Speech disturbance

Speech disturbance is usually one of two types: dysarthria or aphasia. When it is due to

dysarthria – a problem of articulation –the patient will usually be acutely aware of the

problem. With aphasia – a problem of language – the patient may not be aware of the

problem or is unable to explain it. The term aphasia is usually reserved for patients

with a focal lesion involving the dominant cerebral hemisphere (usually the left, even

in left-handed patients) of the brain. Speech may also be impaired in dementia and

many other neurodegenerative disorders where there is widespread disturbance of

function in the cerebral hemispheres (see Chapter 13).