Why do people with dementia stop reading?
It's a common misconception that someone with dementia stops reading because they have forgotten how. The fundamental mechanics of decoding text, much like brushing teeth, are often preserved even in later stages of the disease. The withdrawal from reading is typically an indirect result of other cognitive deficits that make the experience frustrating or overwhelming.
- Working memory limitations: Dementia significantly impacts working memory, making it difficult to remember the beginning of a long sentence by the time the end is reached. This short-term memory failure disrupts the flow of comprehension and plot tracking, leading to confusion and discouragement.
- Processing difficulties: As the disease progresses, individuals struggle with simultaneous processing, where the brain handles multiple pieces of information at once. Complex sentence structures, clauses, and sub-clauses become nearly impossible to follow, leading to a breakdown in understanding.
- Attention deficits: Sustaining attention becomes increasingly challenging for those with cognitive decline. Reading mainstream books or newspapers, with dense text and visual stimuli, requires a level of focused attention that many people with dementia can no longer maintain for long periods. They may become easily fatigued and lose the thread of the story.
- Visual and environmental factors: Poor ocular motor control and light perception can make reading difficult. Furthermore, environmental factors like low lighting, background noise, or a lack of physical comfort can make concentration even harder.
How to re-engage a loved one with reading
Caregivers can play a vital role in adapting the reading experience to be more manageable and enjoyable. Instead of traditional books, modified materials and new approaches can stimulate cognitive-language processing and provide a sense of pleasure.
Here are some strategies for reintroducing reading:
- Choose the right materials. Look for books with large, clear text, simple language, and abundant photographs or illustrations that relate directly to the text. Avoid materials with complex plots or cluttered layouts.
- Incorporate audiobooks. For those who struggle with reading but still love stories, audiobooks are an excellent option. They can provide cognitive stimulation without the stress of decoding text and following a visual page.
- Read together. Reading aloud to a loved one creates a shared, interactive experience. You can read shorter passages and discuss the content, which helps with retention and provides social connection.
- Create thematic materials. Consider making personalized books or scrapbooks with familiar themes, like family history, old hobbies, or local history. This familiar content can trigger cued recall and memories.
- Adapt reading sessions. Keep reading sessions short and hold them during a time of day when the person is typically most alert. Focus on engagement and enjoyment, rather than comprehension accuracy.
Comparison of Conventional vs. Adapted Reading Materials
To better understand the required adjustments, here is a comparison of conventional reading material versus adapted materials for individuals with dementia:
| Feature | Conventional Reading Material | Adapted Reading Material |
|---|---|---|
| Layout | Dense text, low contrast, cluttered with information. | Large, clear text with high contrast, ample white space. |
| Content | Complex plot, shifting storylines, intricate vocabulary. | Simple, familiar, and predictable themes with concise text. |
| Sentence Structure | Long, complex sentences with clauses. | Short, simple, and independent sentences. |
| Visuals | Limited or no images, or images not directly linked to text. | Abundant, high-quality, and intriguing photographs tied to the content. |
| Comprehension | Requires sustained attention and strong working memory. | Each page can be a stand-alone unit, not dependent on previous pages. |
Practical strategies for caregivers
Caregivers can employ several practical strategies to help their loved ones continue to engage with reading.
- Observation is key: Pay close attention to your loved one's body language and reactions during reading. Are they relaxed and engaged, or do they appear frustrated and confused? This helps you gauge if the material is appropriate or if it's time to try a different approach.
- Build the right environment: Ensure the reading area is well-lit, quiet, and comfortable. Removing distractions can help them focus their limited attention more effectively.
- Encourage non-sequential reading: Some individuals may read by jumping around the book, which can seem unusual. As a caregiver, you should respect this interaction style and not force a linear approach. The goal is engagement, not perfect comprehension.
- Re-read familiar favorites: Going back to favorite books or familiar topics can provide comfort and security. The content is not new, so the pressure to remember details is removed, allowing for pure enjoyment.
- Don't force it: If a person with dementia consistently resists reading, pushing the activity can cause distress. It's important to respect their choices and explore other stimulating activities.
Conclusion
People with dementia do not typically lose the basic ability to read, but rather the skills necessary to comprehend and enjoy complex material. The resulting loss of interest is a protective mechanism against frustration and confusion, not a rejection of reading itself. By understanding these underlying cognitive deficits, caregivers can adapt the reading experience to meet the individual's changing needs. Choosing simpler, visually rich materials, utilizing audiobooks, or reading together can help rekindle a love for books and continue to provide valuable cognitive stimulation and connection. The true measure of success isn't full comprehension but the engagement and pleasure derived from the activity.
Reading and Dementia - American Speech-Language-Hearing Association (ASHA) Journals
