Alzheimer'S Disease: While The Memory Fades Away, The Emotion Remains
Abstract
By aging, the expression and perception of emotions decreases. The cognitive and relational function degrade, particularly for people with Alzheimer’s disease.
The management of emotions is first and foremost about putting one's feelings into words, about expressing one's perceptions. The support of speech makes it possible to distance certain over-invasive emotions and to raise awareness of emotions that have remained in their raw state. Despite this degradation of verbalization, Alzheimer’s patients maintain body language which can be considered as a privilege. This is the reason why studying the expression of emotions in these patients was interesting.
Results showed that there is an increasing difficulty of expression of the emotions verbally, even if the non-verbal expression remains the same. These changes from language to body language are the main interest of the study to understand the facility of introduction of new communication techniques to limit the obvious appearance of behavior disorders.
Introduction
In a neurodegenerative pathology such as Alzheimer's disease, where cognitive and behavioral disorders often lead to a breakdown in the relationship between the patient and his or her family and friends, the question of the emotion felt, verbalized and perceived arises.
This question is important because the relationship between communication and emotion is obviously sensitive.
An emotion is usually created following an external stimulus and is translated into a psychological and physical reaction to a situation, first presenting an internal manifestation and then generating an external reaction. It has three components: physiological, behavioral and cognitive.
From our youngest age, we are immersed in a rich and complex world made up of exchanges and meetings. During the course of our lives, we learn to recognize a considerable number of people, and this, from very reliable way: we identify others by their faces, their eye looks, their voices or their postures.
In addition, we are able to recognize and interpret the emotional state of others, which allows us to engage in social interactions rich and meaningful. These fundamental aspects of human social cognition linked to faces and human voice play an essential role in interpersonal relationships. They allow us to adapt to the behavior of our fellow human beings, to become aware of their mental states, of their feelings and to anticipate their actions. On the other hand, a wrong identification of others' emotions, whether it is a false recognition or erroneous interpretation, can lead to a behavior with inappropriate social conditions.
People with Alzheimer's disease have more identification difficulties, are less effective in determining their emotional state and do not express themselves correctly, in return, appropriate emotions. These anomalies appear early, leading to socialization disorders behavior. That's why researchers in psychology and neuroscience are studying how emotional capacities change with age and how they can change to be altered in the disease.
Alzheimer's disease disrupts non-verbal communication by altering the perception and production of emotions. The latter aims to improve the understanding, screening and management of these diseases.
It is in this context that our study aims to better understand the ways in which emotions are expressed in Alzheimer's patients by trying to answer these questions:
- How will an emotion be felt in people with Alzheimer's disease?
- What influence will the more or less conscious feeling of emotions in these subjects have on their cognitive and communicative abilities?
- Could a disturbance in emotional perception explain the behavioral and communication gaps in Alzheimer patients?
Emotion and Communication
The Main function of language is the communication. It makes it easier for individuals to communicate through it. Language is a communication tool, intimately linked to the way people live their lives. Sapir’s theory (1921) has been the first who suggested that language is not a simple instrument of reality description, but helps to structure it. The language of a human society organizes the experience of the members of this society and, consequently, shapes its world and its reality. Language therefore plays an important role in the determination of cognitive processes and these cognitive processes may vary across languages. Emotional communication is crucial for human survival. For example, if you’re visiting somewhere far from home and see an animal that you don’t recognize, at first you don’t know if it’s dangerous or harmless, if you see other people around you smile at it and keep walking, you do too but if they shriek and start running away, so do you. This process is referred as social referencing. A human-being bases his own emotional reaction to the ambiguous situation on your perception of other’s people emotions. The aim of the research was to analyze the communication of a population with Alzheimer's disease by trying to identify language acts that verbalize emotion and the influence of communication situations on the production of these acts.
To evaluate the communication skills of Alzheimer patients (AP), researchers used the GECCO test, since it allows an assessment of the communication skills specifically of AP through the analysis of three communication situations with a contact person: - a directed interview in the form of an autobiography, which is the one that most facilitates communication from a cognitive point, because it actually concerns the patient himself, his history, his life, which is obviously emotionally charged - a task of exchanging information from photos, which is the one that requires the lowest communication performance emotionally neutral and also among those that require the most cognitive resources. - a free discussion from the present moment, which is the one that allows the subject to choose his or her topic of discussion, This means that this type of exchange arouses the patient's appetite for communication because he probably wants to discuss subjects that are close to his heart, but he has difficulty in verifying his thoughts, feelings and feelings, particularly because of cognitive and linguistic problems, and cannot benefit from the 'support' provided by the interlocutor in the guided interview situation.
This study makes it possible to draw up a profile of communication by identifying the acts of language (verbal and non-verbal) still relevant to the patient's competence, versus those that are no longer so, and to determine whether these acts are adequate (allowing the exchange to continue) or inadequate (causing the exchange to be interrupted). The results of this study showed the influence of emotion on the communication skills of Alzheimer's patients: it is often clearly verbalized, expressed, within the patients' speech but it also shows, indirectly, its influence through the quality of patients' communication performance in different communication contexts. It is clear that a context of exchange that appeals to feelings and generates emotion in Alzheimer's patients encourages them to express themselves even if their language skills do not always allow them to be consistent. These data have clinical applications for the assessment and therapy of communication disorders.
In fact, evaluating the communication of a patient with Alzheimer's disease cannot be limited to the evaluation of language, which is only a communication tool and which, in this pathology, is subjected to the outrages of neurological damage. Consequently, it is necessary to evaluate the intention of communication with an approach based on pragmatics and not only on linguistics. It also means considering all other means of communication, particularly non-verbal communication, but also behavior modification, which in many cases must be seen or read as a means of communication and not simply as a disorder. This communication assessment, and this is probably also true for cognitive assessment, must take into account all the 'emotional' or more generally contextual factors that we have shown to be influential.
Alzheimer and Emotion
Alzheimer's dementia (DTA) is the result of an irreversible and progressive damage to the central nervous system, namely neuro-fibrillary degeneration and the formation of senile plaques. It is characterized by memory impairment and at least one of the following cognitive disorders: aphasia, apraxia, agnosia or disturbances of executive functions (non-exhaustive list). These disorders appear gradually with continuous cognitive decline, but the rate of progression remains highly variable. The linguistic disorders present are not only related to a language disorder, which would only depend on an organic impairment, but represent a communication disorder on which cognitive, personal, psychosocial and contextual factors act. Depending on the influence of these factors, there are qualitative and quantitative changes in the means of communication. At the beginning of the disease, there is a lexical disorder while phonological and syntactic abilities seem to be preserved. In communicative situations, the emotion is clearly verbalized by the Alzheimer's patient (AD), but the quality of the speech can be altered by the emotion.
According to the psychologist Paul Watzlawick (1980), we use two types of languages: - The First Type is explicit, rational, essentially verbal and requires detail and precision, - The Second Type is a language of figures, symbols, metaphors, dreams and emotion. It is unclear and mostly non-verbal. In Alzheimer's patients, cognitive collapse leads the patient to express himself more and more with type 2, in a symbolic or even poetic way. Due to the deterioration of his semantic memory, the demented patient speaks in extinguished metaphors; the meaning of the sentence is to be grasped outside the literal meaning of the words spoken. It seems to proceed by simple metaphorical enunciation where it says something and metaphorically expresses another thing integrated into the discourse. Despite a phasic attack, Alzheimer’s patients succeed in producing prosodic markers of emotion in their speech. It is easier for them to produce an emotion than to perceive it in the voices of others. In the severe stage of the disease, language production and comprehension are affected, the symptoms are similar to Wernicke's aphasia. The subject jargon, becomes palilalic, logoclonic (repetition of a syllable in the middle or at the end of the word), echolalic, even silent. It is issuing fewer and fewer verbal acts, but non-verbal acts persist. The patient overcomes his or her language difficulties through non-verbal communication. Body language is very involved in Alzheimer's disease when language functions are impaired.
Communication will preferably be done in a non-verbal mode through hand gestures, eye looks, facial expressions, postures. . . In the severe stage of the disease, ideomotor and ideological praxis disorders hinder the ability to voluntarily produce symbolic gestures. Sign language communication is not always appropriate, but it remains so until the subject's death. In addition to memory, praxis, gnosis and phasic disorders, there are changes in executive functions that the subject compensates relatively well for when the disorders appear. The patient will have increasing difficulty adapting to new situations and inhibiting maladaptive behaviors. The presence of a dysexecutive syndrome is an aggravating factor in communication disorders. The alteration of verbal and bodily expression skills makes it difficult to understand the message delivered, also reducing the feedback of the interlocutor. The risk is that the patient renounces any attempt at communication, indulging in depressive manifestations and withdrawal. His only means of expression will then be a behavioral disorder (aggressiveness, running away, withdrawal, refusal of care and food. . . ). The decrease in sensory, language, cognitive, memory and psychomotor skills related to Alzheimer's dementia leads to difficulties in understanding the context. Altered perception of others' emotions may be related to some behavioral disorders in Alzheimer’s patients. It appears that the greater the cognitive impairment, the more difficult it is for subjects to identify and express their emotions, particularly by altering the identification of internal states.
Results of researches showed that people with Alzheimer's disease are sometimes able to recognize emotions, but above all that they react to it, even to advanced stages of the disease. Other researchers have been interested in emotional recognition skills conveyed by voice. They examined perception and production of emotions expressed by voice in people with Alzheimer's disease and healthy elderly subjects. They are ill and have difficulty perceiving the emotions, whatever they may be. On the other hand, when the sick of orally reproducing a emotion heard or read aloud a sentence with a certain emotion, he is able to express different emotions. Thus, even at an advanced stage of the disease and even if the language withers gradually, people with Alzheimer's disease are able to maintain a certain amount of non-verbal communication. From then on, see around you the faces of loved ones smiling or hearing their laughter and sharing emotions could calm the patients and make them happy, even if they don't seem not recognize their loved ones or understand what's going on around them.
Perception of the emotion
We have found that Alzheimer's subjects, despite significantly reduced verbal communication skills in comprehension and production, still manage to produce a speech with emotionally charged vocal inflections. Their greatest difficulty is therefore not to produce speeches with appropriate emotional prosody but to be able to perceive the emotions conveyed in the voice of their interlocutor.
This study is a new illustration of the complexity of disorders in Alzheimer's patients. It is therefore essential to put in place effective management strategies. The role of speech-language pathology in the management of individuals with Alzheimer's disease is to maintain and adapt communication functions. Managing the difficulties of non-verbal communication is obviously essential, especially since it seems to be better preserved than verbal communication during the course of the disease and would allow for the preservation of comprehension and expression for longer. The use of this protocol in speech-language pathology practice would offer prospects of management to hold the patient in communication while remaining attentive to the messages of those around him.
Conclusion
The influence of emotion on Alzheimer's patients is well established. Also, The interrelationships of cognitive, behavioral and language processes in emotional expression patterns are altered in Alzheimer's disease. This is why emotion can be expressed in a pathological way, particularly through behavioral disorders. The studies showed on the one hand, that exchanges based on feelings lead in return to more verbal communication at the expense of a cohesive discourse. On the other hand, despite the severity of the disease, this communication remains and must continue through emotionally charged vocal inflections. Acts of affirmation of the internal state occupy the same place in the discourse of patients regardless of their cognitive level. The desire to communicate one's emotions is therefore preserved in Alzheimer's disease. This study also found that the more verbally expressed emotions, the less behavioral problems there were. Stimulating the verbalization of patients, particularly through techniques that facilitate communication, would be a new approach to limiting behavioral disorders.
References
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