Talk

Dysphasia in any of its guises is a frequent manifestation of dementia. Sometimes it is obvious, but not always. For example, it may be difficult at first to differentiate between an expressive dysphasia (Broca's dysphasia) and retardation. It is relatively mild or moderate receptive dysphasia (Wernicke's dysphasia), however, which traps the unwary clinician. In such cases the patient may appear to be obtuse, unintelligent, or hard of hearing until it is appreciated that she simply does not understand a considerable proportion of what is said to her.

Even if the patient is not dysphasic, she may be evasive and given to circumlocution. Again, this should not be taken automatically as evidence of a premorbid lack of intelligence or pompousness, since it is frequently used as a camouflage for cognitive impairment. A patient with dementia might say 'Oh of course I know that' or 'I never paid any attention to that sort of thing' when asked to give an item of current affairs.

In manic or hypomanic illness in old age slow flight of ideas is sometimes missed by inexperienced clinicians or mistaken for evidence of cognitive impairment. Here the normal coherence of thought is disrupted because the patient is distracted from one idea to another, just as in characteristic flight of ideas, but they are delivered at a normal or even slower pace. The latter can occur if a mixed affective state is present.

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