[Confusing stories, not always confusion! Language disorders and dementia]

Sometimes confusing stories may have unexpected causes. A confused patient is not necessarily delirious or demented. We present three patients in which diagnosis was difficult. Their confusion appeared to be caused only partially by memory impairment. Dementia often presents with memory impairment, but sometimes a language disorder is more prominent. Ten percent of the dementias show language disturbances as the first sign. Language disturbances may exist for a long time, even before the onset of the memory impairment. The language disorder causes difficulty in proper judgment of memory. Logopedic examination is necessary to diagnose the language disorder. Neuropsychological testing should take the language disorder into account. Diagnostic accuracy is important. Distinguishing dementia from a language disorder has implications for the judgment of the patient's (dis)abilities and management.