The Memory Unit OT

Do you ever notice your residents with dementia sometimes just won’t do what you ask? Not in a defiant way. They just don’t seem to understand what you’re asking of them.

As always, dementia is a complex condition that manifests in various ways depending upon where and how it progresses within the brain. But let’s talk about 3 general reasons why direction following can be difficult for individuals with dementia.

1. Individuals Living with Dementia can Experience Diminished Processing Speeds.

There are three main areas of the brain responsible for receptive language (ie. language comprehension). They are the angular gyrus, the insular cortex, and Wernicke’s area. These areas work together to process words and word sequences in order to determine meaning. The dementia process causes atrophy and deterioration of brain tissue. As these areas of the brain atrophy, their ability to process auditory language slows down.

This is why it’s so important to give individuals living with dementia time to answer a question before you move on to the next question or sentence. Asking rapid fire questions or giving a quick series of directions can actually increase confusion ore than promote increased understanding.

2. Individuals Living with Dementia can Experience Auditory Hallucinations.

Many studies have occurred with the intent to assess where in the brain auditory hallucinations originate. Depending on which study you read, the answer somewhat varies, but studies typically show changes in the frontal lobe, the temporal lobe, and the basal ganglia. Again, if we remember that dementia causes atrophy of brain tissue, then it would make sense that atrophy in these areas could result in the experience of auditory hallucinations. But why would that impact direction following?

I’ve actually had a patient ask me to stop talking because he was “trying to hear that other guy”. Now, it was just myself and this patient in the room. But he was hearing some other man giving him directions, and he felt that those directions were more important than mine. This made our transition to the next activity a little longer and a little slower because I was, in a sense, competing with those auditory hallucinations.

3. Individuals Living with Dementia can Experience Decreased Language Comprehension.

Let’s look back at those areas of the brain we talked about in the first point. As the dementia process advances, the atrophy becomes greater and therefore the ability to actually comprehend spoken language fades away. But we can also see this in individuals who have endured a stroke or traumatic brain injury, and we usually term this ‘Wernicke’s aphasia’. This is because Wernicke’s area within the brain works together with the angular gyrus, the insular cortex, and the basil ganglia to determine context and meaning after processing auditory language.

This is why it’s so important to explore various types of communication and cues in order to promote understanding of directions.

Generally speaking, most language processing occurs in the left hemisphere of the brain. Modern science does not presently have a clear explanation for this, although there are many hypotheses. If you’re working with an individual who has also sustained some sort of neural trauma to the left hemisphere (such as a stroke or traumatic brain injury) you may notice that language and language comprehension impairment is even more pronounced.

source: ncbi.nlm.nih.gov