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Do not assume that someone who is not speaking has nothing to say. Ask questions and allow time to answer.

What if you woke up one day unable to say: "I want," "I need," "I love."

It seems unfathomable and yet thousands of people who were once fluent can no longer express themselves because they can't say or remember the words; others, worse yet, can't understand them. It's frustrating for anyone afflicted and difficult for those around them.

The basis of our social existence is based on verbal communication. Although nonverbal communication can enhance or augment our verbal exchanges, without language meaningful interactions may be lost to us.

It's important to be aware that not only strokes can rob people of speech and/or language. So can neurodegenerative diseases, and the onset of symptoms can be subtle enough to go unnoticed for a while.

It can be especially difficult when it comes to diagnosing a loved one since, when you know someone well, you automatically fill in any gaps, unconsciously read body language or correct misunderstandings. In my clinic, I often encounter caregivers or family members who haven't really grasped the extent of the problem and are stunned when someone cannot answer basic questions I ask them.

Primary progressive aphasia (PPA) is a family of three neurodegenerative diseases where language problems are the prominent feature. Over time, however, patients with the condition develop other problems that include memory deficits as well as motor impairments.

Although most common with PPA diseases, problems with speech and language can play a role in all neurodegenerative diseases: Sufferers of Alzheimer's eventually forget words or can't remember the question they are attempting to answer. With Parkinson's, patients take a long time to respond, or their voice is inaudible, or their words incomprehensible. With frontotemporal dementia, sufferers' language can become increasingly inappropriate, since the frontal lobes largely govern social conduct.

The following traits may alert you to someone's impaired speech and/or language:

1. Speaks less.

2. More hesitant in their speech.

3. Stops partway through sentences.

4. Uses incorrect words.

5. Frequently uses "thing" or "stuff" instead of the correct word.

6. Often asks you to repeat yourself although their hearing is fine.

7. Asks you what something means when they obviously should know, such as "what is salmon," "what is weather."

Once you suspect someone is suffering from a speech or language problem, what can you do?

1. Evaluate comprehension. If you are concerned that this person is not understanding everything you say or maybe is just more forgetful, ask some simple questions that require more than a yes/no answer, such as:

Is the sky green?

How many children/grandchildren do you have?

What is your address?

When is my birthday?

2. Advocate. Demand language therapy for people with neurodegenerative diseases such as Alzheimer's disease, primary progressive aphasia, or Parkinson's disease. Every effort should be made to maintain communication as long as possible.

3. Find other ways to communicate. Familiar gestures or pictures can be a great help when speech and language become too impaired.

4. Do not assume that someone who is not speaking has nothing to say. Ask questions and allow time to answer. Get pictures of objects for people who can't express themselves. Ask questions that require yes/no answers if understanding is a problem. Check that the person has understood your questions and their response is truly what they mean.

5. Educate yourself on the different disorders and especially on the specific disorder that your friend or family member is facing. Get advice from speech language pathologists on finding alternative ways of communicating. With few programs for people with language problems that do not originate in post-stroke brain damage, many such patients and their families are left without resources. Communication problems lead to frustration, distress and caregiver burnout and the final result can be an inability to care for the patient at home.

Communication is essential for quality of life for both patients and their caregivers. Every effort must be taken to preserve communication for as long as possible.

Dr. Carmela Tartaglia is a neurologist at the Krembil Neuroscience Centre's Memory Clinic at Toronto Western Hospital, researcher at the Tanz Centre for Research in Neurodegenerative Diseases and assistant professor at the University of Toronto.

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