Brain changes in Parkinson’s disease stiffen muscles, including those that shape your facial expressions and help you speak. Up to 90 percent of people with advanced Parkinson’s develop problems with their voice and speech. But these changes don’t diminish your value as a person or a partner in relationships.
When you can’t communicate the way you used to, you may feel like avoiding social situations and you may stop doing things you love. But you have a lot of options to adjust how you talk and connect with the people you care about, and the tools and techniques below can help you communicate well while living with advanced Parkinson’s disease.
How Parkinson’s Can Affect Voice and Speech
Parkinson’s disease can change several areas of your body that allow you to speak. “Muscle movements are slower and less accurate, and the overall coordination of the lips, tongue, throat, and larynx, or voice box, may be weaker or have difficulty coordinating a movement,” says Kristen West, a clinical speech pathologist at Cleveland Clinic Nevada.
Not everyone will get speech changes, says Rachel Dolhun, MD, a neurologist and the principal medical adviser at the Michael J. Fox Foundation. “And even if you have speech changes, yours may be different from somebody else's.”
As Parkinson’s progresses, you may notice these changes to your voice and speech:
Speaking quietly
Monotone pitch
Hoarse, strained, or breathy voice
Difficulty pronouncing words clearly
Noticeable tremor in your voice
Slurring words together
Speaking in fast, short bursts
Lack of facial expression (“masking”)
The most common symptoms reported to West include pushing words together, loss of facial movement, and a weak voice. “But slow, labored speech follows those symptoms frequently,” says West.
Why Conversations Can Be Challenging With Parkinson’s
Besides muscle control, Parkinson’s can change the way that your brain processes information and speech. For example, it may take you a little longer to understand a question before you can answer, and fatigue can make it more difficult to find your words, express yourself, and keep up with a conversation, says Dr. Dolhun.
Slower processing isn’t the only culprit in conversation challenges. Facial masking can sometimes lead to misunderstandings. For example, if you say, “Thank you so much. This means a lot to me,” but your face shows no expression, your listener could mistake your meaning.
Parkinson’s can also make it difficult to focus and pay attention in conversation, says Katherine D. Amodeo, MD, a neurologist and assistant professor of neurology at the New York Medical College School of Medicine. “Slowness of thought, or bradyphrenia, can make it appear as if a person with Parkinson’s disease is not listening or not remembering well,” says Dr. Amodeo, but they often simply need more time.
Advanced Parkinson’s can sometimes cause hallucinations (seeing or hearing things that aren’t there) and delusions (firmly held false beliefs), which can add another layer of difficulty with communication, says Amodeo.
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Tips for Better Communication With Parkinson’s
As listening and speaking gets harder with advanced Parkinson’s, it’s easy to feel discouraged, but you have a lot of options to help you improve Parkinson's disease communication.
Set the Stage
Before any conversation, prepare. When you know that your speech might get quiet and multiple noise sources will distract you, you can set the stage for a successful conversation, says Dolhun.
Here’s how you can get ready:
Sit in a quiet, well-lit room, face-to-face with the person you’re speaking to.
Remove distractions like TV, phones, and the radio.
Choose a time of day when you have the most energy.
Have a topic and notes ready beforehand.
Plan for extra time (no rushing).
Communicating well can mean several things, says Dolhun, who recommends asking yourself, “What do I want or need out of the conversation? How do we work through that together?”
Dolhun recommends dedicating regular time to conversation. For example, one of her patients sits down with their family at the kitchen table every day at 4 p.m., after a nap. This built-in period makes time for talking and connection.
Use Parkinson’s-Friendly Speaking Techniques
Try adopting certain strategies to help you speak more clearly with Parkinson's:
Rest your voice before conversations when you can.
Take a breath before each sentence or phrase.
Make sure that the person you’re talking to can see your face.
Use short sentences.
Swallow pooled saliva before speaking.
For a dry throat or mouth, sip water throughout the conversation and avoid caffeine and alcohol.
Make sure that you’re comfortable sitting or standing.
Sit up straight and hold your chin up while you speak.
Imagine that you’re speaking to people in the back of a big room (without shouting).
Speak slowly and try to make each word very clear.
Put emphasis on key words.
As you practice these techniques, you’ll find the combination that gives you the best conversational success.
Practice Conversation Often
The more you practice speaking and listening, the better you’ll get at it. “You're building a skill just like anything else,” says Dolhun.
You can get extra speaking practice with other activities, too:
Talking out loud to yourself when alone
Speaking to your pets
Singing
If you feel nervous speaking in some social settings, you can start by joining a Parkinson’s support group, where you know others may better understand your needs and differences.
Ask for Clarification
Even in the best of circumstances, we can misunderstand others in conversation. As a caregiver, if you aren’t sure you understood what your loved one said, ask them to repeat or clarify it.
Keep follow-up questions simple. It also works well to ask for a one- or two-word clarification. For example, you could say, “You’re looking forward to what?” Or “Did you mean this: (Repeat what you heard.)” Then they can answer with the missing word or yes or no.
Try to avoid pretending to understand what your loved one said or jumping in to finish a sentence for them, unless they have asked you to.
Stay Patient
Learning new communication skills can feel frustrating for both the speaker and the listener. But Amodeo urges staying patient with each another, remembering that this is hard on both partners in different ways. If you have Parkinson’s, give yourself and others plenty of grace.
As a caregiver, give your loved one lots of time to respond, and avoid tapping your foot, walking away, or making gestures that add pressure. Try not to push too hard for them to join in a conversation if they don’t want to.
Be Ready to Adjust
As Parkinson’s progresses, new symptoms can appear or worsen, and it helps to prepare for possible changes. “For some people, there does come a point where verbal speech words are much more challenging, whether that's because of the speech itself or other symptoms of Parkinson's,” says Dolhun.
If you reach a point where you need help to communicate, you can try these options:
An electronic voice amplifier
TTY telephone relay system (typed speech read aloud)
Writing difficult words with pen and paper
Alphabet boards to spell out words
Hand signals for common words
Whatever your speaking challenges, think about how you can connect and communicate in ways outside of words, says Dolhun. You don’t always have to speak — you can listen to music or a podcast together, too, Dolhun adds.
Getting Help With Speech Problems
Even using the valuable tools above, you may still benefit from extra resources. “Because there are so many wonderful new programs that can help improve communication, seeing a speech pathologist would be my first recommendation,” says West.
Speech and language therapy pathologists specialize in speech, voice, and swallowing, says Dolhun. “There are a lot of exercises that they can do to help you project your voice, make it clearer, or speak more loudly.”
Treatments offered by your speech pathologist may include these options:
Speak Out involves exercises that retrain your brain for better control of your voice and speech.
SpeechVive, a wearable device, plays ambient noise when you speak, which naturally prompts you to speak louder.
Muscle training targets breathing muscles that help you push more air out while you talk, increasing your volume and how long you can speak.
Medications can decrease off times in Parkinson's that can trigger more speaking difficulties.
It’s also smart to get prepared for emergencies. If you have trouble speaking with Parkinson’s, you can use an intercom system, baby monitor, buzzers, bells, or other noisemakers to signal urgency. Or if you live alone, you can purchase a service that sends help to you at the push of a button.
The Takeaway
When advanced Parkinson’s disease causes difficulty speaking, you have options for easier communication.
For optimal conversations with Parkinson’s, plan to talk face-to-face in a quiet room, take your time, and practice speaking to yourself or a pet.
Caregivers can support their loved ones with Parkinson’s by giving them plenty of time to speak and respond, asking for clarification, and repeating what you heard if you aren’t sure.
If you have Parkinson’s, a speech pathologist can offer several therapies and techniques to help you communicate well.
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Resources
Speech and Communication. Parkinson's UK. December 13, 2024.
Tips for Improving Communication in People With Parkinson's Disease. Cleveland Clinic. August 21, 2020.
Rohl A et al. Speech Dysfunction, Cognition, and Parkinson’s Disease. Progress in Brain Research. August 13, 2024.
Stang CD et al. Incidence, Prevalence, and Mortality of Psychosis Associated With Parkinson Disease (1991–2010). Journal of Parkinson's Disease. March 2, 2022.
Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.
Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.
