title: More Delusions May Be Observed in Low-Proficient Multilingual Alzheimer's Disease Patients.
abstract: BACKGROUND
  Language impairment and behavioral symptoms are both common phenomena in dementia patients. In this study, we investigated the behavioral symptoms in dementia patients with different language backgrounds. Through this, we aimed to propose a possible connection between language and delusion.
  
  
  METHODS
  We recruited 21 patients with Alzheimer's disease (AD), according to the DSM-IV and NINCDS-ADRDA criteria, from the memory clinic of the Cardinal Tien Hospital in Taipei, Taiwan. They were classified into two groups: 11 multilinguals who could speak Japanese, Taiwanese and Mandarin Chinese, and 10 bilinguals who only spoke Taiwanese and Mandarin Chinese. There were no differences between age, education, disease duration, disease severity, environment and medical care between these two groups. Comprehensive neuropsychological examinations, including Clinical Dementia Rating (CDR), Mini-Mental Status Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), Verbal fluency, Chinese version of the Boston naming test (BNT) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), were administered.
  
  
  RESULTS
  The multilingual group showed worse results on the Boston naming test. Other neuropsychological tests, including the MMSE, CASI and Verbal fluency, were not significantly different. More delusions were noted in the multilingual group. Three pairs of subjects were identified for further examination of their differences. These three cases presented the typical scenario of how language misunderstanding may cause delusions in multilingual dementia patients. Consequently, more emotion and distorted ideas may be induced in the multilinguals compared with the MMSE-matched controls.
  
  
  CONCLUSIONS
  Inappropriate mixing of language or conflict between cognition and emotion may cause more delusions in these multilingual patients. This reminds us that delusion is not a pure biological outcome of brain degeneration. Although the cognitive performance was not significantly different between our groups, language may still affect their delusion.
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan.|Fu Jen University School of Medicine, Taipei, Taiwan.|Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: Yi-Chien
authors.initials: YC
authors.lastname: Liu
authors.affiliation: Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: Yen-Ying
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Fu Jen University School of Medicine, Taipei, Taiwan.|Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: Ping-Keung
authors.initials: PK
authors.lastname: Yip
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Akanuma
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Meguro
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D016022:Case-Control Studies; D003071:Cognition; D003702:Delusions / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D015994:Incidence; D007806:Language Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D019303:Multilingualism; D009483:Neuropsychological Tests; D010258:Paranoid Behavior / Q000209:etiology / Q000523:psychology; D000067073:Psychological Trauma / Q000523:psychology; D012720:Severity of Illness Index; D013624:Taiwan; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology