Conversations

When Jim developed dementia, one of the things I missed the most was our conversations. No matter what the daily schedule, we always took time to drink a cup of coffee and talk. Most of the time, our first cup of coffee was in bed propped up on our pillows.

Our first indication that Jim had dementia was the day he couldn’t remember his social security number or his birth date. To forget any date, much less his birth date, set off the alarms in my head.

At first, he still looked and sounded the same. As time passed, he became vague in his speech and searched for words for common objects. He often became frustrated when he couldn’t communicate.

Gradually, our conversations became less meaningful until after a few years, Jim developed aphasia and became mostly nonverbal. He used what I refer to as “stock” phrases. Some of his favorites were “right here, but I can’t find it” or “I have no idea” or “is that right?” and “you’re going the wrong way.” I saw him have conversations with strangers, and he inserted enough “is that right’s” that the person had no idea that Jim had dementia.

After you are around someone with dementia, you are more attuned to the language changes that indicate an underlying neurodegenerative disorder. Subtle changes in speech may occur up to a decade before the onset of dementia, or as in Jim’s case, a short time. Researchers are using speech patterns as a way to identify at risk individuals with mild cognitive impairment (MCI) and those who are in the earliest stages of dementia.

1.      Rambling and Non-specific Speech. People with MCI may use more words than necessary when they speak. Individuals in the early stages of dementia will have trouble finding the correct words, talk in simplified sentences, and make more grammatical errors than normal. Word finding may lead to calling objects by the wrong name, for example calling an apple an “orange.” It can also lead to a lengthy description instead of a word. When they can’t recall the word “book,” they may say, “You know, that thing with words and those things you turn…”

2.      Formulaic Speech. Formulaic speech is a more scientific version of what I referred to earlier as Jim’s “stock” phrases. Using a lot of common phrases repetitively such as “you know what I mean” when a person cannot express what he or she is trying to say.

3.      Weak Language. A person with dementia may start to speak in fragmented sentences and not finish complete thoughts. They stop using less common words and use fewer meaningful adverbs or adjectives.

4.      Not Understanding Written Language. Along with speech problems, persons with cognitive problems may have trouble reading. They might be able to recite written words, or even read a book, but not fully understand what they have read. Jim was a prolific reader and we were regulars at our local independent bookstore. I began to notice that Jim sometimes bought a duplicate or triplicate of the same book. He was reading, turning the pages, but he couldn’t follow the storyline.

5.      Unusually Rude Speech. As language skills erode, frustration can make a person with dementia rude. If the part of the brain is damaged that filters thoughts from being spoken aloud, the brain doesn’t censor what comes out of the mouth. After Jim quit smoking and stores relegated smokers to benches near the entrance of the store, Jim would shake his finger at complete strangers and say, “You better quit that damn smoking.”

6.      Repetitive questions. Individuals with dementia often use repetitive phrases or ask the same question multiple times. When short term memory is affected, they may not realize they are repeating themselves. As annoying as it is, it is best to validate the person with an acknowledgement they have spoken. 

The stage of dementia and the type of dementia affects communication to different degrees and in different ways. It is sad that a degenerative brain disease can so adversely affect a person who was once highly intelligent and a great conversationalist.

When I watch old videotapes of Jim, I realize how much I missed his jokes, observations, and singing during the last several years of his life. But most of all, I missed our conversations over our morning coffee.

Copyright © November 2019 by L.S. Fisher

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