Mutism in the Older Adult

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


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

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In frontotemporal dementia (FTD), emphasis on one or other of the lobes has led to two main types: frontal variant[26] and temporal variant.[27] Prominent manifestations of the temporal subtype are language disturbance (primary progressive aphasia) and behavioural disorders. According to Kertesz and Munoz,[28] mutism is a mid-stage characteristic heedless of how this group of illnesses begin. It tends to be the end stage characteristic of all forms of FTDs (now referred to as the Pick's complex) irrespective of whether they present with disturbance of behaviour or language. There are few initial neurological signs but with progression, striatal signs of akinesia and rigidity emerge.[29,30]

Aphasia is one of the essential requirements for the diagnosis of Alzheimer's disease, along with agnosia and apraxia. The aphasia of Alzheimer's disease often fits with an extrasylvian pattern.[31] Initially, the patients have an anomic aphasia, followed by a transcortical sensory aphasia or Wernicke's aphasia.[32] As the dementia progresses there is decreased fluency together with perseveration, echolalia, and nonspeech utterances such as grunting to complete dissolution of speech. These features are rarely seen in patients with global aphasia following stroke.[33]

Binswanger's disease (BD), or subacute arteriosclerotic encephalopathy, is characterized by diffuse demyelination of the white matter with lacunar lesions in the basal ganglia and brain stem. Depending on the location and severity of the lesion, a variety of symptom-clusters may emerge. Clinically, it is characterized by disorders of memory, cognition, and mood changes together with pyramidal and extrapyramidal abnormalities. Pseudobulbar palsy (dysarthria and dysphagia) is frequent.


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