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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(04): 283-289
DOI: 10.1590/0004-282X-ANP-2020-0123
ARTICLE

Language impairment in the moderate stage of dementia due to Alzheimer's disease

Alterações de linguagem na fase moderada da demência na doença de Alzheimer
Karin Zazo ORTIZ 
1   Universidade Federal de São Paulo, Departamento de Fonoaudiologia, São Paulo SP, Brazil.
,
Juliana Onofre DE LIRA 
2   Universidade de Brasília, Ceilândia Campus, Brasília DF, Brazil.
,
Thais Soares Ciariancullo MINETT 
3   University of Cambridge, Department of Radiology, Cambridge, United Kingdom.
,
Paulo Henrique Ferreira BERTOLUCCI 
4   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
› Author AffiliationsSupport: Grant Sponsor CNPq (303323/19).
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ABSTRACT

Background: During the moderate stage of dementia due to Alzheimer’s disease (AD), language disorder is more evident and it impacts on communication. An overview of language impairment could be helpful to find compensatory communication strategies for these patients. Objective: To identify all language impairments among patients with moderate-stage of AD. Methods: 20 patients diagnosed with probable AD based on the criteria of the NINCDS-ARDRA, with a MMSE score of 13-23 points and CDR=2, who were undergoing treatment for AD with therapeutic doses of acetyl cholinesterase inhibitors, were assessed using the Boston Diagnostic Aphasia Examination (BDAE), a test that provides a broad assessment of language. The results were compared with the performance of a normal population. Results: The patients assessed in this study presented normal scores for oral and written word recognition, repetition, mechanics of writing, primer-level dictation and spelling to dictation but also had impairment at most levels of linguistic processing, in oral and written comprehension and production. In general, as expected, the tasks relying on access to the mental lexicon were most significantly affected. However, they performed well in the naming task, in which semantic cues were presented. Moreover, the patients assessed in this study had better performance in written comprehension tasks than in oral ones. Conclusion: The severity of the language impairments was not homogenous, with some linguistic abilities more impaired than others. The abilities that were found to be preserved can help to guide strategies for aiding in communication at this stage of AD.

RESUMO

Introdução: Durante o estágio moderado da demência na doença de Alzheimer (DA), o distúrbio de linguagem se intensifica, afetando a comunicação. A identificação minuciosa das habilidades linguísticas mais comprometidas nessa fase da doença pode auxiliar no uso de estratégias facilitadoras para a comunicação. Este estudo visou identificar as alterações de linguagem em pacientes com DA na fase moderada. Métodos: 20 pacientes com o diagnóstico de DA provável com base nos critérios do NINCDS-ARDRA, MMSE entre 13 e 23 pontos, CDR=2 e em tratamento medicamentoso para DA foram submetidos à avaliação da global da linguagem por meio do teste de Boston para diagnóstico de Afasia. Os resultados obtidos foram comparados aos da população normal. Resultados: Os pacientes apresentaram escores normais nas tarefas de compreensão oral e escrita de palavras, repetição, mecânica da escrita, ditado do primeiro nível e soletração para o ditado, mas também apresentaram comprometimento em todos os níveis do processamento linguístico, tanto na compreensão quanto nas emissões oral e escrita. Em geral, como esperado, as tarefas envolvendo o acesso lexical foram mais afetadas, porém os pacientes obtiveram desempenho adequado para a nomeação responsiva em que a pista semântica é o eliciador para a resposta. Além disso, os pacientes tiveram melhor desempenho em tarefas de compreensão escrita do que oral. Conclusão: A gravidade da alteração linguística não foi homogênea com algumas habilidades linguísticas mais alteradas do que outras. As habilidades identificadas como preservadas podem contribuir para o uso de estratégias facilitadoras da comunicação nessa fase da DA.

Keywords:

Dementia - Alzheimer Disease - Language

Palavras-chave:

Demência - Doença de Alzheimer - Linguagem

Authors’ contributions:

KZO: collected, analyzed and interpreted the data, and drafted the paper. JOL and TSCM: performed the statistical analysis and interpretation of the data. PHFB: supervised the data collection and critically revised the paper.


Support:

Grant Sponsor CNPq (303323/19).




Publication History

Received: 28 March 2020

Accepted: 18 June 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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