TOUCHON, GABELLE, BRUN, Maladie d’Alzheimer et communication. Montpellier : Sauramps médical, 2013. 103. ISBN ( 978-2-84023-872-0)
Introduction
“Alzheimer’s Disease (AD) and Communication” is a scientific book published after a symposium about, as the title indicates, the communication abilities of Alzheimer’s patients. It is written for medical professionals that work within the field of patient care.
The purpose of this publication is to outline the essential of knowledge on the communication abilities of Alzheimer’s patients. Through this aim, the authors hope to highlight the importance of paying attention to this cognitive field in AD care.
Indeed, while AD is frequently associate with memory disorders, communication disorders are put aside. However, patients face with this kind of troubles from early stages of the sickness. More generally, these authors offer a new perspective to understand neurodegenerative pathologies.
Summary
Throughout the book, authors had sought to consider patients as individuals with skills rather than considering them as individuals with symptoms and impairments. Moreover, each chapter questions the practices and methods used to take care of the patients. The book offers a critical approach in regard of the ethic.
I. Alzheimer’s Disease : therapeutic news
In France, AD is diagnosed about 24 months late. There are four symptomatic medicines that target the correction of neurotransmitter deficiency. Treatments can not improve the cognitive and functional state but decrease the progression of the disease. A lot of studies are still looking to influence on neurotransmitters that may be involved in AD. However, to prevent cognitive decline, non pharmacological approaches are advised. For example, physical exercise or obesity prevention can be suggested.
II. Humour and Alzheimer’s disease : an oxymoron ?
Humor is used as a relational tool to promote exchange in a positive way. It involves cognitive, emotional, behavioral and physiological aspects.
Sometimes, Alzheimer’s patients still have their judgment abilities so they can use humor.
Literature explores several areas such as :
– Humor concerns two sides : abilities to make jokes and abilities to understand jokes.
– AD alteration of the neuroanatomic structures underlying humor
– Humor has a therapeutic effect: it reduces the stress of patients and gives them the impression to control their daily life.
In reference to Van der Linden : today, the public image of AD is very negative. Humor could be a way to fight against it.
III. Neuropsychological rehabilitation and primary progressive aphasia : the privileged position of semantic dementia
The primary progressive aphasia is an isolated and progressive language deterioration during the first two years. However, the autonomy remains intact. Since this is a localized disorder, rehabilitation can be done to preserved abilities.
Semantic dementia refers to a subtype of primary progressive aphasia. Its rehabilitation plans to re-learn the lost concepts by associating them with a spatio-temporal context and passing through the episodic memory.
Consequently, it is important to encourage transfers of new acquisitions in daily life.
IV. Alzheimer’s disease and language : new perspectives
Language implies several neuronal bases, mostly the left hemisphere.
In AD there are several language disorders :
– A lack of words and a verbal fluency disorder implying a deficit of selection, exploration and control
– Poor and less coherent discourse
– Difficulties to understand the implicit and the pragmatic of the language
– Difficulties to read the irregular words
Assumptions have been made about the origin of language disorders. One goes for an executive dysfunction and working memory disorders. The other suggests a progressive atrophy of the structures underlying the language and of the white matter beams involved in the communication between the different cortical regions.
V. When patient’s words escape
There are two types of communications : verbal and nonverbal.
Mirror neurons are present to understand others intentions, feelings, and thus interpret the nonverbal modalities of communication.
There are four categories of manifests signs of nonverbal communication:
– exterior appearance
– proxemic modalities (interpersonal distance)
– mimic and gaze
– voice: intensity, articulation, melody
AD mainly leads to verbal communication problems. Hence, it is important to take into consideration the non-verbal language that is preserved over a much longer period which help to the interpretation of verbal language.
VI. Modern technology contribute to assess and take care of AD
New technologies have their interests in the assessment and AD management:
– to replace pencil paper methods.
– to objectively assess behaviors
– to assess motor troubles
Nevertheless, it is necessary to explain roles and consequences of the sensors use with patients and their families by making sure of their agreements.
Furthermore, modern technologies can be used in diverse ways :
– Use video games to remedy attention deficits
– Applicable also through virtual reality.
On the other hand, there is little knowledge about the effectiveness of these methods on an AD population.
VII. Neurodegenerative pathologies and emotional processing : from diagnostic biomarker to care
Here, authors seek to expand the discussion by treating other neurodegenerative pathologies than AD.
A link could be made between the disorders of facial emotions recognition and their social behavior impact. Few studies were interested about this link in AD.
This article aims to highlight new knowledge to compare cognitive profiles of AD, frontotemporal lobar degeneration (FTD), middle cognitive impairment (MCI) dysexecutive and normal functioning.
The results show:
– FTD patients are inferior when it is come to attribute a value to a facial emotion
– They have an inability to decode the gaze’s expression.
– In the treatment of emotional expressions, the profiles of FTD patients and MCI patients are parallel. The profiles of AD patients and control patients are also parallel.
These results make it possible to show new ways in the care by precociously preventing the disorders of the perception and the identification of the emotions.
VIII. Gineste-Marescotti care methodology : « humanitude »
« Humanitude » is a philosophy based on a reflection on the methods of care in institutions to remedy the dehumanization of care acts.
The four actions pillars in « Humanitude » are : gaze, word, touch and verticality.
From this, authors have conceptualized steps to approach a care respecting the individual.
This method allows an increase of resident’s well being, a decrease in aggressivity and an increase in the feeling of personal effectiveness of care professionals.
IX. From working group to cognitive stimulation (CS)
The authors present the tools of CS and open the debate on limits that can be highlighted.
CS aims to keep some autonomy in daily life acts and to optimize and preserve cognitive efficiency through learning and the use of strategies. It is a global method that does not target a particular cognitive function.
The development of computerized cognitive stimulation industry can be attributed to concepts of cognitive reserve and brain plasticity.
The effectiveness of computerized care is criticized. The choice of the tool is therefore very important to transfer acquisitions in everyday life.
X. The interaction robots supporting vulnerable person
The authors propose to discover these new technologies and an ethical reflection of their use.
Robotics in the care of people with cognitive disorders aims to allow serenity and reassurance, limit social isolation, safety and mobilize cognitive resources.
Robotics raises questions about ethics, of dehumanization, job loss, technological dependence and risk of failure.
We can, however, show a number of interesting points:
– The use of animal robots show many benefits (for instance: mood improvement, conversation enrichment, an anxiolytic role and a decrease of the behavioral manifestations of anxiety)
– Robotics remote surveillance makes a contribution to home care
– Mobility robotics (walk with obstacle avoidance functions, environment recognition, feedback to the user).
XI. The action of France Alzheimer in supporting families
France Alzheimer is an association of families of patients. Its roles are:
– proximity assistance
– shared actions (Alzheimer holiday-break, “Café mémoire”)
– support for families (support groups, individual meetings)
– place of accompaniment for patients (stimulation group, day-care center)
– research activities on AD
– political action with public authorities
– professionals training
Critical evaluation
The book purpose is twofold : outline the main knowledges on communication abilities in AD and change the way AD is addressed.
The first goal is partially achieved. On one hand, it is interesting to note that communication theme has been treated in the wide sense. Each chapters give a different approach of communication, from humour abilities to cognitive stimulation. On the other side, this wide variety of approaches results in a superficial presentation of each topics.
The second goal is mostly reached. While the vast majority of publications on AD deals with memory disorders, this work adopt a new perspective focused on communication abilities. Moreover, we normally defined AD in terms of declines and incapacities, this book offers a new way to consider patients as individuals with identity and abilities. This new perspective on AD can result on new practices. By changing the health-workers gaze on AD, we may improve the society gaze and contribute to a better care.
Conclusion
To conclude, Paul Watzlawick said that “we can’t not communicate” (1967). The book shows that Alzheimer’s patients are not an exception. It encourages open-mindedness and arouses curiosity. The preservation of Alzheimer’s patient communication abilities is source of hope and deserve that health professionals be made aware of it.
Bibliography
Touchon, J., Gabelle, A., & Brun, V. (2013). Maladie d’Alzheimer et communication. Montpellier : Suramps Médical.
Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Une logique de la communication. Seuil, Paris.
Laura Recalde, Clémentine Piau, Camille Bastard