Unintentional Speech Errors in Older Adults: A Neurological Perspective

Q: Unintentional Speech Errors in Older Adults: A Neurological Perspective

Hello： Based on the symptoms mentioned, there is a suspicion of cognitive decline. <br>Both depression and dementia may present with the aforementioned symptoms. <br>A differential diagnosis is necessary for treatment, and it is recommended to visit a neurology outpatient clinic.

Mom often makes unintentional verbal slips?

Hello Doctor: My mother is 60 years old and has been receiving treatment from a psychiatrist for some time.
I am not entirely clear on her exact diagnosis, but I know she has sleep disorders.
Living with her, I notice that she has a very anxious personality and may also have issues with depression, although I am not sure since she hasn't asked her psychiatrist about her diagnosis.
I myself have been a patient with major depression for 8 years.

Since last year, I have noticed that my mother often makes verbal slips, such as saying "I am going to the health center to get medicine" but instead saying "I am going to the township office to get medicine," and she does not realize that she has made a mistake.
Initially, I found it hard to understand what she was saying, but later I realized it was a verbal slip.
Now, it seems that the frequency of these slips has increased.
Recently, she has confused "third uncle" with "elder uncle" or "second uncle" (referring to her brother who committed suicide due to depression).
After returning from a trip to Vietnam, she often confuses "Vietnam" with other countries like "South Korea" or "Thailand." Typically, her verbal slips involve nouns.
I have searched online for similar cases but have not found anyone with these issues.
It feels like a precursor to dementia, but it doesn't seem to fit entirely (as there are no other early symptoms).
It doesn't seem to be aphasia either.
I would like to ask the doctor if this condition could be considered a specific disorder and if there is a particular specialty she should see for evaluation.
Thank you.

Niming, 30~39 year old female. Ask Date: 2023/09/13

Dr. Cai Zongzhang reply Neurology

Hello: Based on the symptoms mentioned, there is a suspicion of cognitive decline.
Both depression and dementia may present with the aforementioned symptoms.
A differential diagnosis is necessary for treatment, and it is recommended to visit a neurology outpatient clinic.

Reply Date: 2023/09/13

More Info

Understanding unintentional speech errors in older adults can be complex, especially when considering the interplay of neurological, psychological, and cognitive factors. In the case of your mother, who is 60 years old and has a history of mental health issues, including anxiety and possibly depression, the speech errors you describe could be indicative of several underlying conditions.

Firstly, it’s essential to recognize that speech errors, such as substituting one word for another (e.g., saying "公所" instead of "衛生所"), can occur for various reasons. These errors might be benign and related to normal aging processes, or they could signal more significant cognitive issues. In older adults, particularly those with a history of mental health conditions, these errors can sometimes be linked to cognitive decline, which may include conditions like mild cognitive impairment (MCI) or even early stages of dementia.

Your mother’s frequent word substitutions and her inability to recognize these errors could suggest a decline in her cognitive processing abilities. This might not necessarily mean she has dementia, but it does warrant further investigation. Cognitive decline can manifest in various ways, including difficulties with word retrieval, which is often seen in conditions like aphasia, where individuals struggle with language despite having intact comprehension abilities.

Moreover, the context of her mental health history is crucial. Depression and anxiety can significantly impact cognitive function, leading to what is sometimes referred to as "pseudodementia." In this scenario, cognitive symptoms arise from mood disorders rather than neurodegenerative diseases. The overlap of symptoms can make it challenging to differentiate between these conditions without thorough evaluation.

Given your mother's symptoms, it would be advisable to consult a neurologist or a psychiatrist specializing in geriatric mental health. They can conduct a comprehensive assessment, including cognitive testing, to evaluate her memory, language skills, and overall cognitive function. This assessment may include neuropsychological testing, which can help distinguish between cognitive impairment due to depression and more permanent cognitive decline associated with dementia.

Additionally, it might be beneficial to explore her current mental health treatment. If she is experiencing anxiety and depression, addressing these issues may improve her cognitive function and reduce the frequency of her speech errors. Treatment options could include therapy, medication, or a combination of both, tailored to her specific needs.

In summary, while your mother’s speech errors could be indicative of cognitive decline, they may also stem from her mental health history. A thorough evaluation by a healthcare professional is essential to determine the underlying cause and to develop an appropriate treatment plan. Early intervention can make a significant difference in managing symptoms and improving quality of life.

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