Speech losses• Aphasia “inability to use words as symbols for speech.” Many kinds. • Slurred and slowed speech “dysarthria”• Loss of voluntary speechRepetition, parroting speech, storytelling, repeating questions “patients are reassured by our consistent answers to their repeated questions. Whether they know it or not, patients are conducting surveys, trying to figure out what has changed and what has stayed the same. “Tracking subjects• Abrupt changes (failure to identify the subject and failure to signal a change of subject)• Generalities and slangTime delaysLoss of tactHurtful speechAggressive speech – two simple actions, walking with patients and talking in a calm voice, can soothe agitated patients. Agreeing with the patient is another helpful tactic.Agnosia, the inability to recognize sensory stimuli.• Failure to recognize objects• Difficulty recognizing places or spaces• Reading problems• Inability to perceive color• Unreliable depth perception (for example, not being able to tall where tan carpet ends and a tan wall begins)Misidentification• People in the house. This is a common misidentification in Alzheimer’s patients. The patient may think a gang has moved into the house. To make matters worse, some patients confuse misidentifications with dreams.• Misidentification of mirror images• Misidentification of televisionSundowningAbout 40% of the time a patient is in bed at night, he or she is awake, and many daytime hours are spent sleeping. This disturbance in the sleep/wake cycle throws off the person’s circadian rhythm. The common features of sundowning include an inability to track events, disorganized thinking and speech, restless or agitated behaviors, perceptual disturbances (such as delusions or hallucinations) and emotional problems. Caregivers may lie awake half the night, listening for sounds, and wondering what the patient will do next. Needless to say, this is stressful on caregivers, who often wind up in sleep deprivation. Sundowning is one of the primary reasons for transferring patients to nursing homes However, moving the patient into a nursing home adds to their confusion. Alzheimer’s patients may become psychotic and lose touch with reality. Messages behind statements:Everyone is crazy. Message: I see people doing odd things and I wonder if I am doing them, too. They take good care of me here. Message: I like feeling protected and safe.I let my son do things for me, like managing my funds. Message: Giving my son permission to do things makes me feel more in control. Things to say when the patient expresses anger or argues.• I love you, and I’m not going to argue with you.• I can understand why you’re angry. I would be angry too.• I’ll get to that as soon as I can. PaperworkMany Alzheimer’s patients have left a paperwork trail behind them. Attempts to follow this trail cause discord among family caregivers and patients. While the caregiver is working feverishly, the patient may be thinking, “What have you done for me lately?” Chances are the caregiver is ignoring his or her own paperwork to help the patient. Finances are all mixed up in Mom’s mind, and she covers her confusion with anger. One day she was especially critical. I didn’t want to argue with my mother, so I said, “I’m doing the best I can.”“You may be doing your best,” she responded, “but it isn’t good enough.” I decided to react with silence. Caregivers don’t have to fill in every blank in conversation.PitchIt’s best to avoid ending sentences on a higher pitch. While this has become a trend, ending sentences on a higher pitch turns every sentence into a question. Alzheimer’s patient have enough questions in their lives without adding any more. Moreover, as Dr. Tannen points out, a higher pitch can come across as uncertainty or need for approval. Shadowing“Shadowing,” the practice of clinging or following caregivers, is also an emotional self-defense. The patient does these things because he or she feels insecure. …Shadowing can test a caregiver’s mettle. You may literally have to pry the patient’s fingers from your arm to extricate yourself. Adding a conciliatory sentence such as “I’ll see you later” puts a better slant on the situation. Offering the patient a hot or cold drink may work as well. WisdomSome Alzheimer’s patients rediscover the simple pleasures of life, such as good soup, warm blankets, and sunny weather. … Let’s listen for the wisdom of the elderly and learn from it. If nothing else, Alzheimer’s teaches us to appreciate life – each day, each hour, each moment. The challenge of finding the words leads caregivers in new directions. We can grow in ways we never dreamed. Communication tipsVoice• Keep your voice calm.• Use a low, even pitch.• Speak clearly.• Communicate with songs and music.• Be respectful of silences.Style• Use simple words and avoid slang.• Keep sentences short.• Ask “yes” or “no” questions.• Signal changes in subject, direction, and so forth.• Repeat message for emphasis.• Rephrase message if patient is hard of hearing.Body language• Make eye contact. • Use open gestures• Avoid the raised, slapping gesture.• Approach the patient from the front or side, not from behind.• Respect personal spacePlace• Eliminate background noise.• Find a private place to talk, if necessary.• Make patient comfortable.• Avoid discussing problems in public.