Perseveration in Alzheimer's and Other Dementia

Getting Stuck

Perseveration is a common symptom of Alzheimer's disease, often beginning in early-stage Alzheimer's and increasing significantly as the disease progresses.

Perseveration is the persistent repetition of a word, phrase, or gesture despite the stopping of the stimulus that led to the word, phrase, or gesture. For example, if a person answers "Boston" to the question, "Where were you born?", he may then answer "Boston" to the question, "Can you say the days of the week backward?". Or, he may repeat "Boston" over and over again despite my trying to ask other questions. This shows that the person is unable to switch ideas. The person is usually unaware that he or she is perseverating (it is involuntary).

In addition to Alzheimer's disease, frontotemporal dementia, and other dementias, perseveration may occur in other brain disorders such as schizophrenia or traumatic brain injury.

Another type of perseveration- called graphic perseveration- has also been seen in people with Alzheimer's, Lewy body dementia, and vascular dementia. Graphic perseveration is when a person continues to draw the same shape or figure he was previously asked to draw. For example, if someone with dementia is asked to copy a cube figure, they may continue to draw it repeatedly despite being asked to move on to a new task.

Woman sitting with father
 Peter Zander / Getty Images

How Should You Respond?

Although you might find yourself becoming irritated and impatient if someone with dementia repeats the same phrase over and over, try to take a deep breath and remind yourself that he's stuck and doesn't know how to move on from where he is. It may help you to visualize the situation as if the person with dementia is in a car that's stuck on ice. He is probably spinning the wheels of his mind, yet unable to get any traction to be able to move forward.

Remember, too, that arguing with someone with dementia, or pointing out the fact that he's perseverating, is unlikely to help. You can try to use distraction to lead him away from the word or action that he's stuck on by offering him meaningful activities or music of his choice.

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By Andrew Rosenzweig, MD
Andrew Rosenzweig, MD, MPH, is an Alzheimer's disease expert and the chief clinical officer for MedOptions.