Aphasia Versus Dementia
In long term care, fluent aphasia is often mistaken for cognitive-deficits associated with dementia because the two disorders share many common characteristics. In fact, aphasia and other communication problems are commonly present in various types of dementia to some degree. Caregivers, nursing staff, and families may need specific training and may be unaware that the language deficits associated with fluent aphasias do not necessarily mean that a patient has cognitive deficits. It is important to determine the specific underlying reason for communication deficits in order to plan the best course of therapy.
To start, of course the diagnosing SLP will look for a history of CVA versus some type of dementia, and it some cases there may be a history of both. If there is a history of CVA alone, the treating therapist will want to incorporate family and staff education in order to maximize the carryover and use of specific communication strategies and reduce misconceptions regarding cognition.
I often meet staff, and even occasionally therapists from other disciplines, who state that an aphasic patient is not oriented, has poor memory, or cannot respond to questions. I have been told that a person is "oriented to person only" or "does not know her own name" because she was perseverating on a previous answer to a question or was producing clag associations (words that rhyme or are similar in sound to an intended word). Fluent aphasics are often very verbal, and require specific verbal and visual cues to cease verbalizations and listen. This is often confused with the expressive language and speech patterns seen in dementia patients.
Caregiver and family education should include:
● specific details of what the patient can do.
● contrast of the characteristics of dementia, including the pervasive and underlying presence of memory, intellect, and personality in dementia and the specific expressive and receptive deficits present in the patient.
● the progressive nature of dementia versus the sudden onset of aphasia following a stroke.
● communication strategies, including using pictures and communication boards.
● the common presence of some degree of auditory comprehension deficits with aphasia, which can be confused with memory and orientation deficits.
● teaching caregivers to always assume that the patient knows what they are are being told and asked, and to always continue to speak to the patient as an adult who understands what is being said.