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: Alzheimer’s disease50 % of all dementia (1 – 2 % of the population) Always implies aphasia vascular dementia, Binswanger disease, multi-infarct dementia transient ischemic attacks 30 % of all dementia Often implies aphasia frontotemporal dementia, Pick’s disease 10 % of all dementia Almost always implies aphasia dementia relating to other illness: Parkinson disease, Huntington disease, multiple sclerosis, AIDS dementia complex Lewy body dementia(observed in Parkinson and Alzheimer’s) alcoholism, Korsakoff's dementia, prion diseases (Creutzfeldt-Jacob- disease, Kuru...) Seldom aphasia primary progressive aphasia (PPA), semantic dementia (variant of frontotemporal dementia) Causes aphasia without other common dementia problems 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: 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. Mixed dementia In many cases a dement person has a combination of several different types of dementia. aphasia depression loss of memory low self- esteem

First stage Anomia - forgetting names of familiar things - can’t find words they want to say May make up words, or quit talking Decreased verbal fluency Repeating stories and conversations Increasing difficulties comprehending reading material Difficulties in reading and listening simultaneously Middle stage Low information content Difficulties with complex semantics and syntax Problems finishing sentences Difficulties in observing conversation principles Discourse lacking in cohesion, sudden topic shifts May still be able to read, but cannot respond correctly Bilinguals may revert to their L1 Last stage, Severe Alzheimer’s Speaks incoherently, with just words or phrases, or not at all Can’t write or comprehend reading material Impaired non-verbal communication Alzheimer’s disease 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. Healthy brain Alzheimer’s brain Onset Early onset (age 40-65): predominant language disturbance Late onset (age 65+): slower progression of language disturbance Risk increases exponentially with age 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 Impaired language

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 Sources: Obler, Gjerlow, ”language and the brain” Alzheimer’s association, MedlinePlus, Pick’s disease support group, Helpguide, National institute of neurological disorders and strokes, This poster was produced in the course neurolinguistics, spring semester 2007, by Roger Herlin 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?