Changes in the ability to communicate can be one of the most debilitating symptoms of PD. Non-verbal communication by the patient can be limited by the mask-like facial expression that often accompanies PD.42 Individuals may lose the ability to control volume and/or emotion in their voice. Providers may notice a patient’s voice becoming softer or beginning strong and fading away.1 Speaking approaches may be monotone or in contrast rapid with words crowded together. In advanced stages of the disease stuttering may be present or a patient may only whisper.1,60 This can make communicating difficult for both the patient and the provider.

There are several modifications that can be implemented to overcome communication barriers. Patients diagnosed with PD may experience speech and cognitive impairments that require increased response time. Providers should have time built into their schedule that affords sufficient time for the patient to answer questions. It may be helpful for providers to use short sentences and ask close-ended questions that do not require a long response. It may also be helpful to have a caregiver present during the appointment to assist with interpreting for the patient. When caregivers are present, it is important for providers to keep the patient involved in all aspects of the conversation. Providers need to consider all of these communication challenges when securing informed consent from the patient. At times it may be necessary to secure informed consent from legal guardians or the courts.22