In this episode, Lisa explores one of the most challenging and misunderstood symptoms of Alzheimer’s disease — aphasia, the loss of language and communication abilities that often accompanies dementia.

Through a touching real-life story from her book Truth, Lies & Alzheimer’s – Its Secret Faces, Lisa introduces us to Harvey in “The Pill Box Story.” Harvey’s daughter believed her father could no longer understand or care for himself. But when Lisa visits, she discovers that while Harvey struggles to find the right words, his mind and awareness are far more intact than anyone realized.

This powerful story illustrates how aphasia affects speech, understanding, reading, and writing, and how these challenges can easily be mistaken for cognitive decline. Lisa explains why communication difficulties don’t always mean loss of comprehension — and how loved ones can learn to see the difference.

Listeners will gain insight into:

• What aphasia really is and how it progresses in dementia
• How families often misinterpret communication loss as a total cognitive decline
• Ways to support and engage loved ones living with aphasia
• Practical communication tips for caregivers to reduce frustration and improve connection

Key Takeaway:

Even when words are lost, understanding and emotion remain. People living with Alzheimer’s and related dementias often know far more than they can express — and with patience, empathy, and awareness, we can still connect deeply.

Resources Mentioned:

Truth, Lies & Alzheimer’s – Its Secret Faces by Lisa Skinner

Listen to more episodes at truthliesalzheimers.com

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Hello everyone. Welcome back to another new

episode of the truth, lies and Alzheimer's show. I'm Lisa

Skinner, your host. I want to give you all a quick reminder

that you can always find new and updated information and

resources on our website by going to minding dementia.com.

Today, I am going to explain a common symptom that we often see

with dementia, called aphasia. Now aphasia is a communication

disorder that results from damage or injury to language

parts of the brain. It's more common in older adults,

particularly those who've had a stroke. Aphasia gets in the way

of a person's ability to use or understand words, but aphasia

does not impair a person's intelligence. People who have

aphasia may have difficulty speaking and finding the right

words to complete their thoughts. They may also have

problems understanding conversations, reading and

comprehending written words, writing words and using numbers.

What causes aphasia? Aphasia is usually caused by a stroke or

brain injury with damage to one or more parts of the brain that

deal with language, according to the National aphasia

Association, about 25 to 40% of people who survive a stroke get

aphasia. Aphasia may also be caused by a brain tumor, a brain

infection, or dementia, such as Alzheimer's disease, and in some

cases, aphasia is a symptom of epilepsy or other neurological

disorder. There are several different types of aphasia. Each

type can cause impairment that varies from mild to severe. So

these are the different types of aphasia. One is called

expressive aphasia, or non fluent. And with expressive

aphasia, the person knows what he or she wants to say yet has

difficulty communicating it to others. It doesn't matter

whether the person is trying to say or write what he or she is

trying to communicate, then there's receptive aphasia, or

fluent with receptive aphasia, the person can hear a voice or

read the print, but may not understand the meaning of their

message. Oftentimes, someone with receptive aphasia takes

language literally their own speech may be disturbed because

they don't understand their own language. There's a gnomic

aphasia where the person has word finding difficulties. This

is called anomia, because of the difficulties, the person

struggles to find the right words for speaking and writing,

and there's global aphasia. This is the most severe type of

aphasia. It is often seen right after someone has had a stroke

with global aphasia, the Person has difficulty speaking and

understanding words. In addition, the person is unable

to read or write. And then finally, there's primary

progressive aphasia. This is a rare disorder where people

slowly lose their ability to talk, read, write and comprehend

what they hear in conversation over a period of time. With a

stroke, aphasia may improve with proper therapy. There is no

treatment to reverse primary progressive aphasia. People with

primary progressive aphasia are able to communicate in ways

other than speech. For instance, they might use gestures, and

many benefit from a combination of speech therapy and

medications. Now, aphasia may be mild, or it can be severe. With

mild aphasia, the person may be able to converse yet has trouble

finding the right word or under. Standing complex conversations,

severe aphasia limits the person's ability to communicate.

They may say little and may not participate in or understand any

conversation. Additionally, aphasia also refers to the loss

of spoken language or speech comprehension, reading and

writing abilities, and is due to neuropathology, for example,

having Alzheimer's disease, and it's caused by the deterioration

of neural tissue accompanied by behavioral and functional

decline, including communication abilities as Alzheimer's disease

and other related dementia continue to destroy brain cells,

a significant symptom This one known as aphasia, develops and

aphasia does worsen as the disease progresses. It can be

very common symptom to Alzheimer's disease, and cannot

only include the loss of spoken language or speech

comprehension, reading and writing abilities, but also the

ability to process what other people are saying, and this is

due to the brain damage caused by Alzheimer's disease. So I am

going to illustrate a scenario of what aphasia might look like

in real life by sharing with you a true story taken from my book

truth, lies and Alzheimer's. Its secret faces. It's called the

pillbox story. Well, I was called over to a client's house

to assess a gentleman who had been diagnosed with Alzheimer's

disease. He was living with his wife, who was his primary

caregiver, but his daughter Carly, who was concerned about

him still living at home, as she described him as being unable to

do anything for himself and could not communicate anything

with his family members. I was actually expecting to find

somebody who would be based on how it was described to me in

the later stage of Alzheimer's disease, but to my surprise, he

was much more highly functioning than I expected him to be so I

was introduced to Harvey, as Carly's friend, who was stopping

by to say a quick hello, because they didn't want him to know

that they had asked a professional to come over to

assess him. The first thing he said to me, which I thought was

so cute. Oh, you must be Carly's friend who's going somewhere.

They had told him that I was stopping by on my way to

Ashland, Oregon, Shakespeare Festival. Well, Harvey did not

remember where they said I was going, but he did remember that

I would be stopping by on my way there

someone as far gone as Carly had described to me would not have

been able to retain that much information, and that was my

first clue. I then sat down at the kitchen table with him and

noticed a blue pill organizer sitting on the window sill

marked with the letters, m, t, w, T, H, F, S, S. So I pointed

to it and asked him what it was. He replied to me that that was

his thing. I asked, well, what does it do Harvey? And he said,

well, the things I put in there are the things that keep me

alive. I was taken aback by that response. I continued with

Harvey, well, how do you know where to put the things? Well,

he couldn't recall the word for medication, or what those

letters on the organizer stood for, Monday, Tuesday, Wednesday,

Thursday, Friday, Saturday, Sunday. But he did show me how

he took a pill from each of his prescription bottles and place

them in that organizer, beginning in the leftmost

compartment, and then the next one to the right, and so on and

so on until each pill was correctly placed in a

compartment. Then I heard his wife Darlene call out and say,

yeah, the old call. Roger gets them right every time I do check

to make sure. Carly, as it turns out, had been mistaking her

father's decline in verbal skills for a decline in his

cognitive skills, but it was very apparent to me by then that

he understood much more than they believed he did. He was

actually incredibly still very highly functioning. After my

visit, I wrote up my assessment of Harvey with some

recommendations of what they could provide for him in the way

of activities and care options to keep him engaged and active,

to slow down his decline and to keep him as independent for as

long as he was capable based on his obvious skill level, and to

avoid the temptation to do everything for him. And they

agreed to that plan. Further thoughts about this scenario as

Alzheimer's disease and other related dementias destroy brain

cells, a significant symptom, the one we've been talking

about, known as aphasia, starts to appear. Aphasia does worsen.

As the disease progresses, it becomes harder to remember the

right words and process what others are saying, as we heard

in the pillbox story, Harvey did suffer from aphasia, and it

presents itself in many different ways, but the thing to

remember as this condition is a result of damage being done to

the communication centers of the brain. It was evident in this

story that Harvey was very highly functioning cognitively.

He understood everything that was being said to him. However,

he had difficulty finding the correct words to use, as well as

difficulty articulating his thoughts. For example, when I

did ask him what that pillbox was, he couldn't remember the

correct name for it, even though it was obvious to me that he

knew and understood its function, a more cognitively

impaired person would not have been able to recognize what a

pillbox was or what it was used for, As Harvey did. There were

also a lot of misperceptions from the family members in that

story, which is perfectly natural and by no means a

negative reflection on the family members. We all have

blind spots, especially when we don't know what we don't know,

and that includes me. It's important to remember that what

connects us with others in the world is our ability to

communicate. It's the ability to get and give information, as

well as express our needs and feelings. Using language is the

most common form of communication that we can all

use effectively, such as body language, facial expressions and

gestures. But sadly, with dementia, the ability to

communicate is gradually lost. It is not uncommon for people

with dementia to substitute words when they can, can't think

of the words that belong, or they unintentionally make

something up. There's actually a name for that. It's called

confabulation. The first problem is typically with finding the

right words that fit into what they are trying to tell us later

in the disease, a person may have even more difficulty

expressing thoughts and ideas. Their brains might know what

they want to say, but they lose the ability to actually

articulate those thoughts. This decline in the ability to

communicate can often lead to frustration, understandably and

also emotional outbursts, also the ability to understand what's

being said to them, as I mentioned, also decline

significantly. Words become less effective to them, and

eventually, efforts to communicate will become shorter

and simpler, and may be limited to single words and gestures,

but we will explore several ways in which we can more effectively

communicate with people suffering from. Dementia and

aphasia in upcoming episodes, but eventually, family members

and caregivers will have to learn to rely on visual cues and

touch. So that is the information that I have planned

for this episode today of the truth lies in Alzheimer's, and I

want to just give you another gentle reminder that if you'd

like more information, please visit our website at minding

dementia.com, thanks again for being here today. I appreciate

you taking the time to listen to this informational episode. And

as always, I wish you a happy and healthy week ahead, and I'll

be back next week with another new episode of the truth lies

and Alzheimer's show, once again, I'm Lisa Skinner, your

host.