How is language affected by dementia?

Language could not exist without memory. How can we talk of people, places, and times if we cannot remember their presence, their passage, their purpose or their particular name?

Damage to the brain in dementia leads to memory loss—and language difficulty.

Could early language changes act as a subtle sign of dementia and aid timely diagnosis and treatment?

Speech in dementia can be “fluent but empty”, with surprising words in a jumbled order. Later on, words may be lost completely, replaced by sounds or silence.

Mamie Baird, a renowned journalist and author, and Nigel Starmer-Smith, former England rugby player and commentator, both had a clear gift for words, until it was disrupted by dementia.

Mamie’s daughter, broadcaster and reporter Sally Magnusson, writes in her memoir that her mother “loved words and taught her children to cherish them too. Then, little by little, she lost them."

Nigel’s son, Charlie, describes the moment when his father stumbled, very unusually, during rugby commentary live on air. Within six months, he was “barely able to string a sentence together," such was the onset of his dementia.

Television presenter, Fiona Phillips, describes the late stages of dementia for her mother, when she “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds."

Listening to music can help alleviate stress if someone is suffering from hallucations brought on by dementia

Due to changes in the brain, people with dementia may experience frightening hallucinations, paranoia and delusions—and their words may act as a window to their troubled mind.

Retired doctor Jennifer Bute speaks of ambulances reversing into her upstairs bedroom and of being surrounded by swarms of bees in her visual hallucinations.

Just as intense are those involving the senses of sound and smell. She may be all alone yet hear the clatter of an old-fashioned typewriter or a baby’s cry, while bizarrely smelling burning.

A person with dementia may accuse you of theft, or of trying to harm them, in a distorted reality that is very real to them.

Validating feelings, removing triggers, alleviating distress, and providing distraction with music, exercise, food or photos can help—but if the hallucination is not upsetting, it is best not to intervene.

“Linguistic markers predict onset of Alzheimer’s disease,” reports Dr Elif Eyigoz and her team in The Lancet.

In the study, participants without symptoms of dementia were asked to describe, in writing, a picture of a person stealing cookies (a widely used test to assess language disorders).

Years later they were assessed for Alzheimer’s and their earlier writings analysed using artificial intelligence.

Remarkably, these small samples of language predicted, in many cases, who would develop dementia—way before the onset of any other symptoms.

Frequent repetition, misspelled words, or omission of words like “the”, “is” or “are” in notably simplified sentences were found, in retrospect, to foretell a diagnosis of Alzheimer’s.

In a different study, the writings of Iris Murdoch, who developed dementia in later life, were analysed. Writing in longhand, with few revisions and little editing, her works provided rich study material.

Sentences less complex, with fewer rare and obscure words, between 1954 (Under the Net) and 1995 (Jackson’s Dilemma), betrayed subtle signs of her cognitive well-being.

The big hope is that simple language tests will one day allow earlier diagnosis of dementia, so that treatment can be started when it has the highest chance of helping.

A new study will ask people to fill out yearly questionnaires to discover early indicators of dementia

Is it a case of use it or lose it when it comes to the brain and language loss?

So far, no studies have shown that brain training, in the form of crosswords, puzzles or bespoke computer games, prevent dementia—but research continues.

The PROTECT Study, led by the University of Exeter and King’s College London, will follow 50,000 people without dementia over the next 25 years and ask them to complete yearly questionnaires to reveal risk factors for dementia—and what works to lessen its likelihood.

Meanwhile, maintaining a healthy weight, stopping smoking, spending time with others, managing any heart conditions and taking regular exercise can promote brain health.

Day-to-day, for the person with dementia, it’s important to avoid and alleviate tiredness, pain, and illness, while maintaining routine, to aid word retrieval.

If language loss is sudden, or communication abruptly confused, it could be a sign of delirium—an acute disorder of attention which needs urgent medical assessment.

Read more: Is dementia in young people possible?

Read more: Sensory exploration and dementia

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