Speech and Language Disorders in the Elderly (Reprinted)

Cerebrovascular insults and neurodegenerative diseases are the main causes of acquired speech and language disorders. A massive increase in the prevalence of both is evident from the age of 65 years. By the age of 90 years, more than 10 % of the population would have experienced a stroke and 30 % would have suffered from neurodegenerative diseases. Common risk factors are adiposity, hypertension and diabetes. The term aphasia subsumes acquired language disorders that have to be further classified in order to optimize diagnostics and therapy. Also prognosis depends on whether the disease is progressive or not. The Primary Progressive Aphasia (PPA) is based on neurodegenerative cortical lesions. It causes speech and language disorders. The 3 variants of PPA complete the former classification of Broca-and Wernicke aphasias that are mainly caused by cerebrovascular insults. In cerebral diseases, disorders of articulation are often combined with dysphonia. Therefore, in addition to dysarthria, a "dysarthrophonia" is evident. The main reasons for this are cortical lesions due to cerebrovascular insults or neurodegenerative diseases. Degenerative extrapyramidal diseases also often affect articulation. Depending on the kind of basal ganglia disease, dysarthria or dysarthrophonia is seen in 70-100 % of patients which might be combined with dysphagia. Vascular insults and neurodegenerative diseases are also causes of brainstem and cerebellar disorders that affect motor speech. Therapeutic approaches to the speech and language disorders depend on the nature of the underlying disease, namely whether it is progressive or regressive.