

Cause and Prevalence

Over 747,000 Canadians are living with Alzheimer's or another dementia. Worldwide at least 44 million people live with this disease. 

One risk factor alone may not lead to Alzheimer’s but rather a combination of factors related to genetics, environment, age, changes in the brain and lifestyle. The impact each factor may have on each person may vastly differ.  

• Age is one of the greatest risks for Alzheimer’s, typically occurring in those ages 65 and older. Following 65, the risk doubles every five years (Alzheimer’s Association, 2023) 

• Genetics and family history may increase the risk of acquiring this disease. If you have a parent, brother or sister with Alzheimer’s, you are more likely to develop the disease. Research shows that there are two genes that influence whether a person develops this disease - risk and deterministic genes (Alzheimer’s Association, 2023) 

• Your health history such as head injuries, conditions that damage the heart and blood vessels such as diabetes, heart disease, stroke, and high cholesterol or blood pressure (Alzheimer’s Association, 2023) 

Symptomatology

Symptoms of Alzheimer’s can vary from person to person. Often memory challenges present as an initial sign of the presence of the disease. Different stages of the disease may express symptoms differently and more intensely. Someone may be aware and frustrated by the changes while others may not have the same level of awareness.  

Often symptoms present as: 

• Overall challenges with memory 

• Losing track of dates or not knowing where you are

• Increase in the time it takes to complete tasks 

• Losing track of where you left items 

• Misplacing items

• Forgetting names and faces 

• Forgetting newly learned information

• Forgetting familiar routines 

• Challenges with reasoning and thinking through steps 

• Making irrational and impulsive decisions 

• Increase is the presence and severity of psychological conditions such as anxiety and depression 

• Trouble understanding visual images and spatial relationships

• Difficulty with completing familiar tasks 

• Forgetting common words in speaking and writing

• Changes in mood and personality 

• Challenges with organizing and expressing thoughts 

(Mayo Clinic, 2023, Alzheimer’s Association, 2023, National Institute of Aging, 2017)

Symptoms of Alzheimer’s can vary from person to person. Different stages of the disease may express symptoms differently and more intensely.

Stages

Mild Alzheimer’s Dementia: Most people are able to function independently in many areas of life but often require support with various activities, particularly with finances and needing more time to complete tasks.

Moderate Alzheimer’s Dementia: Often the longest stage, where people often experience increased challenges with memory and language, confusion and difficulty recognizing familiar people, and completing multi-step tasks. Behavior and mood changes may also occur at this time. 

Severe Alzheimer’s Dementia: Verbal communication will likely be significantly challenging and often will require full time support. Swallowing may also become difficult due to damages to the brain involved with movement.

Impact On Communication

• Withdrawal from social activities and communication 

• Increase in saying repetitive statements 

• Challenges with word finding and forgetting word meaning

• Challenges with reading, writing and working with numbers 

• Reduced attention during longer conversation 

• Difficulty following along or joining in on conversation 

• Reduced ability to remember what you had just said 

• Sensitivities to tone and loudness of voices

• Increased use of inappropriate language 

• Reverting to first language learned 

• Mixing unrelated ideas together 

• Difficulty with accurately being able to express yourself 

All of these challenges may lead to a breakdown in the forward flow of communication. 

The symptoms of Alzheimer’s disease typically become more frequent and severe as you age. It’s important for these individuals to continue to have the right to the highest level of care, consideration and quality of life. The Alzheimer Society communities this effectively;

“ . . . each person with dementia is an individual, regardless of the stage of the disease, and that care should be individually tailored to their unique needs, interests, habits and desires.” (2020) 

How to Support Communication 

• Communicate in brief and direct statements 

• Use keywording to express main ideas and important concepts

• Don’t ask too many questions at a time 

• Don’t provide too much information or directions at a time 

• Use photos, visual schedule or other reminders to support memory 

• Offer corrections as suggestions

• Reduce distractions 

• Support the use of nonverbal communication 

• Direct your face towards them 

• Ensure you make eye contact

• Avoid open ended questions

• Speak clearly and slowly 

• Give them time to respond 

• Encourage and welcome them into conversation 

• Provide simple options to support decision making

(Alzheimer Society, 2023, Mayo Clinic 2021, Leisure Care, 2022)  

Our Masterclass on Communication Wellness can be found here.

Impact on Caregivers and Close Others

Alzheimer’s Disease can evidently be overwhelming not only for those living with it, but also for their caregivers, friends and families. Be sure to take care of yourself and intentionally reflect on your thoughts, behavior, tone and mood. Speaking to a psychotherapist may be a supportive avenue to consider. 

A Speech-Language Pathologist can provide clinical perspective and support for those living with and affected by Alzheimer’s Disease. Together or individually, you will work with the clinician to address topics such as understanding the breakdown of communication abilities, strategies, supportive technology and communication partner training. As Alzheimer’s Disease is a progressive neurodegenerative disease, different amounts and types of support throughout the process may be necessary. 

To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.