Speech abnormalities, or dysphasia, may be either nonfluent (expressive) or fluent (receptive). In expressive aphasia, the speech pattern is hesitant and labored, with poor articulation. The patient has no problem with comprehension. When asked to say, ''no ifs, ands, or buts,'' the patient has great difficulty. In receptive aphasia, the speech is rapid and appears fluent but is full of syntax errors, with the omission of many words. Handwriting changes are nonspecific but indicate an impairment of neuromuscular control. Ask the following questions:

' 'Have you noticed any recent change in your speech pattern, such as slurring of your words?'' Do you have trouble understanding things that are said to you?'' Have you had any difficulty finding the right word in conversation?'' Has your handwriting changed recently?''

Language problems, as well as slurred speech, are found commonly in patients suffering a stroke.

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