How Early Memory Loss Shows Up in Everyday Speech

Conversational cues may arise sooner than other signs of mental decline.

By Lisa Esposito, Staff Writer Aug. 11, 2017, at 10:04 a.m.

If your memory seems OK but your speech is slipping – you can find the car keys but not always your words – should you be concerned? Possibly so, according to a new study. Among a group of adults in late middle age who were functioning fine in their day-to-day lives, those whose conversational patterns declined most during a two-year period were more likely to develop mild cognitive impairment.

It’s perfectly normal to use fillers like “um” and “ah” in your speech, says Kimberly Mueller, an associate researcher at the University of Wisconsin–Madison and lead author of the study presented in July at the Alzheimer’s Association International Conference in London. It would take a much more marked deterioration in fluency and syntax to possibly foreshadow a progressive loss of memory and eventual dementia.

Having a word on the tip of your tongue is a common experience. However, when retrieving words takes longer and longer, or someone can’t retrieve words at all, that’s significant. Repeating sounds and filling pauses with “um” more and more frequently as time passes is another telling sign.”It does become harder to retrieve words in normal aging,” says Mueller, who is a speech-language pathologist. “But the problems we see in mild cognitive impairment and dementia are so severe that they happen multiple times, even in one or two sentences. And often the message is just lost and [people] can’t get their thoughts across.”

Participants for the study had previously enrolled in the Wisconsin Registry for Alzheimer’s Prevention. Launched in 2001, WRAP is believed to be the largest long-term study of healthy people who have a family member with Alzheimer’s disease, putting them at higher risk of developing dementia themselves. An unexpected finding in the new study, which included 264 at-risk adults from the larger WRAP group, was that participants found to have early MCI performed higher on syntax at the study’s start. That was analyzed from a one-minute speech sample after they were asked to describe a simple picture.

However, at the repeat speech analysis done at the two-and-a-third year mark, their speech had declined more steeply than for those adults with stable cognitive health. That drop in language ability correlated with development of early mild cognitive impairment in 64 participants, based on up to 10 years of follow-up testing.Identifying these conversational cues at home might be important for getting people to seek help sooner. “If it is noticeable and interfering with socializing or with getting needs met, then it would be worth going to your doctor and talking about that,” Mueller says. That could prompt further screening for cognitive impairment, she adds, as well as a discussion among health care providers, patients and families.

Recording snippets of conversation during regular doctor’s visits could potentially serve as a new type of screening tool to pick up mental changes sooner than current methods, Mueller says. Speech comparisons and analysis done from one visit to the next might provide a quick, simple and inexpensive measure of cognitive ability over time. Once dementia is diagnosed and has progressed, speech deterioration becomes more obvious. Different types of dementia cause different speech problems, says Dr. Ken Brummel-Smith, a professor emeritus with the department of geriatrics in the Florida State University College of Medicine. With Alzheimer’s, he says, speech-related issues usually don’t occur until the middle stages.

Conversational problems tied to memory loss often show up before actual language changes. People “often make things up, and especially if they’re very social, they have pretty ingenious ways of getting around the fact that they don’t remember something,” Brummel-Smith says. He recalls working with a patient and trying to perform a mental status test. Whenever the patient was asked who the current U.S. president was, a standard test item, she would say, “They’re all crooks; I don’t pay attention to that anymore,” to cover her memory lapses. In terms of language, Brummel-Smith says, “Usually, the first change in Alzheimer’s-type dementia is anomia: difficulty remembering words. The next thing is [people] start saying words incorrectly.”

In this stage, known as paraphasia, if an evaluator held up a wristwatch, for example, someone with dementia might respond with “clutch,” combining the words watch and clock. “They’ll often try different sounds until they hear something that sounds right,” Brummel-Smith explains. Neologisms – made-up words that are completely indecipherable – mark the nadir of language decline. Unfortunately, Brummel-Smith says, a person at this stage may only be able to say one or two words, frequently cry out, moan or make guttural sounds.

With a less-common type of dementia called primary progressive aphasia, language problems start before memory problems arise. People can still function intellectually at this point, Brummel-Smith says. He recalls a case of a lawyer who could still write fluently but had difficulty speaking and others had to take on his court-related trial work. Eventually, he progressed to dementia. Whatever the type of dementia, Brummel-Smith says, language deterioration is similar in final stages.

Some family members and caregivers instinctively “get” how to talk to people struggling with dementia. Others might benefit most from interventions to improve their communication, for instance by working with a speech-language pathologist. Helpful strategies include using simple sentences, bringing instructions down to single steps rather than multistep commands and, when appropriate, accompanying spoken language with a gesture, like pointing to your eyes when talking about them.

On the other hand, making comments like “I told you 100 times” is counterproductive after someone asks the same question over and over, Brummel-Smith says. “They don’t remember being told the first time,” he points out. Scolding born of frustration just raises their levels of anxiety and anger. Accepting that loved ones have a brain disorder that doesn’t allow them to do what they used to do is key, according to Brummel-Smith. “They can’t change,” he says. “They don’t have the brain power to make a change. But we can always change for them.”

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