Do people with dementia lose ability to read? Understanding comprehension versus skill

Reading is a deeply ingrained skill, often preserved even in the advanced stages of dementia. The real challenge lies not in the inability to decipher words, but in the progressive decline of cognitive functions that render conventional reading material nearly impossible to comprehend, prompting the question: do people with dementia lose ability to read?

Quick Summary

Many individuals with dementia retain the mechanical ability to read words, but their capacity for comprehension, focus, and memory diminishes significantly due to cognitive changes. This often leads to a loss of interest or frustration with reading conventional materials rather than a complete loss of the skill itself.

Key Points

• Reading Skill Persists: The mechanical ability to decode words is a deeply ingrained procedural memory that is often preserved longer than other cognitive functions.

• Comprehension is Lost: The ability to understand, remember, and process narrative information diminishes progressively due to damage to working memory and other cognitive areas.

• Frustration Causes Avoidance: The gap between the ability to read words and the inability to comprehend text often leads to frustration, causing people to stop reading conventional materials.

• Modified Materials Are Key: Using large-print, high-contrast, and simple-language books with abundant images can make reading accessible and enjoyable again.

• Shared Reading is Beneficial: Reading aloud together can provide cognitive stimulation, emotional comfort, and a valuable opportunity for connection and interaction.

• Alexia May Develop: In some cases, specific reading disorders (alexia) can arise from brain damage, further complicating reading and comprehension.

• Focus on Engagement: The priority should be on creating a pleasurable and engaging activity, not on testing or assessing a person's reading performance.

The Difference Between Reading Ability and Comprehension

Understanding how dementia affects reading involves distinguishing between two cognitive processes. The mechanical skill of decoding words is a procedural memory, similar to other deeply ingrained skills like riding a bike, and is often preserved as the disease progresses. However, reading comprehension relies on cognitive functions severely impacted by dementia, such as working memory, attention, and executive function. Damage to these areas means an individual may read words but not grasp their meaning.

Why Conventional Reading Material Becomes Inaccessible

Despite the potential to still decode words, traditional reading materials pose challenges due to the effects of dementia. These materials often have a high cognitive load with complex structures that are difficult to process with diminished cognitive skills. Visual processing deficits and poor visual contrast in standard publications can also hinder reading. Additionally, the loss of working memory makes it hard to follow narratives, leading to frustration and disinterest. In some instances, dementia can lead to specific reading deficits like alexia, an acquired dyslexia resulting from brain damage.

Reading Ability Through the Stages of Dementia

Reading abilities typically decline progressively with the stages of dementia:

Early to Moderate Stage

Individuals in these stages usually retain decoding skills but experience a significant decline in comprehension and memory of what they've read. Frustration often leads to decreased interest in independent reading. Some may still find comfort in holding and looking through familiar books.

Late Stage

In late-stage dementia, interest in reading typically wanes considerably, with minimal engagement. Holding a familiar book may still offer a sense of peace and security, even if the content is not being processed. Interactions with books might be non-traditional, such as holding them upside down, which should be accepted as a form of engagement.

Comparison: Early vs. Late Stage Reading

Feature	Early/Moderate Stage Dementia	Late Stage Dementia
Reading Aloud	Still largely preserved and functional, though not always with comprehension.	May only read occasional words or lose interest entirely.
Comprehension	Significant breakdown in comprehension and remembering details.	Essentially absent, though familiar objects can provide comfort.
Engagement	Reluctance due to cognitive demands and frustration.	Minimal interest, may interact with books in non-traditional ways.
Material Preference	High-interest, simple-read books, familiar topics, and photos.	Books as comfort objects; physical interaction more important than content.

Strategies to Encourage and Support Reading

Adapting reading experiences can offer cognitive stimulation, autonomy, and connection.

1. Use Adapted Reading Material: Look for books designed for cognitive impairments featuring large print, high contrast, simple sentences, brief passages, clear images, and repeated vocabulary.
2. Make it a Shared Activity: Reading aloud together is a powerful way to engage and connect, allowing for discussion and context.
3. Explore Audiobooks: Audiobooks can be an alternative, though they may not work for everyone. Listening together allows for pausing and discussion.
4. Create a Comfortable Environment: Minimize distractions and ensure good lighting and physical comfort.
5. Focus on Engagement, Not Assessment: The goal is enjoyment and engagement rather than testing comprehension. Signs of engagement, like smiling or tracking text, are positive.

The Benefits of Adapted Reading

Modified and shared reading offers numerous benefits:

• Stimulate Thought and Memory: Engagement with written material, even adapted, can stimulate cognitive pathways, help maintain language skills, and spark memories.
• Reduce Anxiety and Boost Mood: Reading can provide a calming routine and a sense of accomplishment, reducing boredom and improving mood.
• Foster Connection: Shared reading creates opportunities for interaction and strengthens the bond between individuals with dementia and their caregivers.

Conclusion

While the ability to decode words may persist in individuals with dementia, the loss of comprehension significantly impacts their ability to engage with traditional reading materials. By using adapted books, engaging in shared reading, and creating supportive environments, caregivers can help maintain cognitive engagement and connection. For more information, visit the Alzheimer's Association website.

Frequently Asked Questions

Does losing the ability to read mean a person has severe dementia?

Not necessarily. A person's ability to mechanically read words can persist even in later stages. The primary loss is typically reading comprehension and the ability to follow a narrative due to cognitive decline. The loss of interest in reading often happens earlier due to frustration.

What is the difference between reading and reading comprehension in the context of dementia?

In dementia, reading refers to the retained, procedural skill of decoding or sounding out words. Reading comprehension, however, is the ability to understand and remember the meaning of the text, which depends on higher-level cognitive functions and is typically lost progressively.

Can reading help slow down the progression of dementia?

Research indicates that cognitive stimulation, which includes reading and language processing, can help slow the decline of language skills and provide mental engagement. While not a cure, it can be a valuable tool for preserving cognitive abilities and enhancing well-being.

Why do some people with dementia hold a book but not read it correctly?

This can happen for a few reasons. They may enjoy the familiar feel of the book as a comfort object. The action might be a habit that provides a sense of peace. In advanced stages, they might not recognize the proper way to hold it, but the activity is still a source of security and should be respected.

What modifications can be made to books for someone with dementia?

Modified reading materials should feature large, high-contrast print, simple and direct sentences, and engaging, colorful images. Books focusing on familiar and high-interest topics, such as nature or cooking, are also more effective.

How do visual problems, like contrast sensitivity, affect reading for dementia patients?

Visual deficits, such as a reduced ability to see contrast, can make it difficult to distinguish text from the page, especially in standard, crowded formats. Using materials with high contrast and ample white space can help compensate for these issues.

Is it better to read to a dementia patient or have them try to read on their own?

Both methods can be beneficial, depending on the stage of dementia. In earlier stages, the individual may be able to read modified materials independently. As the disease progresses, reading aloud to them can be more effective for maintaining engagement and connection, as it removes the burden of processing the text visually.