It may start with a simple word an individual can't pronounce. The tongue and lips stumble, and gibberish comes out. Misspeaking might draw a chuckle from family and friends. But, then, it keeps happening. Progressively, more and more speech is lost. Some patients eventually become mute from primary progressive apraxia of speech, a disorder related to degenerative neurologic disease. Two Mayo Clinic researchers have spent more than a decade uncovering clues to apraxia of speech. Keith Josephs, M.D., a neurologist, and Joseph R. Duffy, Ph.D., a speech pathologist, presented "My Words Come Out Wrong: When Thought and Language Are Disconnected from Speech" on Sunday, February 14, 2016, at the American Association for the Advancement of Science (AAAS) 2016 annual meeting in Washington, D.C. Because patients and even many medical professionals don't recognize apraxia of speech, treatment is typically sought only in later stages of the disease, says Dr. Josephs. As apraxia progresses, it is frequently mis-diagnosed as Alzheimer's disease or amyotrophic lateral sclerosis (ALS). One patient received vocal cord injections of Botox by a physician who thought the issue was muscle spasms of the larynx. Apraxia of speech has even been diagnosed as mental illness. "Because it first presents as 'just' a speech problem, some people are told, 'This is in your head.' We've seen that. It's very sad," Dr. Josephs says. When it's caused by a stroke, apraxia of speech typically does not worsen and may get better over time. But, apraxia of speech is often ignored as a distinct entity that can evolve into a neurologic disorder, causing difficulties with eye movement, using the limbs, walking, and falling that worsen as time passes. "I don't want the take-home message to be that this condition is benign," warns Dr.
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