Screaming, shrieking and muttering: the noise-makers amongst dementia patients

We have described twelve dementia patients with noise making. We categorized noise making into (i) persistent screaming, (ii) perseverative vocalization, (iii) continuous chattering, muttering, singing or humming, and (iv) swearing, grunting and bizarre noise-making. The patients' ages ranged from 70 to 92 years with a mean of 78. There were four males and eight females. Five had Alzheimer's disease and the remaining seven vascular dementia. Five exhibited mild to moderate aggression while another five displayed severe aggression. All but one had motor restlessness and four had delusions or hallucinations. In ten patients the dementia was moderate to severe with five having total dissolution of speech. All but two were in the third stage of the illness and were totally dependent for basic self care. There was a wide network of anatomical structures involved in the twelve patients. The findings are related to what is known of the neuroanatomic location of the lesions and the role of frontal subcortical circuitry and neurotransmitter systems in relation to behavior. Noise-making could be explained by damage to the frontal lobe or interruption of the complex subcortical circuits and related brain chemistry. Treatment of patients with noise-making remains a challenge.