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Working with Dementia patients I see a lot of language and communication problems. One of the more common problems is Aphasia, this could be imparement of speech, language comprehension, or recognition of written words, or all three. Sometimes Aphasia is also accompanied by swallowing difficulties.

There a two major types of Aphasia, Broca’s and Wernicke’s, both have their own unique characteristics.

People with Broca’s often speak in a very short and to the point manner. They can sometimes understand what others are saying, and can be aware of their own mistakes when speaking. An example of what someone may say is: “lunch now” They could mean to say “I dont want to eat lunch now.”  Or  “Are you making lunch now?” Broca’s is usually present when there is a paralysis in the right hemisphere of the brain.

Those who have Wernicke’s speak in nonsensical, long sentences with little or no meaning. they are not aware what others are saying or their own mistakes. People with Wernicke’s will invent words, this is called a “neologism.” An example of what this may sound like is: “Well, aren’t you a snoggering theatre.” Or “Mushle the reticulator up there or it won’t cumberlate!” One of the patients I care for speaks out loud all day, inventing some very interesting and sometimes entertaining combinations of words. When you speak to this patient you will get a response and can carry “conversation” though neither of you know what the heck the other is saying! I find this patient responds better to facial expressions and exaggerated body language.

I have included a couple links if you would like to read further:

Aphasia Institute Canada

Aphasia Hope Foundation

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I want to begin this entry with a brief but in my opinion accurate excerpt from an article. I have included the link so you may view the entire entry.

Glenn Smith, Ph.D.

http://www.mayoclinic.com/health/sundowning/HQ01463

“The term “sundowning” refers to a state of confusion at the end of the day and into the night. Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease. The cause isn’t known. But factors that may aggravate late-day confusion include:
fatigue, Low lighting, Increased shadows.
When sundowning occurs in a care facility, it may be related to the flurry of activity during staff shift changes. Staff arriving and leaving may cue some people with Alzheimer’s to want to go home or to check on their children — or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time during that period.

In the setting I work in, Sundowning is a common behavior.  In many cases the patients were busy people, working people with children or homes and meals to be taken care of. Because they experienced a transition in their daily activities in the evening for so many years, they seem to feel a need for a change of scenery, or feel an urgency to exit even now.

Many times the behaviors can be diverted by finding out from the patient what is they feel they need to be doing and finding an appropriate diversion. For example I find with one patient if I extend an invite to stay for dinner, explaining we would love to have the company, more times than not the patient “chooses to stay” because it is the polite thing to do! In many cases all you can do is try to distract the patient, some will respond to being re-oriented to their surroundings explaining that they are home, that there is no need for them to leave. Unfortunately not every patient will respond to re-orientation. Sometimes walking them to a different area of the floor can be enough of a change to relieve their distress, or creating a daily routine; you may need to be very creative in finding ways to de-escalate. Knowing a little about your patients day-to-day life prior to their diagnosis can help you to find triggers, what did they do for a living?  Did they have children?  What was their role at home?

Because the exact cause of Sundowning is not known, and because of the complexity of each patient, managing the behaviors associated with Sundowning can be difficult. If you can find what triggers each patient has, remain in routine and learn about your patients history, you have a few essential tools to get you started.

funny how when you take the time to really observe someone, listen to them even if the words they are using are out of context you can interpret what they actually mean to say. associate words, most of the time with dementia the words that “surface” are in the same pool as the word they intend to be using, put it into the context of the situation and its like interpreting a code. if you really listen, you will hear what they are saying.

the most valuable skill you can learn in this field is PATIENCE. you have to take your time, let the patient take their time, its amazing what they can do on their own if only given a moment to figure it out and do it. let them have what little independence they have left.

a new admittance to our floor, upon arrival is labelled as aggressive, combative, verbally abusive. really this person didn’t know where they were, what the date was, who we were and wanted to use the bathroom, the nursing staff have me answer the bell at night because i seem to “have a way” really i use simple verbal cues, one direction at a time, always enter the room with a smile and let the patient do as much for them-self as i can. seems to work well, and the patient has not displayed aggressive behavior while in my care.