title: Vocalization in dementia: a case report and review of the literature.
abstract: BACKGROUND
  Vocalizations are part of the spectrum of the 'negative' behavioral and psychological symptoms of dementia (BPSD). We describe a patient with moderate-stage mixed dementia of Alzheimer's disease and cerebrovascular disease and a left orbitofrontal lesion exhibiting vocalization. The use of 'redirection' has been demonstrated to be an effective nonpharmacological means of controlling BPSD, while reducing caregiver distress.
  
  
  METHODS
  A 78-year-old right-handed African-American female presented with complaints of worsening memory and BPSD, causing significant caregiver distress. Throughout the evaluation, she constantly vocalized her son's name and made a continuous grunting noise, correlating with increased anxiety/agitation. We utilized a redirection technique, which achieved the immediate reduction of the vocalization symptoms. Caregiver psychoeducation was provided allowing them to use the redirection technique at home.
  
  
  CONCLUSIONS
  In patients with dementia exhibiting negative symptoms of BPSD, using nonpharmacologic techniques (i.e. redirection) may be indicated. Psychotropic medications rarely address negative BPSD symptoms, while simultaneously decreasing patient's quality of life. Nonpharmacologic approaches are beneficial as first-line therapy for negative BPSD.
authors.affiliation: Alzheimer Disease Center, Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, N.Y., USA.
authors.forename: Arkady
authors.initials: A
authors.lastname: Yusupov
authors.affiliation: Alzheimer Disease Center, Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, N.Y., USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Galvin
keywords: Alzheimer's disease; Behavior and psychiatric symptoms of dementia; Caregiver distress; Dementia; Nonpharmacologic interventions; Vocalization