ABSTRACT
Disturbances of speech and language, ranging from dysarthria through aphasia to mutism, are a common feature of dementia, though often overshadowed by other symptoms of mental deterioration. The symptoms are so diverse and changeable, however, that very few unqualified statements can be made. Some patients present symptoms that can be easily classified as phonological, semantic, or syntactic, while in other cases there are relatively nonspecific communication breakdowns, perhaps related to other cognitive or behavioral deficiencies (Kempler, 1995). The disturbances in verbal communication are sometimes mild, sometimes severe; they may appear late in the course of the disease, or they may be the first presenting symptom of dementia. This diversity results from a complex calculus, whose main factors include the pathogenesis of the disease itself, the characteristics of the speech and language behavior of the affected individual prior to onset, and the cognitive reserves available to cope with and compensate for the loss of speech and language functions (Stern, 2002). Moreover, by the end stages, as the disease progresses, these and other distinctions (even the differences between “cortical” and “subcortical” dementias) are gradually wiped out as the deterioration (both structural and functional) becomes increasingly global. The beginning point and initial course of each dementive illness is relatively specific, but they all converge to a common end point.
