Hi Dr. Mahler,
My husband has YOPD, diagnosed this year. He is 46 years old. He has multiple problems with his speech. One is volume/distinctness, he often speaks relatively quietly. I think there must also be problems with enunciation because often I can hear him speaking but still can't distinguish the words precisely. Sometimes he has dry mouth or slurred speech from medications that cause issues (he takes several psych meds). An additional issue is his "mild cognitive impairment". He has had extensive neuro-psych testing and was found to have deficits in verbal fluency and word finding. This shows up as slowed, hesitant speech at times with some stuttering and inability to come up with the word he wants to say. He says he knows what he wants to say but can't get it out. I've noticed significant progression of these symptoms in the last year. He has started to substitute names for things more often (like "cooking thing" for "stove."). He also frequently changes subject abruptly which makes it harder to follow his meaning.
I've had trouble hearing him for at least 5 years, to the point I would wonder if I had hearing loss. But people at work would point out to me that I don't have trouble hearing in other settings. Recently I was away on a trip for two weeks and had no problems understanding people or needing them to repeat things. As soon as I got home, I noticed having to have my husband repeat almost every other sentence. I know it's not just the quality of his speech but the problems with sentence construction and word choice.
This is a complicated problem and I think he would benefit from evaluation by a speech-language pathologist. Our difficulty lies in our financial circumstances. We are both disabled and on Medicare. Our income is pretty low and medical expenses high. My question for you is how to take the best advantage of speech therapy. I also know my husband tends to follow up poorly on exercises prescribed to him in physical therapy and don't expect ST to go differently. He is perfectly willing to go to therapy, especially if I go with him (which he needs these days due to his memory problems), but then not that willing to do homework or followup practice.
Also I am wondering if you have suggestions for strategies to help me with understanding him? It gets frustrating to both of us and I try very hard not to express impatience with him. The cognitive issues are harder for me than the mechanical speech issues. I am a retired nurse and have experience working with people with cognitive deficits, but didn't have to be with them 24 hours a day.
Does the deterioration of my husband's ability to communicate indicate higher probability of early dementia?
Thanks for listening.