Language and dementia

1. Language and dementia What is dementia? A progressive decline of mental abilities, accompanied by changes in personality and behaviour. There is commonly a loss of memory and a loss of skills that are needed to carry out everyday activities. The most frequent types of dementia: What is causing dementia? A deterioration of brain tissue, often in large areas of the brain. The deterioration can be observed, but the mechanisms behind it are mostly unknown. Dementia and aphasia Many, but not all, types of dementia cause aphasia. Other symptoms than aphasia are usually more severe and important (loss of memory, loss of concentration and attention, depression, apathy . . .) But these factors will also have an impact on language in a down-spiral: depression low self-esteem loss of memory Mixed dementia In many cases a dement person has a combination of several different types of dementia. aphasia

2. Alzheimer’s disease Healthy brain Alzheimer’s brain What happens in the Alzheimer’s brain? The cortex shrivels up, damaging areas involved in thinking, planning and remembering. Shrinkage is especially severe in the hippocampus, an area of the cortex that plays a key role in formation of new memories. Ventricles (fluid-filled spaces within the brain) grow larger. Alzheimer tissue has many fewer nerve cells and synapses than a healthy brain. Plaques, abnormal clusters of protein fragments, build up between nerve cells. Dead and dying nerve cells contain tangles, which are made up of twisted strands of another protein. Impaired language • More women than men are diagnosed with Alzheimer’s • Many people have Alzheimer’s without a diagnosis • People may have had Alzheimer’s several years before a diagnosis Onset Early onset (age 40-65): predominant language disturbance Late onset (age 65+): slower progression of language disturbance Risk increases exponentially with age

3. Frontotemporal dementia, Pick’s disease • Caused by shrinking of the frontal and temporal anterior lobes of the brain. • Usually gives change of personality and behavior before language impairment. • Typical language problems: • Echolalia (person repeats anything spoken to them) • Decreased spontaneous speech • Difficulty finding a word • Shrinking vocabulary • Tonal loss • Weak, uncoordinated speech sounds • Decreased ability to read or write • Expressionless faces • Sometimes the patient becomes mute. • Vascular dementia • Impaired blood flow to parts of the brain deprives cells of nutrients and oxygen. • There is also a form in which a series of very small strokes, or infarcts, block small blood vessels. This type is often called multi-infarct dementia. • Symptoms vary depending on which area of the brain that is worst hit. • Typical language problems: • Poor verbal fluency • Reduced speech • Motor speech disorder • Primary progressive aphasia • Caused by degenerative diseases of the part of the brain most important for speech/language. Memory and other abilities remain relatively preserved. • Typical language problems: • Wrong word substitution (e.g. “fork" for “spoon") • Mistakes in pronunciation (e.g., “fork" for “pork") • Difficulty with written directions, reading signs • Problem following conversations, especially in larger groups • Asking for repetition often • Frequent misunderstanding • Decreased use of language • This rare form of dementia tends to occur more often in men than in women. • What is normal aging? • Can give mild symptoms similar to dementia: • bad memory • ”tip of the tongue” anomia • Are the language changes associated with Alzheimer’s only an exaggeration of what happens with normal aging? • If everybody lived to be 150 would everybody have dementia? Sources: Obler, Gjerlow, ”language and the brain” Alzheimer’s association, www.alz.org MedlinePlus, www.nlm.nih.gov Pick’s disease support group, www.pdsg.org.uk Helpguide, www.helpguide.org National institute of neurological disorders and strokes, www.ninds.nih.gov This poster was produced in the course neurolinguistics, spring semester 2007, by Roger Herlin