Dementia can involve language changes
Language changes are problems with finding the right words, understanding what others are saying, or speaking and writing clearly.
In neurodegenerative diseases such as dementia (including Alzheimer’s disease), sometimes language changes can slowly get worse over time. They may make everyday communication harder, such as:
- following instructions
- having conversations
- reading
- writing.
In some types of dementia, language problems can be one of the first main symptoms, including a range of disorders under the umbrella term ‘primary progressive aphasia’.
How cognitive disorders affect language
Language changes in cognitive disorders, such as dementia, may include:
- comprehension difficulty – trouble understanding spoken or written language, especially complex sentences
- naming and meaning changes – difficulty naming items or understanding what words mean
- non-fluent speech – difficulty getting words out, slow speech, pauses, fewer words and/or shorter sentences
- reading and writing changes – spelling mistakes, reduced writing clarity or difficulty reading for meaning
- speech sound errors – mispronouncing words or mixing up sounds
- word-finding difficulty – challenges retrieving names of objects or people. They may:
- say the phrase ‘the word is on the tip of my tongue, but I can’t get it out’
- substitute the wrong word (eg saying ‘knife’ instead of ‘fork’)
- use vague terms like ‘thing’ or ‘that stuff’ more often.
Language changes may be associated with:
- depression
- hearing loss (when you cannot hear clearly, communication becomes harder)
- normal ageing (mild pauses when trying to find a word)
- primary progressive aphasia (a form of dementia syndrome)
- stroke or transient ischaemic attack.
When to seek help
You should seek medical assessment if language difficulties:
- affect work, study, relationships or daily functioning
- are noticed by family or friends, even if they seem subtle to you
- are persistent or worsening
- follow a sudden event (eg abrupt onset of speech difficulty), which can be a medical emergency
- occur with memory loss, confusion, personality changes or reduced judgement.
Common patient questions
They can be, especially when they are progressive and interfere with daily life.
In some dementias, language changes may be an early or primary symptom, particularly in primary progressive aphasia.
In Alzheimer’s disease, word-finding difficulty is common and typically occurs alongside other cognitive changes over time.
While you arrange assessment or support, some practical strategies include:
- allowing extra time to respond and avoid rushing or ‘testing’ the person
- reducing background noise and distractions
- speaking slowly, using short sentences and focusing on one topic at a time
- using prompts (first sound of the word, category cues) rather than guessing rapidly
- using written keywords, pictures, calendars and labelled items at home.
You should also consider:
- a hearing check and review of medicines with a clinician
- seeing a speech pathologist who can provide communication strategies and carer guidance.