Language impairment in dementia: impact on symptoms and care needs in residential homes

Background. Impairment of language skills affects the level of functioning of an individual, interferes with effective communication and can result in development of disruptive behaviour. Social skills and capacity for self care may be compromised. Few studies have evaluated the impact of language problems on symptoms and socialization in people with dementia in care environments. Method. 315 elderly residents with dementia (29% living in nursing homes, 71% in social care facilities) were assessed using standardized psychiatric schedules including the Sheffield Screening Test for Acquired Language Disorders and Neuropsychiatric Inventory. Dementia Care Mapping was undertaken at random in at least 50% of residents in each facility. Results. Expressive language impairment was associated with the presence of delusions even when severity of dementia was controlled for (p = 0.02) and showed a tendency of association with depression (p = 0.06). Receptive language difficulties were strongly associated with presence of Aberrant Motor Behaviour, even controlling for severity of dementia (p = 0.04). Decreased participation in social activities was correlated with both expressive (p = 0.048) and receptive aspects of language (p < 0.01) but social withdrawal was only correlated with receptive language difficulties (p = 0.01). Conclusion. Language disorders are associated with both behavioural and psychological symptoms of dementia even when severity of dementia is controlled for. Patients' needs in communication skills should be addressed earlier to help them maintain social interactions and reduce the impact on behavioural problems and patients' quality of life. Copyright (C) 2003 John Wiley Sons, Ltd.