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yarnkitty

Difficulty understanding my husband

2 posts in this topic

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.

 

Caryl Mauk

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Thank you for writing with this important question.  Speech problems are very common in people with Parkinson disease!  It has been reported that as many 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.  Unfortunately, the medications that can be so helpful for improving limb movement don’t always have a positive effect for movement of speech muscles and increasing intelligibility.  That is why people who have PD and communication difficulties need behavioral speech treatment.  The experience of having difficulty finding the right words may also be common for people with Parkinson's disease particularly as the disease progresses.  Both of these can have a negative impact on quality of life and I am glad that you wrote to learn more about it.

 

The difficulties initiating speech and slower thinking are similar to difficulties in limb movements with delayed initiation and slowness of movement.  Bradykinesia is the term typically used to describe this slowed initiation of movement.

 

The underlying cause of some of speech and voice difficulties has multiple sources:

•            Reduced vocal fold adduction

•            Reduced mouth opening

•            Decreased dynamic modulation of muscles of articulation

•            Mismatch between the person’s perception of their loudness during communication and actual levels of loudness

 

Many times there is also a mismatch between the person’s perception of their loudness during communication and actual level of loudness and understandability just as the one you reported.  For example, someone with PD may think people in their family need hearing aids when in fact it is the person with PD who is speaking too softly to be easily understood.  No wonder you thought you needed a hearing aid.

 

Unfortunately, the medications that can be so helpful for improving limb movement don’t always have a positive impact on bradykinesia for movement of speech muscles.  That is why people who have communication difficulties as a result of PD need behavioral speech treatment.  Research has shown that the homework component of treatment is critical for long-term success and carryover outside of the clinical environment.

 

The good news is that speech treatment may help your husband.  I recommend that you speak to your physician and get a referral to a speech-language pathologist (SLP).  Find an SLP who is experienced in treating communication deficits associated with PD.  That person will do an evaluation to determine how much of your difficulty is due to changes in speech motor control and how much may be caused by changes in cognitive/linguistic abilities.  The significant memory changes that you described in your email are of concern so soon after diagnosis and is something that should e evaluated specifically.

 

I hope this information helps and that you will seek an evaluation soon to get started on improving your communication skills.

 

Please write again if you have any additional questions.

 

Sincerely,

 

Dr. Mahler

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