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Repetitive Questions/ Stories | What's Happening in the Brain

The basis of repetitive questioning is not well understood, even though it is a common complaint in Alzheimer's disease , and is distressing to caregivers. Many lines of evidence point to involvement of the frontal lobes, and one theory is that it represents a specific failure of monitoring the external flow of conversation. Another observation is that it reflects anxiety in relation to upcoming events, where part of the difficulty appears to be that people have problems seeing how one item entails the next in a logical flow or sequence of events.

To take an example from everyday life, compare two people about to go on a trip to a foreign country to which neither of them has been. The experienced traveller, however, knows the outline of what will happen - where to check in at the airline, what to expect at customs and immigration, how to get to the hotel. The inexperienced traveller can understand that each of these things makes sense, but without the experience will have a great many questions about what will happen that will never occur to the experienced traveler, who sees items as being linked (of course one picks up the bags between customs and immigration, and the taxi lines are usually just outside on the arrivals level, and an up-to-date guidebook will tell us how far the airport is from the hotel, and so on). Now imagine what happens if the inexperienced traveler also has a memory problem - they cannot see how one event flows into the next, but also cannot remember where in the sequence they are. Alzheimer's disease is a lot like being stranded in a strange place, and trying to get back home.

The Geriatric Medicine Research Unit at Dalhousie University did a descriptive study of 100 patients with mild-moderate Alzheimer's disease, of whom 88 completed a full year 12 months of treatment with donepezil. The study is described in Rockwood K, et al., Goal setting and attainment in Alzheimer's disease patients treated with donepezil. J Neurol Neurosurg Psychiatry. 2002;73:500-7. Of the 100 patients, 46 families identified repetitive questioning as a problem. (In that study, unlike here, there was no list of symptoms provided. Instead, people were relied upon to tell us things spontaneously). About 40% of these patients met the repetition goals, and those who did were more likely to meet other goals too. Interestingly, patients in whom decreased repetition was a goal were more likely to have signs of impaired executive function (i.e. to show problems with initiative, judgment and insight) than others. The conclusion from this study was that treatment can improve executive function. (Note that in the study reported here donepezil was used as the treatment, and the same pattern has also been shown in a galantamine treatment study; other drugs may or may not work as well - the more research that is conducted the more knowledge we have about symptoms and their treatment).

Many physicians have made similar observations, so that they commonly track repetitive questioning. Such symptom tracking is described in Rockwood K et al., "Potential treatment effects of donepezil not detected in Alzheimer's disease clinical trials : a physician survey". Int J Geriatr Psychiatry. 2004;19:954-60.

See Also:
About Dementia > Alzheimer's Disease > Early Signs
About Dementia > Alzheimer's Disease > Mild
About Dementia > Alzheimer's Disease > Severe
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Last updated January 13, 2019
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