intellectual/behavioural
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neurological communicative
neurological communicative
neurological communicative
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intellectual/behavioural
Although each underlying neurological disease adds some unique features to the symptom complex, forms of progressive dementia due to different causes share many common features. Alzheimer's dementia has been researched the most. Therefore, the description of dementia is often colored by Alzheimer's dementia symptoms. Generally, progressive dementia symptoms have a slow onset in most cases. Subtle memory problems are among the earliest signs. Some family members miss them or attribute them to old age. Memory for remote events may be much less impaired than that for new and recent events. Soon, poor reasoning and judgment problems surface and are more often noticed by the family members. Such daily living skills as cooking, checkbook balancing, or bill paying deteriorate. On occasion, individuals are slightly disoriented to time and space. Depression or mood swings may be evident in early stages. In its more advanced stages, dementia affects all aspects of life. Memory for both remote and recent event is severely impaired. Impairment in daily living skills extends to bathing, dressing, personal grooming, and eating. Because of relentless intellectual deterioration, the individual may be unable to think rationally, make decisions, plan daily activities, make rudimentary arithmetic calculations, and perform self-care tasks. Naming things and persons may be impaired. Further behavior changes include delusions and hallucinations, uncontrollable emotional outbursts, paranoid reactions, inappropriate or obscene social behavior, sleep disturbances, wandering away from home and profound disorientation to time, space, people, and self. Spasticity of muscles, unstable gait, frequent falls, incontinence, and swallowing disorders may precede death. Speech and language disorders in people with dementia also evolve over time and deteriorate as the disease progresses. Initial symptoms may be a mild naming problem that gets progressively worse, leading to verbal paraphasia. The individuals may find it difficult to understand speech spoken to them. Humor and abstract language may be especially difficult for them. Problems in describing a picture are another early language sign of dementia. However, conversational skills may deteriorate quickly. Individuals may be unable to maintain a topic of conversation and may not ask for clarification when they fail to understand what others say. Speech production, grammar, and autonomic speech may not be affected in the initial stages of the disease. As the disease progresses, the early communicative problems intensify and new problems continue to emerge. Progressively shrinking vocabulary may eventually lead to mutism. Speech becomes incoherent and irrelevant. In case of severe paraphasia, speech is mostly meaningless to listeners. Individuals may repeat what others say or what they themselves say. All verbal and non-verbal social conventions deteriorate. Individuals may be unable to great people, bid farewell, and thank others. Many develop a faint and monotonous voice. Handwriting may deteriorate to gibberish. Eventually, as the neurological disease spreads in the brain, speech production also may be affected, causing dysarthria. In the final stages, individuals may be speechless.
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