Mutism in the Older Adult

Nages Nagaratnam, MD, FRCP, FRACP, FRCPA, FACC; Gowrie Pavan, MBBS, FRAGP


Geriatrics and Aging. 2005;8(8):61-68. 

In This Article

Terminology and General Considerations

Terms such as apathy, abulia, and akinetic mutism (AM) are used to designate behavioural abnormalities relating to reduced activity and slowness. It is believed that these clinical disorders exist along a continuum of severity of reduced behaviour, and AM may be an extreme form.[1] The term abulia was initially used by Auerbach[2] and later called akinesia. Fischer[3] used the term abulia to embrace the full spectrum of abnormalities, characterized by a reduction in speech, spontaneous activity, prolonged latency in responding to questions, and lack of persistence with tasks.

In 1865, Broca[4] used the term aphemia to describe eight patients with loss of speech, which Trousseau later referred to as aphasia.[5] Aphemia is now recognized as an articulatory disorder with normal propositional language. Aphemia has often been misdiagnosed as aphasia; this is partly due to confusion resulting from the numerous terms that have been used to describe this syndrome.[6] In mutism, unlike in aphemia, the patient makes no attempt to communicate verbally or by gesture.[7] Aphemia more often than not follows mutism.


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