Speech and Language Problems in Parkinson's Disease

Difficulties are common but can be managed

If you have Parkinson’s disease (PD), you probably notice that people ask you to repeat what you just said more than they used to. In addition, speaking clearly and intelligibly becomes a little more difficult when you have PD.

Older woman with a mature woman
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While the majority of people with PD experience some type of speech problems, few get treatment for those speech problems. This is unfortunate as research shows that effective treatments are available for speech, voice, and language problems in PD.

Speech Problems of Parkinson’s Disease

The most common speech problems experienced by people with PD involve reduced volume (hypophonia), reduced pitch range (monotone), and difficulty with the articulation of sounds or syllables (dysarthria). In essence, you can’t speak as loudly as others, you find it more difficult to convey emotion when you do speak, and you find it difficult to form the words you are trying to pronounce.

You don’t need me to tell you that this combination of factors makes speaking extremely frustrating. When you couple all of these voicing problems with the so-called ‘masked faces’ of PD, the difficulty in expressing emotions via facial expression, it's no wonder that people occasionally find it challenging to understand what you are trying to say.

It may be tempting to withdraw from conversations with others altogether, but that would be a mistake. You need to interact with others on a daily basis, no matter how frustrating it becomes — this is critical for your mental health, and be assured that your loved ones want to interact with you. The good news is that there are treatments, such as voice exercises, that can dramatically improve the voicing problems associated with PD.

Language Problems of Parkinson’s Disease

Besides the frustrating speech and voicing problems of PD, there may also be language problems. These language problems very likely make the speech problems more difficult to deal with, so it is important to identify these language difficulties when they appear.

Speech is about expressing ideas via the use of language. Language is a cognitive ability that can be present even when you cannot speak. In the case of people with PD, they may exhibit word-finding difficulties and grammatical difficulties. They tend, for example, to use simplified sentence structures with an increase in the ratio of open-class items (nouns, verbs, adjectives) to closed-class items (determiners, auxiliaries, prepositions, etc.), as well as an increase in the frequency and duration of hesitations and pauses.

When listening to others speak, it's sometimes hard for persons with PD to understand the other’s language, if they use complicated sentences to express their ideas. Thus, in both the production of language and comprehension of language, people with PD sometimes experience significant difficulties.

Treating Speech and Language Problems in Parkinson’s Disease

Potential treatments for speech and language problems of PD include medication, behavioral therapies, and surgery. The most recent assessments of these therapies suggest, however, that surgery (particularly deep brain stimulation) is not effective for speech problems, although it may improve some of the severe motor problems of PD. In addition, there are no medication therapies that are effective when used alone.

Treating the basic motor problems of PD optimally (with medication) appears to be a prerequisite for improving speech problems. That is, if the PD motor problems are untreated, the speech problems do not respond well to behavioral treatments. PD medication is, therefore, necessary but not sufficient. In short, the optimal treatment strategy for speech and language problems of PD appears to be a combination of PD medication (like levodopa) plus some form of behavioral speech therapy.

Behavioral Speech Therapy for Parkinson's Disease

Behavioral speech therapy usually involves a series of voice exercises administered by a trained and certified speech therapist. These exercises include training in control of speech rate, stress/intonation, or expression of emotion, loudness, articulation, and breathing, so as to support the voice. Sometimes the therapist uses assistive instruments, such as delayed auditory feedback, voice amplification devices, or pacing boards.

Some investigators have claimed significant success with PD patients by using the so-called Lee Silverman Voice Treatment (LSVT), an intensive program of voice exercises that targets vocal intensity, quality, and variation — precisely the areas of difficulty for persons with PD.

The LSVT approach centers on a single therapeutic target at a time so that effort can be invested in achieving that target alone. A therapeutic target might be increasing vocal loudness or enhancing speech intelligibility. In pursuing these sorts of therapeutic targets, the patient is drilled on a series of voice exercises and is taught to be aware of sensory feedback from the voice, as well as to self-monitor voicing patterns and voice quality. The increased self-awareness of voice allows for the correction of errors and for faster progress toward the target.

Bottom Line

The available evidence suggests that these sorts of behavioral speech therapy regimens really work, so there is no reason for you to keep having frustrating conversations with others who pretend they understand what you are saying. Instead, you will re-learn to clearly and loudly speak your mind.

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By Patrick McNamara, PhD
Patrick McNamara, PhD, is an associate professor of neurology and the director of the Evolutionary Neurobehavior Laboratory.