If you’ve ever know someone with Alzheimer’s then you know how destructive it is.  Alzheimer’s is the progressive deterioration of a person’s mental functions that is due to generalized degeneration of the brain. Alzheimer’s usually occurs in middle to old age and is the most common cause of premature senility. There are 7 stages of Alzheimer’s that a patients must endure. Many areas of language are affected by this disease, including semantic memory, working memory, language comprehension, Grammar complexity, syntactic comprehension, and communicative competence like sarcasm and metaphors. All of these areas are important for normal language and social interactions.

During the first stage, a person is unlikely to know that there is anything wrong. They won’t show any noticeable impairments that people with a recognizable case of Alzheimer’s would have. They will have no memory problems, nor will they have any noticeable symptoms of dementia (7 Stages of Alzheimer’s, 2000-2017). During stage 2, the emergence of slight memory problem may become noticeable but nothing that will cause alarm. For example, they might lose things around the house or forget where they placed an item. If given a memory test, this person would still probably do well on it. Forgetting things is a part of aging, so these symptoms will likely go unnoticed by a physician and their family members (7 Stages of Alzheimer’s, 2000-2017). During stage 3, the symptoms just start becoming noticeable to friends and family. They’ll start to notice problems in the person’s memory and cognitive functions. The patients will have difficulty finding the right word in conversations and remembering the names of new people they meet. They may continuously lose or misplace their possessions and they also have trouble planning and organizing (7 Stages of Alzheimer’s, 2000-2017).  If a physician gave the patient a memory and cognitive ability test, their performance scores would raise some red flags. Language during the early stages of Alzheimer’s is not effected quite yet. The patient can still participate in meaningful conversations and social activities, but there are difficulties for them. They will often repeat stories, have trouble finding the correct word to use, and feel overwhelmed if they become overstimulated (Alzheimer’s Association, 2016).

Stage 4 is when the symptoms of Alzheimer’s become clear and cannot be mistaken for another disease. In stage 4 of Alzheimer’s, patients have difficulty with simple mathematics and they start forgetting details about their life. They start having very poor short term memory, like not being able to remember what they had for breakfast that day. Individuals will also have difficulty with math related problems, like managing finances or paying bills if they were able to do so before (7 Stages of Alzheimer’s, 2000-2017). During stage 5, there is a moderate decline in the patient’s cognitive functions. Patients will now need help with common daily activities that seem mundane for people without Alzheimer’s. Patients during this stage may experience significant confusion, like the inability to recall simple details about themselves. Details such as remembering their own phone or their home address. They also have trouble dressing themselves appropriately for occasions. In stage 5 patients are still able to recognize their family members, use the toilet and bathe independently, and remember some details from their childhood (7 Stages of Alzheimer’s, 2000-2017). Language during the moderate stages of Alzheimer’s will start to noticeably become more difficult. The patient will have a harder time communicating and will require more care and patience (Alzheimer’s Association, 2016).

Stage 6 is associated with a severe decline of memory and cognitive functions. Patients who are in the sixth stage of Alzheimer’s must be constantly monitored and require the use of professional care. The symptoms of stage 6 include confusion or unawareness of their environment and surroundings, as well as major personality changes and possible behavior problems. They will need assistance with daily activities such as going to the bathroom and bathing. They will lose the ability to recognize faces except for close friends and family members. They won’t be able to remember most of the details from their past. They experience the loss of bladder and bowel control and they will wander aimlessly around their environment (7 Stages of Alzheimer’s, 2000-2017). The final stage of Alzheimer’s is stage 7, which is associated with very severe decline. Since Alzheimer’s is a terminal disease, the final stage deals with patients who are close to death. At this point, the patients have lost all ability to respond to their environment and communicate. When they do manage to communicate they are limited to only word utterances and short phrases that don’t have significant meaning (7 Stages of Alzheimer’s, 2000-2017). They have no recollection of their condition and they need help with all daily activities. Eventually the patient loses the ability to swallow and breathe (Alzheimer’s Association, 2016).  Language at this point is almost obsolete.

Alzheimer’s affects many important areas of language that allow us to communicate with our environment properly. Semantic memory gives meaning to a person’s sensory experiences and is a part of their long term memory. It’s a person’s knowledge about the world that is acquired over the course of their lifetime. Some examples are the remembering the names of loved ones and the names of objects. When patients with Alzheimer’s are given semantic memory tests, their test results show that they have an impairment on verbal fluency. One way to test this is by asking the patient to name items in a certain category. They normally have significant trouble completing this task. Numerous studies have documented that there is a decrease in category fluency, which means there’s a significant loss in sematic memory (Hodges, 1992). This type of loss of semantic memory can happen during the early stages of the disease.

Working memory and language comprehension are also effected. Working memory is a cognitive function that processes perceptual and linguistic information immediately and only holds onto that information for a brief amount of time. Language comprehension is being able to process and understand words, grammar and the meanings of sentences (MacDonald, 2001). When working memory is impaired, the patient has a hard time keeping up with a conversation and responding. There is a debate among researchers on how language comprehension is effected in Alzheimer’s patients and how working memory plays a part in it. Some researchers believe that language impairment is a result of their working memory not functioning as well as it should. Others believe that Alzheimer’s patients have lost both essential linguistic knowledge and have an ill functioning working memory (MacDonald, 2001).

Previous studies have shown that Alzheimer’s patients also have impaired grammatical complexity, speech rate and repetition in sentence comprehension. In one study, Alzheimer’s patients showed difficulty understanding sentence structures like object–object and subject–object. When the sentence they had trouble understanding was repeated and simplified, the patient had a much easier time comprehending it (Small, 1997). This showed that Alzheimer’s patients ultimately have a more difficult time understanding the complexity of the grammar in a sentence and don’t get confused because of the length of the sentence. This study also showed that when the researchers increased the rate at which they were talking, they noted that there was no difference in sentence comprehension (Small, 1997). Many people will often talk slowly to a person with Alzheimer’s but this study showed that the rate of a person’s speech does not matter. It is whether they have the ability to comprehend the sentence at all.

Syntactic comprehension is the way words are arranged to make coherent sentences. The ability to process syntactic information is significantly impaired in Alzheimer’s patients. Patients in the early stages of Alzheimer’s show they can still process syntactic information but as the disease progresses the ability to process syntactic information fades away almost completely. The result of one study shows that when trying to understand a sentence by only using syntactic information and not sematic information, the patient was completely and utterly confused (Bickel, 2000). The reason this may be is because the areas of the brain that are damaged by Alzheimer’s deal with syntax. Areas in the left temporal lobe like the amygdala-hippocampus complex, which deals mainly with long term memory, and the frontal lobe that deals with emotions, language, problem solving and is like the control panel for how people expresses themselves (Bickel, 2000). As the disease progresses, more of these areas are reduced and damaged, which is why Alzheimer’s is classified by stages from least problematic to most problematic.

Communicative competence is also effected by Alzheimer’s. This aspect of language is essential for normal social interactions. For normal social interactions to occur a person must have an understanding of literal lexical-semantic comprehension and non-literal lexical semantic comprehension. Non-literal lexical semantic comprehension requires the listener to understand the double meaning behind the speaker’s words (Maki, 2012).  For example, if someone says, “I love to do school work,” but they put a lot of emphasis and inflection on “love” they are probably being sarcastic. If someone doesn’t have the ability to pick up on sarcasm or metaphors, then a big part of language is lost. Metaphors and sarcasm comprehension has been studied to analyze the social communicative competence during each stage of Alzheimer’s. This type of comprehension starts to decline during the early stages of Alzheimer’s (Maki, 2012). Since Alzheimer’s patients take the literal form of what a person is saying when they are talking sarcastically or metaphorically, there is an increased chance of social miscommunication. If a patient and caregiver are miscommunicating it can lead to the behavioral and psychological symptoms Alzheimer’s patients’ experience and a strain in the patient and caregiver relationship (Maki, 2012).

Alzheimer’s is an incredibly damaging disease that destroys a person’s cognitive functions. Many parts of language are affected by this disease that are crucial for normal social functioning and interactions. Alzheimer’s almost acts as an eraser that slowly deteriorates the parts of your brain that make language and memory possible. Although the first stages of Alzheimer’s usually go undetected because the patient seems normal, many cognitive problems start during these stages. What’s important to remember is that Alzheimer’s patients are still people, our loved ones. Understanding this disease and how it effects an individual cognitively and linguistically can help lessen the stress it has on the patients and their caregivers. In turn this provides the patient and loved ones with a better time together.

References

Hodges, J., Salmon, D., Butters, N. (1992). Semantic Memory Impairment in Alzheimer’s Disease: Failure of Access or Degraded Knowledge?. Newopsychologia, 30(4), 301-314.

Small, J., Kemper, S., Lyons, K. (1997). Sentence comprehension in Alzheimer’s disease: Effects of grammatical complexity, speech rate, and repetition. Psychology and Aging, 12(1), 3-11.

MacDonald, M., Almor, A., Henderson, V., Kempler, D., & Andersen, E. (2001). Assessing Working Memory and Language Comprehension in Alzheimer’s Disease. Brain and Language, 78, 17–42.

Bickel, C., Pantel, J., Eysenbach, K., & Schroder, J. (2000). Syntactic Comprehension Deficits in Alzheimer ’s Disease. Brain and Language, 71, 432–448.

Maki, Y., Yamaguchi, T., Koeda, T., & Yamaguchi, H. (2012). Communicative Competence in Alzheimer’s Disease: Metaphor and Sarcasm Comprehension. American Journal of Alzheimer’s Disease & Other Dementias, 28(1), 69-74

Alzheimer’s Association. (2016). Communication: Tips for successful communication at all stages of Alzheimer’s Disease. Retrieved from https://www.alz.org/national/documents/brochure_communication.pdf

What Are the 7 Stages of Alzheimer’s Disease?. (2000-2017). Retrieved from https://www.alzheimers.net/stages-of-alzheimers-disease/