In spite of language losses suffered by an individual with Alzheimer’s, many skills that support communication are remarkably preserved and remain for a long time. When working with the AD individual, the caregiver should keep in mind six abilities that are nearly always preserved.

1) The Use of Procedural Memories
Individuals with AD begin to lose memory for words, information and events quite rapidly, but procedural memory, or the knowledge of how to perform familiar tasks remain relatively intact until the later stages of dementia. The research suggests that this is because procedural memory is the most elemental of human memory systems and is the only memory system capable of operating independently. This system can sustain some very complex human activity such as walking, washing hands, or even driving a car. Procedural memory is like a computer program whereas other types of memory are like data stored in the computer. Alzheimer patients begin to lose data rapidly but still function. They may forget where they are going, but they still know how to walk. They may forget what they are saying, but they still know how to talk.

2) The Ability to Access Early Life Memories
One particular phenomenon repeatedly mentioned by family and caregivers is the ability of the AD patient to recall childhood memories better than information from more recent decades. Families are dismayed to note that while mother cannot remember the name of her spouse of many years or any of her children, she easily recalls the name of her mother who died when she was a child.

Earliest memories appear to be so “hard wired” that they resist irreparable deterioration for a very long time. Some families may find this upsetting and engage in endless efforts to bring their loved one back to the present. If they can accept and enjoy the old memories that their mother summons, they would find greater satisfaction in their conversations.

3) The Ability to Recite and Sing with Good Pronunciation
Speech language pathologists and linguists who have studied the language of the AD individual, have observed that while the patient with AD has little to say, they can say it with good grammar. They can still respond automatically to greetings, recite prayers and sing long forgotten songs. In fact, this automatic singing and speaking ability often brings comfort to their daily lives.

4) The Ability to Engage in Social Ritual
The AD person retains the ability to use social ritual such as “Please pass the sugar” and “How are you today?” In several studies that looked at dining abilities of the AD person, the subject carried out social rituals offering small talk, “Would you like some coffee?” AD individuals can exchange greetings, ask the time, excuse themselves and accept a compliment.

5) The Desire for Interpersonal Communication
Sometimes an individual with AD can drive their caregiver to total distraction with their constant complaining and asking for things that they don’t need. Their real need is for human contact. They may have learned that if they don’t complain or demand, nobody will talk to them.

Most AD persons retain a strong desire to communicate until one particular study found that loss of the desire to communicate was a signal that they were passing into a more severe stage of the disease.

6) The Desire for Interpersonal Respect
The best evidence that the AD individual retains is their desire for respect and how quickly they can show resentment when treated with disdain by their caregiver. From their point of view, lack of respect includes:

• having their caregiver not talk to them
• yelling at them as if they were children
• being ignored
• being called by “pet” names without permission
• receiving medical treatment without explanation.

Although their behavior may indeed be childlike and exasperating, the AD person continues to expect being treated as an adult and they react more positively when addressed as that adult.

Plato once said, “Never discourage anyone who continually makes progress, no matter how slow.” Plato’s remark holds true even today, especially with regards to caring and understanding the individual affected with Alzheimer’s.