The sounds, phrases, and vocalizations that people with dementia often make—including moaning, repetitive phrases, shouting, groaning, and constant calling out—are common symptoms collectively referred to as persistent vocalizations or verbal agitation. These behaviors are not typically intentional acts of disruption but rather a form of communication or an involuntary neurological symptom that arises as the disease progresses and erodes cognitive function. Understanding the underlying causes is the first step for caregivers trying to respond effectively to these distressing sounds.
Communication Breakdown
Damage to the brain’s language processing centers, a condition known as aphasia, significantly drives vocalizations in dementia. As the illness advances, the ability to articulate complex thoughts, feelings, or needs using structured language diminishes. The person may struggle with word-finding, sometimes saying a related word instead of the correct one, or their speech may become fragmented and difficult to understand.
This functional decline creates deep frustration, and the resulting “noise” becomes a desperate, non-verbal attempt to express a desire for help or movement. A repetitive phrase or an insistent call-out, for example, may indicate the patient is trying to express a concern, a need for reassurance, or a desire to connect, but the words to convey the message are unavailable.
Expression of Unmet Physical Needs
One of the most actionable reasons for persistent vocalizations is the presence of an unmet physical need or discomfort. Since the person with dementia cannot verbalize symptoms or pain clearly, a change in vocal behavior serves as the primary indicator of a physical problem. Nonspecific vocalizations like moaning, groaning, or sharp cries are associated with a state of discomfort.
These sounds can signal pain, which may be acute (like a sudden cramp) or chronic (such as arthritis or pressure sores). Other common physical needs that manifest as vocal agitation include hunger or thirst, or the need to use the restroom. Discomfort can also arise from being in a static position for too long. Any sudden increase in vocalizations warrants a full physical assessment to rule out medical issues such as a urinary tract infection or other internal problems.
Response to Emotional and Environmental Stressors
Many vocalizations are direct reactions to the person’s internal emotional state or their immediate surroundings. Emotional triggers such as fear, anxiety, loneliness, or confusion can result in agitation and subsequent noise-making. People with dementia often repeat sounds or phrases to self-soothe, seeking comfort, familiarity, or security in the repetition.
External environmental factors can be powerful triggers for disruptive vocalizations. Overstimulation from a noisy or crowded environment, sudden loud sounds, or an unfamiliar setting can overwhelm the person, leading to agitation and shouting. The phenomenon known as “sundowning,” where confusion and restlessness increase in the late afternoon or evening, frequently involves an increase in calling out. Disruptions to a consistent routine or the presence of new caregivers can also introduce stress that triggers a vocal response.
Neurological Basis of Involuntary Vocalizations
Beyond communication attempts and responses to stressors, some vocalizations are purely involuntary symptoms caused by structural brain damage. The deterioration of brain cells, particularly in the frontal and temporal lobes, affects the neurological circuits that control social behavior and speech. Damage to these areas can lead to disinhibition, which is the loss of the mental “filter” that prevents inappropriate or spontaneous vocalizations.
This neurological change can manifest as perseveration, which is the uncontrollable and repetitive utterance of the same word, question, or sound, often with no clear communicative purpose. The individual may also exhibit complex repetitive behaviors, such as continuous chattering, humming, or singing. These sounds are less about an immediate need and more a direct consequence of generalized neurological deterioration affecting vocal control. Nearly all disruptive vocalizations are associated with some form of brain injury, emphasizing that these sounds are symptoms of the disease, not intentional behavior.