Cognitive communication difficulties
People can have difficulty with their communication as a result of generalised cognitive problems (e.g. memory, attention, planning, problem solving). Their speech and language skills may be good but they have difficulty communicating effectively. This can be a result of damage to the brain, for example, head injury, stroke or dementia.
Attention and Processing of Language
“He does not listen to what I say”.
Set the scene by reducing distractions (e.g. turn off T.V)
Get their attention before speaking
Make sure only one person talks at a time, it may be hard to follow a group conversation
For important conversations keep sentences short and to the point, and don’t try to do something else at the same time
If the person is upset or tired, their understanding may appear worse – it may be worth avoiding difficult conversations or questions at such times.
“It takes him a long time to answer”
The person is not ignoring you, it may take them a long time to think about what you have said and provide an answer. Be patient. Give them plenty of time to answer. If you change the topic of conversation quickly make sure he knows you are talking about something new.
Memory
“He tells me the same thing or asks the same question over and over”.
The same idea keeps forming in the mind and the person keeps forgetting that he has already expressed that idea. Telling the person that they have just repeated themselves is not usually helpful. Some carers have found that it helps to answer questions briefly and then try to distract the person from the idea.
He starts to say something and then forgets what they were talking about”.
We have all had the experience of forgetting the idea we had in mind when halfway through a sentence. This happens more frequently when someone has memory problems. It can help to remind the person of what they were saying, for example “You were telling me about……”.
Conversation
“He always interrupts me when I’m talking”.
“He never answers my question directly, or he talks about something completely different”.
“When he talks it is hard to follow, and he never stops talking”
These are not deliberate actions, but a result of the brain damage which they may not have control over. You may want to tell family and friends so they have an understanding and know what to expect.
People will have different levels of insight into their actions: they may be very distressed by their difficulties or they may not be aware of them. Each family eventually finds their best way of dealing with this, which balances the risk of upset with the need to provide feedback.
Try to bring the person back to the topic of conversation. If you are finding it hard to understand what he is saying, allow him to talk for a while, you may be able to get the general gist. Make a suggestion based on your understanding “are you talking about ….?”, then ask further yes/no questions for further information.