speech , swallowing and language problems in adults - NICE guidance - suspected neurological conditions - recognition and referral

FREE subscriptions for doctors and students... click here
You have 3 more open access pages.

Speech, swallowing and language problems in adults

Summary points from NICE guidance relating to speech, swallowing and language problems in adults are:

Sudden-onset speech or language disturbance

  • refer imediately adults with sudden-onset speech or language disturbance to have an assessment for a vascular event, in line with local stroke/TIA pathways.

Progressive slurred or disrupted speech

For adults with progressive slurred or disrupted speech:

  • refer for an assessment for neuromuscular disorders to assess for possible motor neurone disease

  • refer urgently if there is any evidence of swallowing impairment

  • refer immediately if there is breathlessness at rest or when lying flat.


  • consider referring adults with isolated and unexplained persistent dysphonia (a quiet, hoarse or wobbly voice) to have an assessment for laryngeal dystonia (involuntary contractions of the vocal cords) if hoarseness caused by structural abnormality or malignancy has been excluded by ear, nose and throat examination.

Be aware that persistent dysphonia in adults may be a presenting symptom of a neurological condition such as Parkinson's disease.

Word-finding diffificulties as part of an anxiety disorder or a functional neurological disorder

  • be aware that anxiety disorder and functional neurological disorders are the most common causes of minor word-finding difficulties in adults, and people with a diagnosis of anxiety disorder or functional neurological disorder made by a specialist might not need a referral.


Last edited 07/2019