Chapter 4-The Physician's Guide to Management of HD
Communication, or the transfer of information from one person to another, requires a complex integration of thought, muscle control, and breathing. HD can impair all three of these functions. There are two main aspects to communication: getting the information IN (understanding) and getting the information OUT (talking). Both of these aspects can be impaired by HD, making communication a difficult task.
The most prominent language difficulties in people with HD are (1) speaking clearly (articulation), (2) starting conversation (initiation), and (3) organizing what's coming in and going out.
Motor speech impairments are quite typical in HD. Persons with HD have even been accused of being drunk due to their sluggish speech articulation. A lack of motor coordination causes difficulties with enunciation and the breath control underlying speech.
Impaired Initiation of Speech
Word finding is often impaired, while knowledge of vocabulary is retained, because it takes the brain much longer to search and retrieve the desired object. Listeners sometimes fail to wait long enough for the brain to do its job.
In addition to speed limitations, the brain fails to regulate the sequence and amount of traveling information, resulting in impairments in starting and stopping.
When language initiation is compromised by HD, techniques such as phrasing questions with alternate choice answers (e.g., yes or no; lasagna or spaghetti) may help someone get started or retrieve the desired response.
Disorganization of Language Content
In contrast to the basic impairments in language output, the basic capacity to understand language remains relatively intact in HD. Even in later stages of the disease, language comprehension may remain when the ability to speak is significantly diminished. This fact is important to communicate to family members, staff at care facilities and other professionals involved.
Even if a patient cannot express herself, it is likely that she can understand what is being said. Difficulties with word usage are rare in persons with HD, as are frank aphasia or impairments in semantic memory. The trouble that occurs in persons with HD is an inability to organize the outgoing and incoming language, resulting in miscommunication.
To aid the person with HD in organizing language output and input it is best to rely on short simple sentences and to assess understanding frequently during important conversations.