Language changes are a common and often distressing symptom experienced by individuals living with dementia, presenting a significant challenge to effective communication. Among various speech difficulties, one of the most confusing is the use of neologisms, which are words that have no recognizable meaning to the listener. These newly created words are a direct manifestation of the underlying cognitive decline. Understanding this symptom is important for caregivers seeking to maintain connection and reduce frustration.
Defining Neologism in Dementia
A neologism is a completely new, invented word used by a person with dementia in place of the correct word. These creations are distinct from common errors like slips of the tongue or mispronunciations, as they are not real words and often lack phonetic resemblance to the intended word. For instance, someone might call a spoon a “flibber,” a wholly novel creation. The person using the neologism often uses it with confidence, believing it is the appropriate term.
Neologisms must be differentiated from paraphasia, which involves substituting one word or sound for another. Semantic paraphasia is the use of a real, but incorrect, related word (e.g., saying “apple” instead of “orange”). Phonemic paraphasia involves a sound substitution that still resembles the target (e.g., “tephelone” for “telephone”). A neologism, or neologistic paraphasia, involves creating a non-word that has no shared meaning or sound structure with the correct word, representing a severe breakdown in language production.
The Cognitive Mechanism Behind New Words
Neologisms arise from the progressive deterioration of the brain’s language processing centers responsible for accessing and producing speech. The most accepted explanation involves a breakdown of the semantic network, the brain’s organized storage system for concepts and their associated words. When the correct word cannot be retrieved, the brain attempts to fill this gap, resulting in the generation of a novel, non-existent word. This inability to retrieve the precise word is known as anomia, which is a hallmark of many dementias.
The specific location of brain damage influences the type and frequency of neologisms produced. In dementias like semantic dementia, a variant of Frontotemporal Dementia, atrophy of the anterior temporal lobe is observed. This damage leads to a disruption in the connection between a concept and its lexical label, essentially erasing the word from the speaker’s available vocabulary. Neologisms are most commonly associated with severe language impairments, but they can also appear in later stages of Alzheimer’s disease as the disease progresses to affect broader cortical areas.
Identifying Neologisms in Speech
Neologisms are often identified within fluent but incomprehensible speech, sometimes referred to as jargon aphasia or “word salad.” The speaker may produce long, grammatically correct sentences that are nonetheless devoid of meaning because of the frequent inclusion of these made-up words. A key characteristic is the lack of self-correction or awareness regarding the error, suggesting a disconnection between the intended thought and the spoken output.
Unlike a simple slip of the tongue, a neologism is often a consistent substitution used for a specific object or idea, which helps in identifying the phenomenon. For example, the person might always use the same non-word when asking for their glasses or medication. This consistent usage suggests that the neologism has replaced the correct word in their compromised lexicon. Neologisms are particularly noted in Frontotemporal Dementia and Logopenic Progressive Aphasia.
Communication Strategies for Caregivers
When a person with dementia uses a neologism, the most helpful response is to focus on understanding the underlying message rather than correcting the word choice. Caregivers should avoid arguing or insisting on the right word, as this can cause distress and does not help the person retrieve the correct term. Maintaining a calm and patient demeanor is important, allowing the individual time to express themselves without interruption.
A primary strategy is to use context clues from the situation, combined with non-verbal cues, to decipher the intended meaning. The person’s gestures, body language, and the objects they are looking at can often provide the necessary information to interpret the neologism. Caregivers can then use simple phrases to paraphrase what they believe was meant, such as, “Are you asking for your glasses?” to confirm the meaning.