Parkinson’s Disease: Speech, Swallow, and Cognitive Changes

Dec 14, 2022

Parkinson’s disease (PD) is a neurodegenerative disorder that affects predominately the dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.

Approximately 60,000 Americans are diagnosed with PD each year. About 75% of people with PD experience changes in speech and voice at some time during the course of the disease. 33% to 50% of patients with PD have symptoms of dysphagia. Approximately 50% of people with PD can experience some form of cognitive impairment.

Speech Difficulties with PD:

Symptoms of speech vary from person to person. Most common speech problems are:

  • Slurred or mumbled speech
  • Vocal flutter
  • Flat or monotone speech
  • Rapid Speech
  • Slow speech
  • Palilalia or involuntary repetition of syllables, words, or phrases
  • Soft, breathy, or hoarse vocal quality
  • Short rushes of speech

Unfortunately, most of the time, we don’t know why this happens. There are some theories why speech gets affected.

  • It could be because of the disordered motor system that comes with PD, such as rigidity, slowness of movement and tremor. Which is why speech becomes hoarse, breathy, or monotone.
  • Or it could be the change in sensory processing which is related to speech. It is believed that people with PD may not be aware that their speech is getting softer and more difficult to understand. They have difficulty with internal cueing to “cueing” themselves to produce speech with adequate loudness.

Cognitive changes in PD:

The prefrontal cortex of the brain and the dopamine system are responsible for executive function. And when that is affected, we see impairments in memory, thought processing, visuospatial difficulties which appear as difficulty navigating around their home, reaching for objects, or avoiding obstacles in their path.

Therefore, symptoms to look out for are:

  • distractibility
  • disorganization
  • forgetfulness
  • difficulty planning, problem solving, and multitasking
  • delayed information processing speed

Swallow problems with PD:

With the progression of PD, a person could have dysphagia or swallowing difficulty where food or drink can go down into the lungs instead of the stomach causing aspiration pneumonia which could be life threatening.

Common symptoms to look out for are:

  • Unexplained weight loss
  • Excessive Drooling
  • Recurrent pneumonia
  • Choking or coughing while eating or drinking
  • “Pocketing” of food in the mouth
  • Frequent heartburn or sore throat
  • Extra effort needed to chew/swallow
  • Sensation of food getting stuck in throat or chest

If you see any of these symptoms in you or your loved one, talk to your doctor or seek a speech language pathologist.

Treatment Choices:

Speech & Voice Treatment Choices:

  • The Lee Silverman Voice Treatment (LSVT®) LOUD
  • Collagen injections
  • Assistive Communication Devices

Swallowing Treatment Choices:

  • Neuromuscular Electrical Stimulation (NMES)
  • Expiratory Muscle Strength Training
  • Diet Modification
  • Swallow Exercise

Managing Cognitive Impairments:

  • Medication
  • Speech and occupational Therapy

Some of these treatments require special certification in addition to a master’s degree. In Autumn Oak, we have speech language pathologists who are certified in LSVT-LOUD and Neuromuscular Electrical Stimulation (NMES) and specialize in helping patients with neurological disorders.


Eshita Anjum, M.A., CCC-SLP



Statistics. (n.d.). Parkinson’s Foundation. Retrieved September 16, 2022, from

Speech and Swallowing Difficulties. (n.d.-b). Retrieved September 16, 2022, from

Speech & Swallowing Issues. (n.d.). Parkinson’s Foundation. Retrieved September 16, 2022, from