Strength for Today and Bright Hope for Tomorrow

Volume 8 : 2 February 2008
ISSN 1930-2940

Managing Editor: M. S. Thirumalai, Ph.D.
Editors: B. Mallikarjun, Ph.D.
         Sam Mohanlal, Ph.D.
         B. A. Sharada, Ph.D.
         A. R. Fatihi, Ph.D.
         Lakhan Gusain, Ph.D.
         K. Karunakaran, Ph.D.
         Jennifer Marie Bayer, Ph.D.



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Linguistic Profile in Multi Infarct Dementia - A Case Study

Shyamala Chengappa, Ph.D.,
Sunil Kumar Ravi and Carmel Jennifer


Multi Infarct Dementia (MID) is defined as a disorder involving deterioration in mental function caused by changes or damage to the brain tissues from lack of oxygen as a result of multiple blood clots through out the brain. Symptoms can range from amnesia, visuospatial deficits and aphasia from cortical lesions to memory impairment. The main aim of the present study is to draw attention of speech language pathologists, linguists and other professionals towards the nature of the language and cognitive deficits associated with MID and to profile the language deficits in MID. For this study, the authors had taken a subject who was diagnosed as having MID with onset prior to 6 months. The subject was assessed on Cognitive Linguistic Assessment Protocol in Kannada, Linguistic Profile Test in Kannada, Revised Token Test and Western Aphasia Battery in Kannada. The results were qualitatively and quantitatively analyzed and interpreted. The subject exhibited deficits like word finding difficulty, reduced mental abilities, and syntactic deficits, deficits in executing verbal commands like confusion of colors, sizes and objects. The present study revealed that patients with MID will have significant co-occurrence of language and cognition deficits. There is a greater need to identify them as soon as possible and the treatment should be started to slow down the further worsening of the disorder as there is no treatment that cures dementia. And also we should have more controlled studies to get to know about the language and cognitive deficits in patients with MID so that different treatment programs can be developed.

Area addressed: Brain and Language


Dementia refers to an acquired syndrome characterized by persistent intellectual decline which is due to neurogenic causes. The nature and course of dementia will vary depending upon the etiology. Most dementias are progressive, but some are static and, contrary to widely held belief regarding the disorders, still others are reversible.

The Diagnostic and Statistical Manual states that the essential feature in dementia is impairment in short term and long term memory. This deficit in memory may be also associated with one or more of the following. (1) Impairment in abstract thinking, (2) Impaired judgment (3) Disturbances in higher cortical function, and (4) Personality changes.

The language disturbances in dementia long have been reported. Interest in the dementias has increased in the past decade resulting in more systematic description of the effects of dementia on communication should produce not only a more fundamental understanding of the disorder, but improved avenues of management. Since dementing illnesses are associated with the elderly, the expectation and unavoidable conclusion is that the prevalence of dementia will increase.

Dementia can be caused by a variety of conditions: diseases, infections, or infarcts. The most commonly occurring cause is Alzheimer's disease accounting for 50 to 60% of all the patients with dementia. Vascular dementias (dementias caused by multiple infarcts) are seen in 20% of the dementia patients. Alzheimer's dementia and vascular dementia co-occur in approximately 15% of this sample, and other conditions such as Pick's disease, Parkinson's disease, progressive supranuclear palsy, and creutzfeldt-Jacob disease, account for the reminder of the irreversible dementias.

Multi Infarct Dementia (Vascular Dementia)

Multi-infarct dementia (MID) is the most common form of vascular dementia, which is a deterioration in mental function caused by strokes. "Multi-infarct" means that multiple areas in the brain have been injured due to a lack of blood.

MID affects approximately 4 out of 10,000 people. It is estimated that 10 - 20% of all dementias are caused by strokes, making MID the second most common cause of dementia in the elderly, behind Alzheimer's disease. MID affects men more than women. The disorder usually affects people over 55, with the average onset at age 65.

The symptoms of MID vary. Memory loss is often an early symptom of the disorder, followed by trouble making judgments. This often progresses to delirium, hallucinations, and thinking problems. Personality and mood changes can also occur. Lack of emotion and motivation, withdrawal, and extreme excitability (agitation) are common. Confusion that occurs frequently or is worse at night is another common symptom. Risk factors for MID include a history of stroke, hypertension, smoking, and atherosclerosis.


  • Awareness of mental deterioration, which may cause frustration, depression, anxiety, stress, and tension.
  • Dementia (slowly progressive memory loss) with lack of awareness of mental deterioration and:
  • Difficulties with attention, concentration, judgment, and behavior
  • Confusion, disorientation
  • Hallucinations (hearing sounds or seeing things which are not there) and delusions
  • Uncoordinated or weak movements
  • Aphasia (impaired language ability)
  • Personality changes
  • Progressive decreases in multiple brain functions
  • Withdrawal from social interaction
  • Inability to interact in social or personal situations
  • Inability to maintain employment
  • Decreased ability to function independently
  • Decreased interest in daily living activities
  • Lack of spontaneity
  • Localized numbness or tingling
  • Swallowing difficulty
  • Sudden involuntary laughing or crying (emotional instability)
  • Stages of Progression

    Identifying the course of dementia in stages or phrases has been found helpful in understanding the evolution of the condition. Reisberg (1974) has reported the course of dementia into seven clinical phases with corresponding global deterioration stages. The stages range from no cognitive decline to very severe decline. The clinical stages are characterized as normal, forgetful, confused and demented.

    Early Dementia: in early dementia, the individual's behavior is characterized by moderate cognitive decline. Deficits may be noted during assessment of the mental status as well as in daily life. The patient may be disoriented to time and place and may be unable to recall personal information such address or telephone number. The person may need assistance in activities of daily living, such as getting dressed, etc… communication deficits are present and characterized by disjointed conversation that is reduced in its cohesion and information content.

    Middle dementia: middle dementia is characterized by severe cognitive decline. The dementing individual may forget a spouse's name and be unaware of recent events. Knowledge of the remote past is better preserved but is impaired. More assistance is needed with daily living activities. Communication skills become increasingly impaired, and verbal output becomes less informative with frequent word finding problems. Personality and emotional changes are seen in this stage. These may include delusional behavior, such as talking to imaginary figures; obsessive symptoms, anxiety.

    Late dementia: Very severe cognitive decline is seen in late dementia. In this stage, all verbal abilities are reported to be lost. Patients may be mute, perseverative, echolalic, or palilalic (with excessive reiterative utterances).


    Attitudes Towards English Among Malaysian Undergraduates | Linguistic Profile in Multi Infarct Dementia - A Case Study | Onomatopoeia in Tamil | Interactive Television Programmes - A Study in Media Ecology | Contour Tones in Igbo | HOME PAGE of February 2008 Issue | HOME PAGE | CONTACT EDITOR

    Shyamala Chengappa, Ph.D.
    All India Institute of Speech and Hearing
    Mysore 570 006

    Sunil Kumar Ravi
    All India Institute of Speech and Hearing
    Mysore 570 006

    Carmel Jennifer

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