Complications of Multilingualism for People Living with Dementia

Being bi/multilingual can generate a host of benefits for people in their everyday lives and occupations. For example, it can facilitate interpersonal communication with people from different walks of life, stimulate the brain, and connect people to their cultural heritage. At the same time, it can help people find employment opportunities that require their applicants to be multilingual. Despite these advantages, what would happen if we were to forget certain words or phrases we once remembered? What if we forgot in a public setting and reverted to our mother tongue mid-conversation? How can this decline in language acquisition affect our ability to communicate with others and maintain social relationships? These are a few questions that reflect some of the struggles bi/multilingual people living with dementia may endure in their daily lives as they forget how to speak in languages they are less familiar with or learned later in life.

Dementia is a neurodegenerative condition that is commonly associated with cognitive decline and gradual memory loss. It is a condition that is frequently present among older generations and can affect one’s quality of life (QoL). Since dementia is a progressive illness, it is split up into seven phases from mild to severe symptoms. Researchers agree that Stage 4 is when language acquisition abilities become most impacted as cognition continues to decline. When this happens, people living with dementia generally start relying on their native language, as that is the one they are most familiar with. This phenomenon is still true for people who have just recently learned a new language, as well as those who have been speaking a second language for years. For that reason, it can be hard for people with dementia to maintain fluency in languages they do not use as frequently nor do they have as strong neuronal connections (i.e., nerve cell communication), no matter how much time they spent learning the language.

The cause for this loss of language proficiency comes from the fact that dementia can damage the parts of the brain that are responsible for our language acquisition abilities. This is especially true for frontal-temporal dementia (FTD), a type of dementia that refers to a loss of nerve cells in the brain’s frontal and temporal lobes; consequently, the size of these lobes starts to shrink, thus inhibiting their functions. The frontal lobe is responsible for our decision-making abilities, controls our movement, and shapes our personality as it is considered our “emotional control center.” The temporal lobe manages our ability to hear certain sounds, recognize faces, and our memory. This is because the temporal lobe houses the hippocampus, an important brain structure in charge of our memory. Damage to these lobes in FTD patients is dangerous as it results in behavioral (e.g., poor judgment), speech and language (e.g., inability to recall words or phrases), and movement (e.g., muscle weakness) deficits. A common type of FTD is primary progressive aphasia, which describes someone having difficulty speaking. There are two types of primary progressive aphasia: progressive nonfluent aphasia/progressive agrammatic aphasia, relating to how a person speaks; and semantic dementia, referring to how a person utilizes and comprehends language. With semantic dementia comes a host of clinical features, including anomia, which involves difficulty remembering certain words, names, or faces.

Unlike other types of dementia, FTD is common in younger individuals, aged 40-65. This is important to consider, as people with early-onset dementia typically receive a later prognosis than patients with late-onset dementia. In fact, in one study, researchers estimated that early-onset dementia patients typically get diagnosed 11.2 months later compared to their late-onset dementia counterparts. The authors attributed this delay due to the fact that dementia is not as prevalent among younger individuals as it is for older populations. Therefore, with a lack of proper medical attention, early-onset dementia patients may get misdiagnosed, which can cause further agitation and worsen their symptoms and quality of life.

Considering how impactful dementia is with language retention, this makes it challenging for patients to communicate with their caregivers and loved ones, especially if they do not speak the same language. For instance, a person living with dementia may start out a conversation in one language, and then switch to their native-language. This can sometimes happen without their knowledge of the change. Regardless, when this happens, it can create a confusing environment for both the person with dementia and the people they are conversing with. For that reason, people with dementia may feel burdensome and socially isolated from those around them, even more so if they feel as if no one can understand them or relate to what they are saying. Conversely, they may feel frustrated if they struggle to understand what others are saying to them, which can negatively impact how they hold or follow a conversation. As a result, their attention can get derailed as they start to experience intense, negative emotions, such as extreme fatigue, anguish, pain, and/or uneasiness. These negative emotions can exacerbate their symptoms, contributing to further memory and language deficits.

Despite these negative experiences a person living with dementia can experience, there are ways for their loved ones and caregivers to help. One important suggestion is to be patient with the person with dementia by being understanding when they have difficulty verbally expressing themselves. To best assist with this recommendation, it is beneficial for carers to stay informed about how dementia affects one’s memory and language retention abilities. Doing this can involve meeting the person with dementia where they are at, and not where we are mentally. For example, if the person living with dementia stops talking or changes the topic mid-sentence, it is crucial to not berate them or make them feel bad for pausing or talking about something else. Ultimately, doing so could cause them to feel worse about their condition, and things they cannot control or are not consciously aware of.

Additionally, caregivers should look for nonverbal cues the person living with dementia is displaying, such as signs of agitation or sadness. Doing this can reduce the pressure of relying on the person with dementia for verbal confirmation about what they are trying to say, and will make it easier for the caregivers to address unmet needs. It could also be helpful for caregivers to remember how a lack of autonomy is frequently associated with dementia. As a person with dementia progresses through the stages, they can become more reliant on a caregiver and less on themselves for tasks they might have once been able to do on their own. In turn, these feelings can produce heightened sensations of despair and learned helplessness, which can further influence their symptoms and their rate of communication.

Another suggestion would be to try to provide encouragement for the person with dementia. Words of motivation, affirmation, and support can help the patient by boosting their confidence and self-efficacy to partake in self-help programs, such as lexical learning interventions. These treatment plans are helpful to implement because any form of communication should be promoted to allow the person with dementia to feel seen and heard. Additionally, scientists infer that lexical learning interventions reduce people with dementia’s rates of anomia, especially if they are in the earlier stages of dementia. This is because, at that time, patients can still maintain some form of vocabulary acquisition before their symptoms worsen. By the time their second-language acquisition completely deteriorates, it would be beneficial for there to be someone in the patient’s life who can speak their native language to stimulate further language retention.

Even though dementia can hinder a bi/multilingual person’s abilities to communicate with others, there are plenty of methods to mitigate its effects. Following the advice from medical professionals and staying up-to-date on the recent news concerning dementia and neurodegenerative diseases can help with caring for a person with dementia and raising the quality of life for them, their loved ones, and the caregiver.

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