ABSTRACT
C hanges in cognition, language, and behavior over the degenerative trajec-tory of most dementias lead to limitations in communication and func-tional behaviors. Cognitive diffi culties, such as forgetting where the car is parked, displaying reluctance to socialize, and expressing anxiety about fi nancial matters, can be the fi rst signs of dementia. The different dementia etiologies are characterized by different patterns of breakdown in these domains. Language and its components, phonology, syntax, semantics, and pragmatics usually remain intact longer, particularly in Alzheimer’s disease (AD), masking the underlying cognitive deterioration. Language impairments may not be recognized unless the words are obviously mispronounced, the syntax is not grammatical, or the intent of the communication is not interpretable. Specifi c language impairments are more likely in semantic dementia, progressive nonfl uent aphasia, and possibly vascular dementia (VaD). However, there are subtle changes in language behavior associated with some dementia syndromes that may be signs of underlying memory problems. These changes in language behavior are known as cognitive-communication impairments, may affect ability to convey communicative intent or ability to understand other’s communicative intent, and often lead to challenging behaviors. Frequent caregiver complaints include disruptive or repetitive vocalizations, such as repeating questions. Repetitive verbalizations may be due to word-fi ndinglanguage formulation defi cits, comprehension defi cits, and/or memory defi cits. These cognitive-communication impairments respond well to interventions, such as external memory aids. Thus, clinicians need to understand the defi cits in order to design effective interventions.
