Does expressive language decline before receptive language?

SuptProf

DW was diagnosed three and one-half years ago. Recently her expressive language ability has declined noticeably, but her receptive language seems not to has declined as rapidly or as much. Curious if others’ LO’s have had same experience.

David J

In middle stages, DW’s word recall difficulty was more evident than her less frequent lack of understanding the spoken word. Now in late stages, it’s about even.

Ed1937

My wife has quite a bit of a problem finding the right words, but she doesn't seem to have any problem at all understanding what I'm saying to her. Stage 5/6?

Ed1937

My wife has quite a bit of a problem finding the right words, but she seems to understand everything I say to her. Stage 5/6? She has vascular dementia, if that makes a difference.

SuptProf, welcome to the forum. Sorry you have a reason to be here, but I think you'll find it worth your time.

SuptProf

Thank you. I have been monitoring the forum for some time and have already found it valuable and informative. I am confident that I will have many more questions for the good folks here in the future.

M1

Hi suptprof, I remember an interesting linguistic study about how the diversity of vocabulary declined over time in dame agatha Christie's novels as she developed Alzheimer's. I'm sure you could find it if you Google it. So yes, I think you are correct....

French

Hi suptprof, my partner is followed by a speech therapist (they do some exercises and he likes her) twice a week. She just delivered her report for the neurologist and sent it to me.

Her conclusions :

- he begins to have a lack of vocabulary (70/80 at the test , this means that he has found 70 names for 80 images),

- she noticed « a lack of informativeness, a self-centeredness expression « . Indeed he reduces his sentences so much that it’s often difficult to understand what he means. Yesterday he told me « yes they are all dead ». It took time and lot of questions to understand that he was speaking of a movie about a real event. But sometimes he expresses perfectly so Nobody  remarks he has Alzheimer.

- about understanding she wrote « Listening comprehension can be poor, even in situations of conversation and simple requests ». Most of times I think he understand but quite often the answer is quite puzzling like « Good for you « when I announce a bad news, so that I am never sure he has really understood 

So in our case expression and understanding are quite equivalent, and I would qualify them « random ».

JoseyWales

In our case, I think they're about equal. The expressive language difficulties are obvious, because I'm listening and notice small difficulties. His receptive language seems better, but I think he gets a lot of what I'm saying through context. And when I watch him with others, I know that he doesn't understand much of what the other person is saying, but fakes it really well so they might not notice.

harshedbuzz

We found dad's use of language changed with the progression of the disease. He was a little unusual in that her was quite verbal until he died from complications of aspiration pneumonia; I had a strangely convoluted conversation about my sister with him a few hours before he passed. 

In terms of expressive language, when he couldn't recall a word, he would substitute a highfalutin synonym earlier on and later something that sounded the same (began with the same sound and had the same number of syllables. A lot of his speech became very scripted.

Relative to receptive language, it is hard to say how much he understood as his short term and working memory were so poor. He might have understood something in the moment but didn't retain it. 

HB

zauberflote

For my mom, a very articulate person most of her life, the answer to your question is yes. She always seemed to understand me, but her expressive language slid downhill slowly and then more quickly, and plummeted towards the end. Although her emotional expression (non-verbal) was always clear.

feudman

Welcome. A few thoughts:

Expressive Language can be accurately evaluated, while receptive, cognitive  abilities require a lot more skill to track. Plenty of room for error. I think sometimes they're just distracted when we assume they dont comprehend. Or they may comprehend the words and sentences, but not process them correctly.

There are different types of aphasia, and even the various types can present and progress differently (as in, if you've seen one case of logopenic aphasia, you've seen one case...). When aphasia is the primary diagnosis (PPA), expressive language will steadily deteriorate until the patient becomes mute, but interpretive language isn't similarly affected. We've mapped the brain, but are still exploring its complexities.

It would be interesting to see a study of the relationship between the two. I would guess receptive language deterioration may often lag expressive, but (as others have said) the former eventually catches up. 

Bottom line, it's sad no matter which way it happens. We hate to slowly lose our communication link with them.

SuptProf

Thank you all for your replies. I believe her receptive language, which I am defining operationally as her ability to understand me, is better than her expressive language, which I am defining as her ability to say what she wants to communicate. As many of the members have expressed on the board, this journey is hard and takes some odd twists and turns. I do not begin to comprehend it. It is so hard to see her struggle for a word or phrase. It breaks my heart. As has often been observed, each case is unique in its own way. I do recognize that, but it is sometimes helpful to have others' experiences to compare to ours.

Ed1937

Army_Vet60 wrote:

All I can offer as a suggestion is to learn to interpret her language as it changes and talk to her using her words. It worked for me with my wife and it really helped her to retain her trust in me.  

I wish I had that option. My wife has been wanting me to take her somewhere for 4 days now. But she can't say where she wants to go. It will be "We need to go to the .........;......." There is no way I can figure it out unless it's something I know she's been wanting. Or if she wants me to close the door, she might say "Close the chair" or Close the shoes". Nothing I can decode. It is hard. Other times it might be "Close the door". Most of the time she simply can't find ANY words to say.

Ed1937

I've asked her every question I can think of. Is it something to eat or drink? Is it something to wear?  Nothing I have tried works except for one time when she wanted a particular piece of clothing. I asked he if what she wanted was something to wear. She said it was. So I was able to figure it out. Nothing I have tried since then has worked.

Marie58

Ed, when my DH started having trouble expressing himself, I would sometimes ask if he could show me what he needed/wanted. Might be worth a try. Sometimes that would work. Sadly, he has no language now...occasionally will say yes or no.

JJAz

PPA (Primary Progressive Aphasia) in dementia patients consists of different variants:

Semantic variant primary progressive aphasia

Signs and symptoms include:

• Difficulty comprehending spoken or written language, particularly single words
• Trouble comprehending word meanings
• Struggling to name objects

Logopenic variant primary progressive aphasia

Signs and symptoms include:

• Difficulty retrieving words and word substitutions
• Frequently pausing in speech while searching for words
• Difficulty repeating phrases or sentences

Nonfluent-agrammatic variant primary progressive aphasia

Signs and symptoms include:

• Poor grammar in written and spoken form
• Trouble understanding complex sentences
• Using grammar incorrectly
• May be accompanied by speaking problems such as errors in speech sounds (known as apraxia of speech)