Voice Problems and Alzheimer’s Disease

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel HillLogo for UNC Chapel Hill, Cecil G. Sheps Center
Medically Reviewed by Christopher Melinosky, MD on November 27, 2022
9 min read

Voice and speaking problems are common in people who have Alzheimer’s disease. Voice problems are different from speaking problems in some important ways. Voice problems are often mild and can be treated at home, but sudden speech problems are more likely to need urgent medical care.

Voice problems are caused by changes in a person’s vocal cords or throat muscles. This might make it hard for someone to talk because their voice is weak, hoarse, scratchy, or raspy. This is called dysphonia. Causes of voice problems include:

  • Irritation of the vocal cords. This is by far the most common reason for issues with the voice. It often happens when someone uses their voice too much as they talk, yell, sing, or cough. It can also be an issue if they smoke, have allergies such as hay fever, or have heartburn.
  • Laryngitis. This is when your vocal cords swell because of a viral infection, like a cold. It’s not a serious problem and usually goes away in a few days.
  • Muscle weakness caused by problems in the brain. Conditions such as Parkinson’s disease, dementia, stroke, voice tremor, vocal cord paralysis, and voice muscle spasms can affect your throat muscles and make your voice hoarse or weak.
  • Age. As a person ages, their throat becomes dry, their throat muscles often lose strength, and their vocal cords get weaker and less flexible. These changes make the voice higher in many people but lower in some. They can also weaken the voice and make it shaky or hoarse.
  • Throat cancer. This is relatively rare, but hoarseness with no clear cause that doesn’t get better can sometimes be a sign of throat cancer.

Speaking problems are caused by changes in a person’s brain that make it hard for them to understand what is said, figure out what to say, and put the right words together. Someone with these issues may find it hard to remember words. They may also be hard to understand, slur their words, repeat the same sound (stammer), or say one word when they mean another. Sometimes they’re unable to speak at all. They have several causes:

  • Dementia. All people with dementia find it harder to speak over time. This happens slowly, and the type of problem is different from person to person.
  • Medication. Drugs that affect your brain can affect your ability to speak. The most common example is alcohol. In the same way, narcotics, tranquilizers, and sleeping pills can also cause these problems.
  • Stroke or mini-stroke (transient ischemic attack). A hard time talking can be a sign of this, especially if it happens suddenly.
  • Sudden severe confusion (delirium). People with delirium may have a hard time naming objects, following directions, and choosing the right words.
  • Other problems with the brain. Parkinson’s disease, head injuries, brain infections, and brain tumors can affect the way the brain processes words.

If you see someone with the following symptoms, call 911 right away:

  • They suddenly have trouble trying to speak, they slur their words, or mumble.
  • They struggle to read, write, or understand others when they could before.
  • When you ask them to smile, their face looks uneven or droops on one side.
  • They have new weakness or numbness in one or both arms or in one or both legs.

Talk to a doctor about ways to prevent a stroke, including watching your loved one’s blood pressure, blood sugar, cholesterol, and weight. Try to get them to exercise for at least 30 minutes a day and to eat a healthy diet with lots of fruits and veggies. Help them remember to take all their medicines at the right times every day.

If your loved one has a voice problem, first try to get them to rest their voice. Help them try to cut down on how much they talk, whisper, shout, cry, and sing. Don’t tell them to be quiet. They might not understand and get frustrated or angry. You might just do things that don’t require talking as much, such as watch TV or go to a movie.

Moisture in the air can help ease some irritation that causes voice problems. You can add moisture to the air in your home with a cool-mist humidifier. You might also have your loved one take a steamy shower. Just be sure the water isn’t too hot.

Try to keep your loved one away from things that cause irritation or allergies, like smoke, air pollution, perfumes, dust, animal dander, mold, and pollen.

If heartburn (acid reflux) is causing the problem, help them stay away from high-fat or spicy foods, chocolate, coffee, colas, and juices with a lot of acid. Also, help them cut back on or stay away from alcohol. Have them not eat for 3 hours before they lie down, and raise the head of their bed about 6 to 8 inches. f heartburn persists or recurs, talk to your doctor to see if a medication can help.

If your loved one has voice or speaking issues, it’s best to learn to communicate in spite of it. Cut down as much as possible on distractions and background noise when you talk with them. Give them plenty of time to respond, and don’t finish their sentences.

If you don't understand what they say, don't pretend to. Ask them to make themselves clear with a “yes or no” question. You might say, “Did you ask me if I’d taken out the garbage?” You might need to plan out your talks with them. For example, when you start a conversation, try to get them to agree on the topic first.

You can also use other ways to communicate with each other. For instance, you can write, draw, gesture, touch, and use facial expressions and eye contact. If your loved one works to express words but can read words or pictures, try a “nonverbal communication board.” This is a device with pictures of common needs, such as “tired”, “thirsty”, and “need to use the bathroom,” to help people who have issues trying to talk. They’re available at medical supply stores and online.

Sometimes, the conditions that cause problems with speech can also affect the ability to read, write, and understand words. If your loved one has a hard time understanding spoken words, remember that these problems aren’t the same as hearing problems. Talk in a normal tone of voice. It won’t help them understand if you talk loudly, and it may upset or frustrate them.

Remember that they don’t mean to ignore you. They just might not understand what you say. Don’t show frustration if they often misunderstand you. This might cause them to get anxious or agitated. Make your sentences simple, and speak slowly but don’t talk down to them. Repeat yourself when necessary. Try to make comments rather than ask questions or make demands. If you need to ask a question, try to make it a simple “yes or no” question.

Encourage your loved one to speak, even if it takes a lot of time and energy to communicate. Don’t pay attention to their mistakes and try not to criticize. Let them know you understand the frustration they must feel at not being able to speak as well as they’d like to.

Remember that temporary symptom relief and management at home isn’t a permanent solution for these problems. If they don’t get better with treatment or home care, call their doctor.

Social withdrawal or depression. Because these problems make it hard to communicate clearly and confidently, people who have problems with their voice or speech might feel that you don’t understand them. They might also feel embarrassed, isolated, or that they’re a burden.

Agitated or aggressive behavior. This can happen when someone with Alzheimer’s disease has physical, social, or emotional needs they can’t get others to understand. Because of this, vocal issues can make them irritable and restless. If you’re concerned that your loved one might get upset and take it out on you, protect yourself. Step back, give them space, and take away anything nearby that could be used as a weapon. Tell their doctor about any behavior issues like this.

Hoarseness that lasts longer than 2 weeks. This can be caused by illnesses from the common cold to something more serious. Any hoarseness that lasts longer than 2 weeks should be checked by a doctor.

Sore throat. This is a common problem for people with voice problems. It’s usually caused by upper respiratory infections, like a cold, that get better on their own. Some sore throats, especially one that comes and goes, may be related to heartburn (acid reflux). Others can be very uncomfortable and sometimes they’re a sign of serious illness. If it happens along with trouble breathing, a skin rash, trouble swallowing, or swelling of the neck and tongue, this could be a sign of a serious problem. Call 911 or go to an emergency room right away.

Hard time swallowing. This can be very serious, especially if it makes someone drool, gag, cough, or choke on food. If your loved one can’t swallow their saliva and they drool or have trouble trying to talk, get medical help right away.

Aspiration. This is when food or liquid “goes down the wrong pipe” and ends up in the lungs. It’s more likely to happen in people who have certain types of voice and speech problems. It usually causes someone to clear their throat frequently after they eat, or to cough, choke, or gasp while they eat. It can also lead to pneumonia. If this happens, call or see their doctor.

Because they have many different causes, it might not be possible to keep them from happening. But you can take steps to make them less likely.

  • Help your loved one drink plenty of fluids, such as water, soup, and juice. Ask their doctor how much is right for them.
  • Help them cut down or stay away from alcohol and caffeine.
  • Include plenty of whole grains, fruits, and vegetables in their diet. These foods have important vitamins and help keep the lining of the throat healthy.
  • Help them exercise regularly. Exercise makes muscle tone better and helps provide good posture and breath control, which are necessary for a healthy voice.
  • Voice exercises can help keep problems from happening. For instance, encourage the person to read a book aloud for 10 to 15 minutes a day, or have them sing along to their favorite music.
  • Don’t buy mouthwash that has alcohol or chemicals that irritate. If your loved one really wants to gargle, try to get them to use a saltwater rinse instead.
  • Unless their doctor says otherwise, try to stay away from most cold or allergy medicines. These can dry out their vocal cords.
  • Try to stay away from things that irritate the nose and throat, like smoke, air pollution, and fumes. Also stay away from things that trigger allergies for some people, like dust, animal dander, mold, and pollen.
  • If they smoke and might be able to stop, ask a doctor about programs and products that may help.

Some illnesses that cause voice problems are easily passed from person to person. If your loved one has or could have an infection, help them wash their hands often with soap and water, and wash yours after you touch them. If their voice problems make them cough a lot, have them cover their mouth when they cough. If they can’t follow your instructions, you might want to wear a mask. To help keep the infection from spreading to others, stay away from babies and young children until your loved one is healthy. Ask your doctor or a counselor about vaccines against the flu (influenza virus) and bacterial pneumonia.