Indirect Interventions to Facilitate Communication in Alzheimer's Disease

ABSTRACT

Indirect interventions are designed to maximize the functioning of individuals with Alzheimer's disease (AD) through training of caregivers, modifying the physical environment, and developing therapeutic routines and activities. In this article, characteristics of AD caregivers are described, caregiver communication strategies are discussed, and examples of caregiver communication training programs are provided. Environmental modifications and routines and activities to improve communication are detailed.

KEYWORD

Alzheimer's disease - caregiver training - environment - communication - activities

REFERENCES

• 1 Clark L W. Interventions for persons with Alzheimer's disease: strategies for maintaining and enhancing communicative success.  Top Lang Disord . 1995;  15 47-65
• 2 Bayles K A, Tomoeda C K. Improving Function in Dementia and Other Cognitive Linguistic Disorders.  Austin, TX: Pro-Ed; 1997
• 3 Dunkin J J, Anderson-Hanley C. Dementia caregiving burden. A review of the literature and guidelines for assessment, and intervention.  Neurology . 1998;  51(Suppl 1) S53-S60
• 4 Mace N L, Rabins P V. The 36-Hour Day.  Baltimore, MD: Johns Hopkins University Press; 1999
• 5 Almberg B, Grafstrom M, Winblad B. Major strain and coping strategies as reported by family members who care for aged demented relatives.  J Adv Nurs . 1997;  26 683-691
• 6 Donaldson C, Tarrier N, Burns A. The impact of the symptoms of dementia on caregivers.  Br J Psychiatry . 1997;  170 62-68
• 7 Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Part I.  Am J Med . 1982;  72 127-135
• 8 Kinney J M, Stephens M AP. Caregiving hassles scale: assessing the daily hassles of caring for a family member with dementia.  Gerontologist . 1989;  29 328-332
• 9 Bayles K A, Tomoeda C K. Caregiver report of prevalence and appearance order of linguistic symptoms in Alzheimer's patients.  Gerontologist . 1991;  31 210-216
• 10 Donaldson C, Burns A. Burden of Alzheimer's disease: helping the patient and caregiver.  J Geriatr Psychiatry Neurol . 1999;  12 21-28
• 11 Sigman S. Conversational behavior in two health care institutions for the elderly.  Int J Aging Hum Dev . 1985;  21 147-163
• 12 Lee V K. Language changes and Alzheimer's disease: a literature review.  J Gerontol Nurs . 1991;  17 16-20
• 13 Bohling H R. Communication with Alzheimer's patients: an analysis of caregiver listening patterns.  Int J Aging Hum Dev . 1991;  33 249-267
• 14 Pietro M J. Assessing the communicative styles of caregivers of parents with Alzheimer's disease.  Semin Speech Lang . 1994;  15 236-246
• 15 Kempler D, Curtiss S, Jackson C. Syntactic preservation in Alzheimer's disease.  J Speech Hear Res . 1987;  30 343-350
• 16 Schwartz M, Marin O, Saffran E. Dissociations of language function in dementia: a case study.  Brain Lang . 1979;  7 277-306
• 17 Bayles K A, Kaszniak A W. Communication and Cognition in Normal Aging and Dementia.  Boston: Little, Brown; 1987
• 18 Kempler D, Almor A, Tyler L K, Andersen E S, MacDonald M E. Sentence comprehension deficits in Alzheimer's disease: a comparison of off-line versus on-line sentence processing.  Brain Lang . 1998;  64 297-316
• 19 Bayles K A, Tomoeda C K. The ABCs of Dementia.  Austin, TX: Pro-Ed; 1993
• 20 Small J A, Anderson E, Kempler D. The effects of working memory capacity on understanding rate-altered speech.  Aging Neuropsychol Cogn . 1997;  4 126-139
• 21 Almor A, Kempler D, MacDonald M C, Andersen E S, Tyler L K. Why do Alzheimer patients have difficulty with pronouns?.  <~>Working memory, semantics, and reference in comprehension and production in Alzheimer's disease. Brain Lang . 1999;  67 202-227
• 22 Small J A, Kemper S, Lyons K. Sentence comprehension in Alzheimer's disease: effects of grammatical complexity, speech rate, and repetition.  Psychol Aging . 1977;  12 3-11
• 23 Tappen R M, Williams-Burgess C, Edelstein J, Touhy T, Fishman S. Communicating with individuals with Alzheimer's disease: examination of recommended strategies.  Arch Psychiatr Nurs . 1997;  11 249-256
• 24 Ripich D N, Ziol E, Fritsch T, Durand E J. Training Alzheimer's disease caregivers for successful communication.  Clin Gerontol . 1999;  21 37-56
• 25 Hopper T, Bayles K A, Tomoeda C K. Using toys to stimulate communicative function in individuals with AD.  J Med Speech Lang Pathol . 1998;  6 73-80
• 26 Feil N. The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's-Type Dementia.  Baltimore, MD: Health Professions Press; 1996
• 27 Luterick A M, Altman R. An empathetic approach to dementia.  Provider Magazine . 2001;  April 43-44
• 28 Brush J A, Camp C J. Using spaced-retrieval as a therapeutic intervention during the rehabilitation process (J Chitwood, director). In: CK Tomoeda (producer), Telerounds. Tucson, AZ: The University of Arizona; 1998
• 29 Albert M L, Sandson J. Perseveration in aphasia.  Cortex . 1986;  22 103-115
• 30 Buckingham H W, Whitaker H, Whitaker H. On linguistic perseveration. In: Whitaker H, Whitaker H, eds. Studies in Neurolinguistics, Vol 4 New York: Academic Press 1976: 329-352
• 31 Santo-Pietro M J, Rigrodsky S. Patterns of oral-verbal perseveration in adult aphasics.  Brain Lang . 1986;  29 1-17
• 32 Sloane P D, Davidson S, Knight N, Tangen C, Mitchell C M. Severe disruptive vocalizers.  J Am Geriatr Soc . 1999;  47 439-445
• 33 Cariaga J, Burgio L, Flynn W, Martin D. A controlled study of disruptive vocalizations among geriatric residents in nursing homes.  J Am Geriatr Soc . 1991;  39 501-507
• 34 Cohen-Mansfield J, Werner P, Marx M S. Screaming in nursing home residents.  J Am Geriatr Soc . 1990;  38 785-792
• 35 Ryan D P, Tainsh S MM, Kolodny V, Lendrum B L, Fisher R H. Noise making among the elderly in long-term care.  Gerontologist . 1988;  28 369-371
• 36 Clavel D S. Vocalizations among cognitively impaired elders. What is your patient trying to tell you?.  Geriatr Nurs . 1999;  20 90-93
• 37 Hallberg I R, Edberg A K, Nordmark A, Johnsson K. Daytime vocal activity in institutionalized severely demented patients identified as vocally disruptive by nurses.  Int J Geriatr Psychiatry . 1993;  8 155-164
• 38 Boucher L A. Disruptive behaviors in individuals with Alzheimer's disease: a behavioral approach.  Am J Alzheimer's Dis . 1999;  14 351-356
• 39 Ripich D N. Functional communication with AD patients: a caregiver training program.  Alzheimer's Dis Assoc Disord . 1994;  8(Suppl 3) 95-100
• 40 Ripich D N, Ziol E, Lee M M. Longitudinal effects of communication training on caregivers of persons with Alzheimer's disease.  Clin Gerontol . 1998;  19 37-55
• 41 Ripich D N, Kercher K, Wykle M, Sloan D M, Ziol E. Effects of communication training on African-American and white caregivers of persons with Alzheimer's disease.  J Aging Ethnicity . 1998;  1 163-178
• 42 Clark L W, Witte K. Dealing with Dementia in Long Term Care. Presentation for the New York State Speech, Language and Hearing Association, Kiamesh, New York, 1989, cited by Clark LW. Interventions for persons with Alzheimer's disease: strategies for maintaining and enhancing communicative success.  Top Lang Disord . 1995;  15 47-65
• 43 Clark L W. Caregiver stress and communication management in Alzheimer's disease. In: Ripich D, ed. Handbook of Geriatric Communication Disorders Austin, TX: Pro-Ed 1991: 127-142
• 44 Cleary S. Management of Feeding and Swallowing in Patients with Dementia.  Austin, TX: Pro-Ed; 1998
• 45 Santo Pietro J M, Boczko F. The Breakfast Club: results of a study examining the effectiveness of a multi-modality group communication treatment.  Am J Alzheimer's Dis May/June. 1998; 
• 46 National Alzheimer's Association. Website: www.alz.org.