What are dementia and neurodegenerative diseases?

Dementia as well as neurodegenerative diseases affect the nervous system (diseases related to cognitive behavior). They represent atypical cognitive and neuro-muscular aging secondary to death of nerve cells. Dementia and neurodegenerative diseases are varied in nature, namely: Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, etc.

What are the clinical signs?

Individuals with neurodegnerative diseases do not lose all functions at once, but rather the onset of the aging process is specific to particular functions. For instance, the first signs of dementia are usually:

• Memory impairments in Alzheimer’s disease.
• Language difficulties in primary progressive aphasia.
• Slowness or weakness in movement, stiffness, or tremor found in Parkinson’s disease.
• Muscle contractions, cramps, stiffness or muscle weakness, difficulties while articulating and chewing in amyotrophic lateral sclerosis.
• Etc.

Through dementia and neurodegenerative diseases, cognitive, executive, perceptive, muscular, and respiratory functions, as well as functions related to memory and language may thus be affected.

These diseases are progressive, which means that aging (nerve cell death) is no longer focalized but rather spreads bit by bit in the nervous system. Consequently, initial difficulties increase and are no longer characteristic of a certain function but may affect several functions. For example, a patient with Alzheimer’s disease will not only have memory impairment, but also many other difficulties, such as difficulties in finding words, during self-expression, while identifying people, while getting dressed, etc.

The difficulties progress over time and interfere with daily tasks (having discussions with people, using the restroom, getting dressed, eating, etc.). Patients with dementia become less independent and tend to develop behavioral disorders.

How to act?

Given that neurodegenerative diseases present with atypical and pathological aging, evolution is inevitable. However, this does not prevent the resort to health professionals in order to work on maintaining skills which have yet to be affected by the disease as well as improving quality of life.

In the case of speech therapy, therapy varies depending on :

• The disease itself (Alzheimer’s, Parkinson’s, primary progressive aphasia, amyotrophic lateral sclerosis, etc.).
• The stage of the disease.
• The difficulties specific to the patient (which also depend on the disease).
• The seriousness of the difficulties (which also depends on the stage of the disease).

The speech therapist will thus pay attention to two main aspects, namely, communication and swallowing. The therapist will suggest different methods to the patient and the family which will improve quality of life with regards to those two aspects. Depending on the disease and on the other abovementioned factors, the speech therapist will make a complete and rigorous assessment and establish therapeutic proposals which will, as needed, aim to:

• Identify what the patient sees (namely objects and faces).
• Help the patient find words, correctly build sentences and structure thoughts during speech.
• Give the patient guidelines to help understand what others are saying and give the family tips to help them make themselves understandable to the patient.
• Work on the voice and pronunciation of the patient:
• Increase the volume of the voice in order to be better heard.
• Have a good breathing technique in order to finish a sentence and speak louder.
• Pronounce letters correctly in order to be better understood.

The speech therapist may also suggest alternative ways to provide verbal communication in the absence of vocal abilities (example: voice synthesis).

• Reinforce food intake by providing the patient with all the essential methods to:
• Safely chew food (Strength of cheeks, of the tongue, etc.).
• Properly swallow food by preventing aspiration (food texture – position of the head and body – and many other involuntary functions).