Sudden inability to talkSudden speech changes
Posted 28 November 2013 - 03:41 AM
My mother is 66 years old. She was diagnosed last month with PD. She also has Essential Tremor and was diagnosed with that in 2001. As far as the PD diagnosis goes she was referred to a movement disorder neurologist when she presented with a resting tremor in her right hand. So far that has been the most pronounced motor symptom she has. She was placed on Azilect and Amantadine. These medications made her nearly catatonic at times as well as exaserbated PD symptoms she didn't even have, or at least weren't noticeable up to that point. She was weaned off the Azilect over a 5 day period and the Amantadine dosage was cut in half. She continued to have terrible side effects and her hands, legs and feet began swelling. The doctor had her stop the Amantadine a week ago yesterday (Wed). Her symptoms have improved and she was back to her old self, minus the resting tremor.
Last evening I was at her house for about 2 hours. We talked and laughed and the evening was a typical one for her (she lives next door to us). I was about to leave when she asked me if I needed her coat to walk back home. I told her no thank you and she replied with slurred, garbled, inaudible, speech that was somewhat hard to hear. I thought she was playing a joke on me until I saw the horrified, scared look on her face. I walked her to the couch and called my husband who is a first responder. He checked her for signs of a stroke and she didn't have any except the sudden slurred speech and inability to communicate well. We decided to take her to the ER. Long story short, they did a CT scan and it was negative. So they attributed this to the PD and started her on a low dose of Sinemet and sent her home. Her speech has not improved over the past 6 hours.
My question is this: Is it common for PD patients who have never had speech problems to suddenly, in mid conversation, have slurred, garbled, inaudible speech? In a matter of a seconds she went from her regular self to a scared, frail person unable to speak. And if this does happen, is this permanent or is there help for it? I'm sorry for going on for so long but I wanted you to have some background knowledge about my mom. Thank you for any help/advice you can offer.
Posted 28 November 2013 - 01:48 PM
It is unusual for someone to have a sudden change in the ability to communicate especially to the extent that they can't talk. It was wise of you to consider that your mother might be having a stroke and it is good that you visited the emergency room for experts to evaluate whether or not it was a stroke. Without seeing your mother in person it is not possible for me to determine why this might have happened but it sounds like it could have been a combination of events.
Speech problems are very common in people with Parkinson disease! It has been reported as high as 89% of people with PD have trouble with their speech or voice. The most common difficulties include reduced vocal loudness, monotone, mumbled articulation and a hoarse or breathy sounding voice. In addition, some individuals have difficulties similar to what you have described - difficulty initiating speech, slower thinking, and occasionally stuttering like behavior. However, these changes are typically gradual. It could be that there was a combination of medications, the impact of PD on muscles for speaking and possibly a contribution from swallowing. People with PD are also at risk for swallowing abnormalities and when someone swallows liquids "the wrong way" (into the air passage instead of the passage to the stomach) the vocal folds can be affected making it difficult to speak temporarily.
At the very least, if your mother has not had exercise based treatment for speech, I would recommend that. The data about the benefits of intensive exercise for people with PD is compelling and may very well help your mother.
Thank you for writing. I would be happy to answer any follow-up questions you might have.
Leslie Mahler, PhD, CCC-SLP
University of Rhode Island
Posted 02 December 2013 - 11:42 PM
Your mother's sudden change in speech was atypical of symptoms observed in persons with Parkinson Disease. And you and your husband did the right thing by taking her to the ER. A word of caution, a CT scan completed within 24-48 hours after a stroke will not show signs of a stroke, particularly if it was a small stroke (bleed). I trust she is now recovered? Is she complaining of a "thick tongue"? Have you noticed that when you ask her to raise her arms over her head, one arm is higher? Does she have a slight droop of her face on one side? If so, these are acute signs of a stroke. If you find her speech is still slurred and she still has a dramatic change in her speech, I suggest you pursue a neurology consult and a repeated CT scan to re-evaluate if she did indeed have a small stroke.
Dr. Celia Bassich
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