Well, first would require a correct diagnosis as to whether concerns Parkinson's disease or Parkinson syndrome. Generally: Parkinson disease (PD) = Idiopathic Parkinson’s Disease

There are several classifications of parkinsonism, in my case, I prefer to use in daily clinical practice:

Which classifies Parkinson syndrome in primary and secondary;

Among the secondary (or symptomatic) include secondary to medicines, endocrine, vascular, poisoning, infectious, the NOH among other diseases.

Primary are classified as:

In typical (family and sporadic) and atypical (or Parkisonims plus) which in turn there are sporadic (MSA; PSP; P-D-ALS; CBD and DLBD) and family (Huntington’s disease; Hallervorden-Spatz disease; Pallidal atrophy) ...

Modern immunocytochemical techniques and genetic findings suggest that Parkinson-plus syndromes can be broadly grouped into 2 types: synucleinopathies and tauopathies. Clinically, however, 5 separate Parkinson-plus syndromes have been identified, as follows: Multiple system atrophy; Progressive supranuclear palsy; Parkinsonism-dementia-amyotrophic lateral sclerosis complex; Corticobasal ganglionic degeneration; Diffuse Lewy body disease.

This distinction between idiopathic Parkinson's disease and other parkinsonism is very important when talking of clinical symptoms.

Anyway, another important discrimination should be made concerning the terms used in aphasia and ability to speak.

Aphasia is the loss of ability to produce and/or understand language. This usually manifests as a difficulty speaking or understanding spoken language but reading and writing are also usually impacted. Aphasia can also impact the use of manual sign language and Braille. Aphasia is a cognitive process and actually represents a asymbolia.

the ability to speak might be for example a dysarthria that has nothing to do with cognitive disorders.

Hypophonia and dysarthria sometimes characterize speech in patients with PD. As compared to patients with AD, aphasia and paraphasic errors are rarely observed in PD, although production and comprehension of complex syntax may be reduced on occasion. Comprehension of written material and writing (limited by motor impairments) is also relatively preserved in PD. Visual confrontation naming tasks, requiring naming of pictured or actual objects, is preserved in PD without dementia, although rare studies report subtle naming impairments in early PD. More common are deficits on verbal fluency tasks requiring, within time constraints, the oral generation of words belonging to semantic categories or beginning with certain letters of the alphabet. Verbal fluency decrements are not universally observed in PD, but, when present, probably reflect deficient use of word retrieval strategies such as clustering and/or switching, meaning grouping of words by component sound or category, and moving efficiently between sounds and categories.

It was suggested that most of the language deficits, such as impaired verbal fluency and word finding difficulties, may not reflect a true involvement of language functions, but rather may be related to the dysexecutive syndrome, such as impairment of self-generated search strategies.

Classically parkinson's disease are not present aphasics syndromes, whereas in the parkisonismos yes.

She could have progressive non-fluent aphasia misdiagnosed as PD.

http://www.ncbi.nlm.nih.gov/pubmed/22575236

Agree with both Dr. Ratner and Dr. Gonzales. The only progressive aphasia cases I have seen in the parkinsonian spectrum are in patients with Progressive Supranuclear Palsy. Jankovic describes and interesting case in which a patient is aphasic when awake, but had significant talking during dreaming.

I agree with all above.  Your patient may have PSP or CBD.

a hallmark of CBD is aphasia.  also look for alien limb and apraxia.  is the pt responsive to dopaminergic treatment? if not, this may also suggest a parkinsonism such as CBD.... also if the MRI shows more unilateral and posterior atrophy, this would be more evidence for CBD

Hi, Jenna. I agree. I look at PSP as a midline (speech) apraxia, while CBD a lateral (limb) apraxia. The similar pathologies may suggest that perhaps that "basal ganglia" impairment is not sufficient to explain loss of speech access. This would be an evolution from a time when all parkinsonian symptoms were pushed subcortically.

Sorry -- I don't have an answer, but I do have PD, and with it I have serious problems with my speech. I don't know how relevant any of this is to this fascinating discussion, but in the event that some of it might be of interest, here is a quick summary of my story. I have had PD for about 15 years and been taking Sinemet for the last 9 years. For most of that time my speech has been unaffected, but the last couple of years it has deteriorated significantly. My symptoms include stuttering a lot, a serious volume deficit, and awful problems with enunciation, especially when the muscles of my mouth are tired. At the same time, I don't think I have a problem with cognitive functioning, though my partner, who also has PD, disagrees on that point. She also has a problem with speech, much like mine, but her problem also includes reading, which she says she can no longer do. We both have serious word-finding problems (but so do people our age who don't have PD; I am 72 and she is 68). I think we both have PD, since we both respond well to PD medications (Sinemet for me and, now, Rytary -- another formulation of the same meds -- for her). We both took a round of LSVT BIG therapy, but didn't have real benefits (though, I must confess, we didn't follow up with doing our homework). That's a quick summary of our situation. Again, I apologize for not having an answer to the question posed here and with that apology I also offer one for misusing this space, which I realize is not a forum for this kind of discussion. I just thought that my experience might be relevant. I hope it was.