Processing Speed in Dementia: Why does my mother take so long to respond when I try to talk to her?

Written By Joy Foster MA, CCC-SLP

When we were kids, my younger sister and I had a game we played when getting ready for bed called “Fast man Slow man”. The game consisted of one of us being the “slow man” and one of us being the “fast man”. The “slow man” would have to do everything at half-speed or less, acting sort of sloth-like. The “fast man” would do everything as fast as they possibly could manage, running circles around the slow man and trying to help the slow man do things like brush their teeth and wash their face. It was a chaotic and hilarious sequence of funny interactions and we laughed ourselves silly doing it. Honestly, it reminds me a lot of what dementia looks like, and also to ponder what it must feel like for the “slow man” to have someone running circles around them while they are unable to catch up.

“What do you want to do next Mom?” I asked with a smile. Blankly she stared at me, like she hadn’t heard me even though she was looking right at me. I tried to remain calm, but my phone was ringing. “UGH” I muttered impatiently under my breath. “What…does she think I have ALL day?” Understanding that people living with dementia, any kind of dementia really, have much slower “processing speeds” will help to uncover what’s going on in these frustrating moments. What is happening in the brain when your loved one stares blankly at you? Is there really a disconnect going on inside the brain or are they being stubborn?

Unlike a stroke, which affects just one part of the brain, dementia attacks and affects the ENTIRE brain. Dementia not only affects the number of connections of the brain, but it also shrinks the brain overall.

As this picture shows, Dementia is not an isolated memory disorder, as it progresses, it will impact absolutely everything the person does.

Part of normal deterioration of the human brain during dementia is the reduction or “dying off” of neurons in the brain. The more neurons that die, the less connections there are. Picture a tangle of highways in L.A., with lots of cars speedily going every which way. Now let’s say all of those highways are closed except one or two, resulting in a huge traffic jam. This is pretty much what is going with your loved one’s brain while they try to process your message to them. The few neurons that remain are the ones responsible for handling all that traffic, and of course, that driver in LA will no doubt take longer to get to his destination. Now, once your message finally meets its destination AND is comprehended by your loved one, there is the reciprocal part of communication – the formulation of a response. The technical term for this is called expressive speech. It is very common for persons with dementia to have difficulty with word finding, and yes, response formulation is also prolonged in people with Dementia. Have you ever been in a conversation with a friend and you just can’t remember the name of that hilarious comedian in a new movie you just watched over the weekend? As you notice the breakdown in your message to her, you naturally address this problem by the method of circumlocution….you might say “You know him – the guy who is just so darn funny! Tall, gangly, big teeth!!” Your friend exclaims “Jim Carey!?!” “YES YES JIM CAREY!” you shout! And although an occasional word finding issue is normal for everyone, person’s with Dementia experience this frequently, sometimes in every conversation.

Also compounding communication is reduced visual field in a person with Dementia, making it more difficult for your loved one to use environmental or contextual clues to help interpret your message. You may not realize it, but much of your communication to people when you are talking to them comes in the form of visual cues, through your body language, the movement of your hands, the expressions on your face. So what can you do to help?

TIPS CORNER:

*Approach your loved one from the front. Get down to their level and don’t speak to them from their back side.

*Reduce environmental distractions (i.e. turn off the television, make sure dogs aren’t barking, give your full, undivided attention (i.e. talking to a person with Dementia while you are on the computer or on your cell phone is going to reduce success).

*Allow extra time for your loved one to process your response. Waiting for up to 10 seconds is not too long. Sometimes longer will do the trick. It will depend on your loved one’s individualized needs and their personal processing speed at that given moment.

*If you notice that they didn’t understand what you said, try to simplify your message:

-> Don’t say: Mom, I need you to come to the kitchen and help me make your favorite cheesy scalloped potato recipe. By the way, where did you put the recipe book? Doesn’t that sound good tonight for dinner!?”

-> Do say (with a smile): Mom, let’s cook together. Here – you can peel the potatoes.

* If your loved one tries to formulate a response after giving them extra time to process and they can’t find all the right words, you can try to help them out gently (the idea is not to talk for them, it is to help them find the right word – this increases independence and allows communication skills to last longer in person’s with Dementia). The below is an example of techniques we used in Speech Therapy to elicit speech and language:

-> You loved one’s response to your asking for help chopping onions: “ok, but where’s the…the…oh you know….dad gummit!!! ….it’s the thing that you use to do the potatoes”

-> Two options for caregiver response:

Option 1 response: “You mean the potato peeler? ”

Option 2 and Better response: Get the potato peeler out of the drawer, show it to your loved one, and say: “Oh, you mean this?” Your loved one seeing the device exclaims…”Yes the potato peeler!”

Troubleshooting: If you’ve shown the potato peeler to your loved one and they are still not able to retrieve that word, you can try providing the first sound or first word of that object….i.e. “Oh you mean the “Potato pee…. (you are omitting “ler”). You loved one finally replies “Peeler! Yes the Potato Peeler!!” This allows more independence, better activates your loved one’s speech and language center. Essentially – it increases successful, and meaningful conversational opportunities for your loved one. By frequently allowing for successful interactions like this one, your loved one’s communication skills will not decline as rapidly.

Further Discussion:

What would it feel like to have Dementia? And would understanding how it feels help to improve communication between yourself and your loved one? There is an excellent you tube video from ABC News with Terry Moran which shows what it is really like to live with Dementia, a must watch for any caregiver!! Well worth the 12 minute investment! Watch it here:

https://www.youtube.com/watch?v=LL_Gq7Shc-Y

References:

1. Scientific American; https://www.scientificamerican.com/article/what-causes-the-brain-to-have-slow-processing-speed-and-how-can-the-rate-be-improved/Slowed processing speed contributes to cognitive deficits in amnestic and non-amnestic mild cognitive impairment

2. Slowed processing speed contributes to cognitive deficits in amnestic and non-amnestic mild cognitive impairment. Neuropsychology/early detection of cognitive decline with neuropsychological tests. Ana M. Daugherty,Sarah Shair,Voyko Kavcic,Bruno Giordani First published: 07 December 2020 https://doi.org/10.1002/alz.043163