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• Slurred Speech

6 Causes of Slurred Speech

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6 most common cause(s)

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What is slurred speech?

Slurred speech is when you have trouble speaking, your words are slow or garbled, or your words run together. When you talk, many components of your nervous system work together to form words. When these parts don’t work correctly, your speech can become distorted, or “slurred.” The medical term for slurred speech is dysarthria.

Slurred speech includes problems pronouncing words and regulating the speed or pace of your speech. It can range from a barely noticeable problem to one that’s so severe that others can’t understand what you’re saying.

People often describe slurred speech as feeling like you’re trying to talk with your mouth full of marbles.

Common causes of slurred or slow speech include drinking too much alcohol and not getting enough sleep. In these cases, the slurring will stop once you’re sober again and have gotten rest, respectively.

There are also other causes of slurred speech such as a stroke (a medical emergency), brain tumor, Bell’s palsy, or a serious migraine.

Does slurred speech always need to be treated?

"People often think slurred speech is a minor symptom that does not need a medical evaluation. As our speech and ability to speak is our main form of communication, it is important to look for correctable causes." — Dr. Karen Hoerst

Should I go to the ER for slurred speech?

You should call 911 if:

• Your slurred speech starts suddenly.
• You have other symptoms, such as a sudden or severe headache and weakness or numbness of one side of your body.
• Your tongue, face, or lips are swelling, which could mean you’re having an allergic reaction.

1. Stroke or TIA (transient ischemic attack)

• Slurred speech
• Drooping of one side of the face
• Weakness or trouble controlling one side of the body
• Numbness in the face , arm , or leg
• Difficulty walking
• Sudden loss of vision or double vision
• Sudden, severe headache

A stroke occurs in the brain because the blow flow in a blood vessel is blocked. It can also happen when a blood vessel ruptures or leaks. This affects the blood supply to parts of the brain, which leads long-term damage. If it affects the area of the brain responsible for speech, it can cause slurred speech.

A transient ischemic attack , or TIA, is sometimes called a "mini stroke." A TIA is a temporary interruption of blood flow that causes the same symptoms as a stroke, but improves without any permanent damage to the brain or symptoms.

For example, if you have slurred speech because of a TIA, once the blood flow is restored to that area of the brain, the slurred speech goes away. But people who have a TIA are at a high risk of having a stroke in the future, especially if their risk factors are not treated. Risk factors are the same for stroke and TIA and include smoking, obesity, and cardiovascular disease.

It’s extremely important to call 911 right away if you suddenly have slurred speech. Getting immediate treatment is critical to minimizing permanent damage. Paramedics can begin treating you in the ambulance on the way to the hospital, so it’s better to call 911 than go to the ER yourself.

Treatments for strokes and TIAs include medications to break up blood clots and surgery to remove blood clots from the vessels. If your stroke is from bleeding in the brain, you may need surgery to repair a blood vessel.

Following treatment, your doctor will recommend medications to prevent another TIA or stroke. These typically include drugs that prevent clots from forming in the blood (like aspirin or other blood thinners) and cholesterol medication to prevent plaque from building up on the walls of the blood vessels. You may also need to take medication to control your blood pressure.

Speech therapy is recommended to help treat problems with speech.

It may not be a stroke

"There are so many possible causes of slurred speech. Most of the time we need a detailed history and physical exam to guide the diagnosis and treatment." — Dr. Hoerst

2. Bell’s palsy

• Drooping of the face
• Drooping of the eye
• Changes in taste or hearing

Bell’s palsy is a relatively common condition that affects the facial nerve, which is responsible for movement of your face.

In Bell’s palsy, the nerve gets inflamed typically because of a recent viral infection. This inflammation can cause the facial nerve to not work as well, leading to drooping and slurred speech.

Bell’s palsy usually improves in a few months, but medications such as steroids and antiviral drugs are typically given to help speed the process. If nerve problems continue, physical therapy is recommended. In rare instances, surgery may be needed to help improve facial muscle function.

3. Brain tumor

• Slurred speech or speech difficulties
• New or changing headaches
• Weakness or coordination and balance problems
• Abnormal vision

A brain tumor is an abnormal growth of cells in the brain. A brain tumor may be cancerous (malignant) or noncancerous (benign). Both types can cause symptoms including slurred speech.

The diagnosis of a tumor in the brain or spinal cord is based on an exam and imaging of the brain, such as an MRI or CT scan. A biopsy (tissue sample) may be needed to determine what type of tumor it is.

Some tumors, such as a small noncancerous tumor, do not need treatment, though your doctor will recommend periodic MRI scans to make sure it hasn’t changed.

Most larger or cancerous tumors do require treatment, which may consist of chemotherapy, radiation, or surgery. If you develop physical or cognitive (mental) problems from the tumor, rehabilitation such as physical therapy, occupational therapy, or speech therapy may be needed.

4. Multiple sclerosis

• Blurred vision or decreased vision, typically in one eye
• Weakness or trouble walking
• Numbness or pins-and-needles sensation on your face, arm, or leg (typically on one side)
• A band-like squeezing sensation around the chest or abdomen
• Difficulty focusing

Multiple sclerosis, or MS, is a central-nervous system disease that affects the cells of the brain and spinal cord. In MS, a fatty tissue that surrounds nerve fibers (myelin) is attacked. Myelin helps to insulate the electrical signals sent through the nerves. When there is a problem with this fatty tissue, information sent to and from the brain can be disrupted.

MS is most common in young adults between the ages of 20 and 50, according to the National MS Society .

MS is not curable , but treatments have dramatically improved the ability to control MS, so people usually have fewer symptoms and less disability.

Treatment includes medications that may be taken orally or injected or infused through an IV line. Physical therapy and speech therapy are commonly used to help in physical recovery, and medications can be used to treat other symptoms, such as depression, pain, and fatigue.

5. Amyotrophic lateral sclerosis (ALS)

• Difficulty with speech, including slurred speech
• Progressive weakness and difficulty balancing
• Muscle cramps, twitching, and stiffness
• Difficulty swallowing

Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s disease. It affects nerve cells called motor neurons that control your movement.

The disease primarily causes a loss of strength, impaired swallowing and speech, and in most cases, difficulty breathing because of impaired respiratory muscles. It is a progressive disease, meaning that symptoms are mild at first and worsen over time.

Previously, it was thought that ALS doesn’t affect a person’s mental ability. But it’s now known that people with ALS can get a specific type of dementia called frontotemporal dementia (FTD). That condition can affect behavior, mood, and speech.

Symptoms of ALS can develop in adults of any age, but it’s most commonly diagnosed in people who are between the ages of 40 and 70, according to the ALS Association .

While there are some medications that can be used to delay the progression of the disease, there is currently no cure for ALS. Treatment includes rehabilitation with physical therapy, occupational therapy, speech therapy, and respiratory therapy.

6. Migraine

• Sensitivity to light and sound
• Visual disturbances

A migraine causes a severe headache that is often accompanied by nausea and sensitivity to light or sound. But some migraines don’t cause head pain.

Other symptoms that involve the nervous system can occur. Some of these sensory symptoms are called “auras.” These distortions can cause visual changes , including flashing lights or distorted vision. People may feel tingling or numbness of their face, arm, or leg.

In some types of migraine, people may even develop slurred speech and weakness of the face, arm, or leg. These are also symptoms of a stroke, so it may be hard to figure out which condition you have. If you develop sudden slurred speech or weakness, go to the ER immediately.

In an acute migraine attack, medications can be used to stop a migraine that has already started, such as triptans or newer medications called CGRP inhibitors. These medications can be in pill form, inhaled form, or injectable medications.

Migraine prevention can include taking medications for blood pressure, anticonvulsants, or even antidepressants. In some instances, Botox treatments are used to prevent migraine.

Behavior and lifestyle changes such as exercise, improved sleep, and healthy diet or weight loss are also often recommended to help decrease the number of migraine headaches you experience.

Other possible causes

Slurred speech may occur from alcohol intoxication or tiredness. It can also be a side effect of medications like high dose pain medications, antipsychotic medications or even some allergy medications like antihistamines. Other causes include:

• Infections such as urinary tract infections or electrolyte imbalances (particularly in elderly people).
• Brain infections such as meningitis or encephalitis.
• Problems that affect your mouth or throat, such as poorly fitting dentures, dental infections, dental numbing medications, swelling in your throat, or muscle or nerve problems.
• An allergic reaction , especially if you notice slurred speech along with tongue swelling , lip swelling, or shortness of breath.

"Early speech therapy can not only help with early improvement but also with diagnosis. Speech-language pathologists have special training in detecting the various types of slurred speech, which helps to determine the possible causes."— Dr. Hoerst

Specialty treatment options

• Speech therapy is the most common treatment for slurred speech.
• Injected medications such as Botox are sometimes used, depending on the cause of slurred speech.
• Medications to improve nerve and muscle function.

While it's important to follow your healthcare provider's guidance, here are some over-the-counter (OTC) options that might provide extra support.

• Proper nutrition supports overall health, including nerve function. Supplements like B vitamins may support neurological health.
• Staying hydrated is key, especially if speech difficulties make it hard to drink. Consider a no-spill, easy-sip water bottle designed for easy grip.
• Engaging in exercises to improve speech clarity can be helpful. Explore speech therapy tools and resources that you can use at home.

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• Patient Care & Health Information
• Diseases & Conditions

Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Treating the underlying cause of your dysarthria may improve your speech. You may also need speech therapy. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

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Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria. They may include:

• Slurred speech
• Slow speech
• Inability to speak louder than a whisper or speaking too loudly
• Rapid speech that is difficult to understand
• Nasal, raspy or strained voice
• Uneven or abnormal speech rhythm
• Uneven speech volume
• Monotone speech
• Difficulty moving your tongue or facial muscles

When to see a doctor

Dysarthria can be a sign of a serious condition. See your doctor if you have sudden or unexplained changes in your ability to speak.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Wilson's disease

Some medications, such as certain sedatives and seizure drugs, also can cause dysarthria.

Complications

Because of the communication problems dysarthria causes, complications can include:

• Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Daroff RB, et al., eds. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed April 10, 2020.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/PRPPrintTemplate.aspx?folderid=8589943481. Accessed April 6, 2020.
• Drugs that cause dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 10, 2020.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed April 6, 2020.
• Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed April 6, 2020.

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Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

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• Continuing Education Activity

Dysarthria is a neuromotor disorder that results from abnormalities in speed, strength, accuracy, range, tone, or duration required for speech control. Decreased speech intelligibility characterizes the disorder. The content of the spoken language remains intact, so the patient can write and comprehend spoken and written language. Dysarthria is a motor speech disorder seen with many neurological causes. This activity reviews the main subtypes, evaluation, management of dysarthria, and the role of the interprofessional team in evaluating and improving patient care.

• Identify the different subtypes of dysarthria.
• Determine the etiology of dysarthria in common neurological disorders.
• Implement a comprehensive initial history, physical, and speech evaluation for patients with dysarthria.
• Apply best practices for the interprofessional team to achieve the overall goals of holistic individualized treatment to facilitate communication, decrease isolation, and improve patient outcomes.
• Introduction

Dysarthria is a neuromotor disorder that results from abnormalities in speed, strength, accuracy, range, tone, or duration required for speech control. [1]  Decreased speech intelligibility characterizes the disorder. The content of the spoken language remains intact, so the patient can write and comprehend spoken and written language. Anarthria is the severe form in which there is a complete loss of motor speech production. [2]

Speech is a complex neuromuscular phenomenon achieved through the smooth coordination of 5 subsystems: respiration, phonation, resonance, articulation, and prosody. [3]  Muscular dysfunction affecting any of these subsystems causes impairments in audibility, naturalness, intelligibility, and communication efficiency. Dysarthria profoundly affects the patient and their families, as communication is integrally related to expressing personality and social relationships. Since there is overlap in the functioning of the muscles, feeding and swallowing difficulty in patients with dysarthria is common.

Various neurological disorders can cause dysarthria. Dysarthria can arise from disorders at various locations of the neuroaxis, including the cerebral cortex, basal ganglia, cerebellum, cranial nerve nuclei, or peripheral nerves, and from a primary motor disorder of the tongue, larynx, and pharynx.

Mayo Clinic Classification (commonly used - groups dysarthria based on the location) [4]

Etiopathological Causes

• Infections: Creutzfeldt–Jakob disease, acquired immune deficiency disease.
• Vascular disorder: Ischemic and hemorrhagic strokes, arterio-venous malformations.
• Neoplasm: Primary and metastatic brain tumors.
• Demyelinating: Multiple sclerosis, Guillain–Barre disease.
• Degenerative: PD, progressive supra nuclear palsy, corticobasal degeneration, multiple system atrophy, Huntington disease (HD), ataxia telangiectasia.
• Trauma: TBI, chronic traumatic encephalopathy, cerebral palsy.
• Toxic: Heavy metal poisoning (Minamata disease due to methylmercury poisoning can cause dysarthria), alcohol, drugs
• Genetic: Sensory ataxic neuropathy, dysarthria, and ophthalmoparesis (SANDO) due to a mutation in the gene encoding the mitochondrial DNA polymerase gamma enzyme (POLG1) [5] [6]

In addition to the neurological causes, nonneurological causes, such as cleft lip or palate and laryngeal tumors, also cause difficulty with articulation. However, the condition is not termed dysarthria if it stems from nonneurological causes.

• Epidemiology

The exact incidence of dysarthria is not known, and incidence varies based on the underlying cause. About 90% of patients with PD develop dysarthria during the illness. In ALS patients, dysarthria may predate limb weakness by about 3 to 5 years; dysarthria affects about 70% of patients with limb weakness. [7] [8]  

In one study evaluating stroke patients, 28% had both aphasia and dysarthria, and 24% had dysarthria only. In a study of children with neuromuscular diseases, the prevalence of dysarthria was 31.5%. [9]  It is estimated that 10 to 60% of patients with TBI have dysarthria. [10]

• Pathophysiology

The motor control of speech occurs at multiple levels. The cranial nerve nuclei receive cortical supply through the corticobulbar tract. All other cranial nerves are innervated bilaterally except for the lower face, which receives contralateral innervation. The facial nerve terminates in 5 branches; the branches that contribute to the muscles of speech are the buccal, mandibular, and, to an extent, cervical. The glossopharyngeal nerve (IX), through the stylopharyngeal nerve, innervates the stylopharyngeus muscle and, through the pharyngeal branches, innervates the muscles of the pharynx. [11]

Through the pharyngeal branches, the vagus nerve innervates the pharyngeal muscles, which elevate the palate and cause pharyngeal constriction. The glossopharyngeal nerve provides a sensory supply to the stylopharyngeus, which elevates the pharynx during speech. The cricothyroid muscle supplied by the vagus’ superior laryngeal branch is the vocal cords’ chief tensor. The recurrent laryngeal nerve separates the vocal cords and opens the glottis through the posterior cricoarytenoids, closes the glottis through lateral cricoarytenoids, and relaxes the vocal cords through the vocalis.

Hypoglossal nerve nuclei originating in the medulla provide motor branches to the tongue, supplying the intrinsic and extrinsic muscles (except the palatoglossus).

Suprahyoid muscles:  These influence tongue movements by altering the position of the hyoid bone.

• C1 fibers supply the geniohyoid muscle.
• The trigeminal nerve supplies the mylohyoid muscle and the anterior belly of the digastric muscle.
• The facial nerve supplies the stylohyoid muscle and posterior belly of the digastric muscle.

In the neuromuscular junction, acetylcholine produced in the presynaptic nerve terminal binds to receptors, ultimately creating an endplate potential strong enough to propagate action potential over the surface of the skeletal muscle membrane, resulting in muscle contraction. In myasthenia gravis, various autoantibodies interrupt these processes resulting in dysarthria and other symptoms. [12]

• History and Physical

Multiple neurological conditions cause dysarthria, so the natural course and clinical features can differ. The presentation can be acute in patients with acute ischemic stroke, whereas it can be delayed in neurodegenerative diseases like ALS.

Based on the Mayo classification, there are salient features of dysarthria [13]  described below:

Flaccid: Speech is slow, with hypernasality and breathy vocal quality. One of the most common examples in clinical practice is idiopathic peripheral facial paralysis, in which the patient presents with facial paralysis and drooling. Another common cause is Guillain–Barre syndrome.

Spastic:  Speech is harsh, with low pitch and constant errors. Speech evaluation shows hypernasality, reduced intelligibility, palatal elevation, and slow speech rate. Patients have signs of pseudobulbar palsy with dysphagia, hyperactive jaw jerk, and pseudobulbar affect. Patients with dysarthria-clumsy hand syndrome are noted to have facial weakness, dysarthria, and extremity dysmetria. [14]

Hypokinetic dysarthria:  This is seen in PD due to the loss of dopaminergic neurons. Speech is monotone and poorly articulated and tends to be quiet. Delays in speech initiation mixed with rushing of words can be seen. Other characteristic signs, such as masked facial features, resting tremors, cogwheeling, and festinating gait, can be observed at the examination.

Hyperkinetic dysarthria: This is seen with basal ganglia lesions and associated hyperkinetic movement disorders, such as HD. Speech is harsh, with variation in loudness and rate of speech. There are occasional stoppages while speaking.

Ataxic dysarthria:  This is commonly seen with disorders of the cerebellum or its connections. Speech has a “scanning” quality or irregular rhythm with the explosion of syllables. Prosody is impaired, with each syllable being pronounced slowly, and there is a pause after every syllable. There is decreased motor coordination manifested by axial and appendicular ataxia depending on the part of the cerebellum affected.

Mixed dysarthria:  Two or more central nervous system components are affected in this type. This can be seen with ALS and multiple sclerosis. Speech is slow, prosody is disrupted, voice is strained, and there is marked hypernasality.

A thorough history and a detailed physical examination are crucial in evaluating patients presenting with dysarthria. A comprehensive initial speech evaluation is comprised of (1) history, (2) oral motor/speech mechanism exam, (3) screening of subsystems (respiration, phonation, articulation, resonance, and prosody), (4) perceptual assessment, and (5) intelligibility evaluation.

The water glass manometer test provides a gross assessment of pressure-generating capabilities for speech production. The patient must blow into a water-filled drinking glass with the straw secured at a certain depth inside the glass. If the patient can maintain a stream of bubbles for 5 seconds, breath support is adequate for most speech purposes. To be valid, the patient must maintain velopharyngeal closure and a tight lip seal around the straw. [15]

Perpetual assessment of speech helps observe the function of all speech subsets. This assessment provides insight into deficits and serves as a comparison tool. Passages such as "my grandfather" and "caterpillar passage" help assess perceptual speech. [16] [17]  These passages help evaluate the speech repertoire, examine the subsystems of speech, contemporary vocabulary, and simple syntax, and assess polysyllabic word form.

The Caterpillar Passage

"Do you like amusement parks? Well, I sure do. To amuse myself, I went twice last spring. My most MEMORABLE moment was riding on the Caterpillar, which is a gigantic roller coaster high above the ground. When I saw how high the Caterpillar rose into the bright blue sky, I knew it was for me. After waiting in line for thirty minutes, I made it to the front, where the man measured my height to see if I was tall enough. I gave the man my coins, asked for change, and jumped on the cart. Tick, tick, tick, the Caterpillar climbed slowly up the tracks. It went SO high I could see the parking lot. Boy, was I SCARED! I thought to myself, "There's no turning back now." People were so scared they screamed as we zoomed fast and faster along the tracks. As quickly as it started, the Caterpillar came to a stop. Unfortunately, it was time to pack the car and drive home. That night I dreamt of the wild ride on the Caterpillar. Taking a trip to the amusement park and riding on the Caterpillar was my MOST memorable moment ever!" 

Speech Intelligibility Evaluation

Assessment of intelligibility in dysarthric speakers (AIDS), sentence intelligibility test (SIT), and word intelligibility test are used to assess speech intelligibility. AIDS is the most commonly used and comprises word and sentence tasks. The patient reads or imitates 50 unsystematically chosen words from 12 phonetically similar words for each word. In the sentence task, the patient reads or imitates two sentences each for 220 words. The sentences are chosen from a collection of 100 sentences of each length. The judge derives an intelligibility score based on the percentage of words transcribed accurately.

SIT is an improved Windows version of the sentence portion of AIDS. It examines the intelligibility of words and sentences and estimates efficiency by examining the rate of intelligible words per minute in sentences.

The onset and progression of dysarthria and associated neurological complaints, such as tremors, dysphagia, and gait instability, can provide clues for the diagnosis. A medication list review should include potential overdoses and exposure to toxins, such as alcohol and cocaine. Having the patient count from 1 to 100 can bring out respiratory muscle fatigue in myasthenia gravis. Counting numbers without interruption (1–30) is another bedside tool to assess respiratory status. [18]  Sustaining an "ah" sound is a functional bedside test to assess laryngeal function.

Imaging techniques, such as computed tomography (CT) of the head and magnetic resonance imaging (MRI) of the brain, are helpful initial tools in evaluation. In patients suspected of neuromuscular junction disorders, electromyography (EMG) and nerve conduction studies (NCS) are indicated. CBC (complete blood count), basic metabolic profile (BMP), and urine drug screening are indicated based on history and pretest probability. If GBS is suspected, evaluation of pulmonary function (vital capacity and negative inspiratory force) is indicated. [18]

Speech Assessment Tools

Frenchay Dysarthria Assessment is one of the most commonly used commercially available tools for dysarthria assessment. It was initially devised in 1980 and revised in 2008. It incorporates a series of tasks used to identify the dysarthria subtype. Speech pathologists rate the patient's speech employing a 5-point scoring system on the following (a) reflexes, (b) respiration, (c) lips, (d)palate, (e) laryngeal, (f) tongue, and (g) intelligibility, (h) influencing factors. [19]

For subjective assessment, self-report questionnaires such as Living with Neurologically Based Speech Difficulties (Living with Dysarthria - LwD) may be used. The severity of dysarthria may not always correspond to the extent of perceived communicative difficulties. [20]  

• Treatment / Management

The overall goals of speech and language treatment are to facilitate the recovery of communication, to assist patients in developing strategies to compensate for communication disorders, and to counsel and educate people in the patient's environment on assistive communication supports to facilitate communication, decrease isolation, and meet the patient's wants and needs.

When developing the plan, it is essential to consider dysarthria's cause, severity, and underlying co-morbidities. Speech-language pathologists and physicians work together to formulate an individualized approach for the patient. Recent studies indicate that speech rehabilitation significantly improves speech in adults with stroke-related dysarthria and that interventions such as Lee Silverman Voice Treatment are effective for hypokinetic dysarthria in individuals with PD. [21] [22]

Broadly, types of therapy could be grouped as follows:

• Therapy targeting the speech-production subsystems
• Communication strategies
• Environmental adaptations
• Augmentative and alternative communication (AAC)
• Medical/surgical interventions.

Targeting the Speech-Production Subsystems

Speech pathologists can target the five individual subcomponents that produce speech.

Lee Silverman Voice Treatment and Pitch Limiting Voice Treatment target phonation; the former is a program that improves loudness and intelligibility and has been widely studied in PD, while the latter increases vocal loudness without increasing pitch. [23] [24]  Articulation can be improved by increasing loudness, pausing, exaggerating articulation, and altering pitch variation. Respiratory muscle strength training supports breathing by altering posture to target respiration.

Communication Strategies

Providing feedback, clarifying, and encouraging are practical approaches for the partner. For the patient, setting up the conversation by gaining the partner's attention, slowing and repeating the phrases, and using nonverbal gestures, such as eye contact and facial expressions, are helpful strategies.

Speech supplementation, such as alphabet, syntactic, and topic, are helpful strategies. In alphabet supplementation, the speaker uses an alphabet board to identify the first letter of the spoken word. In topic supplementation, a phrase or cue word is uttered before speaking. Information about the grammar or word class is provided with each spoken word in the syntactic supplementation.

Behavioral communication intervention techniques such as biofeedback are shown to improve intelligibility. In stroke patients, biofeedback techniques increased the volume, decreased the speed, and improved the intelligibility. [25] [26]

Environmental Adaptations

Setting up optimal environmental conditions to increase understandability includes ensuring a quiet conversation background, intimate seating, and face-to-face interaction.

Augmentative and Alternative Communication (AAC)

AAC may include low-tech aids, such as picture boards or pen and paper, or high-tech aids, such as smartphones, voice synthesizers, digital records, and speech-generating devices. [27]  

Computer-based interventions offer an exciting step toward dysarthria management. Some examples are:

• A mobile application for PD patients. It includes an assessment of the speech in addition to various other aspects of disease management [28]
• Feedback and individual practice using computers were as effective as traditional therapy in patients with stable dysarthria [29]
• Improvement in articulation and intelligibility was assessed in Virtual articulation therapy [30]

These small studies hold good promise for further expansion of computer-based interventions.

Medical/Surgical Interventions

Medical therapy should target the underlying neurological cause. In dysarthria arising from PD, therapy should focus on repleting dopaminergic therapy. The effects of PD drugs on dysarthria are variable. Subthalamic nucleus stimulation has some efficacy among surgical treatments, but speech intelligibility worsens, as with most surgical interventions in PD. [31]  Improving spasticity in ALS with baclofen, tizanidine, and botulinum toxin type A has been tried. [8]

Laryngoplasty is an option if hoarseness is associated with recurrent laryngeal nerve palsy and does not improve with conservative management. Palatal lift improves resonance by surgically lifting the weak palate. Since the 2019 COVID pandemic, telehealth has become more relevant than ever. Telerehab (TR) is less expensive and equally effective in improving functional stroke outcomes, including speech, compared to traditional rehab. [32]  

In another review of speech therapy administered via teletherapy in patients with PD, the patient reported overall increased satisfaction due to increased convenience and accessibility. Further research is needed, however, as the studies lacked double blinding, and there was heterogeneity in the protocol. [33]

• Differential Diagnosis

The differential diagnoses for dysarthria include aphasia, apraxia of speech, and aphemia.

Apraxia, in general, is a dysfunction of a learned motor task. Patients need help initiating speech and transitioning between sounds; they speak through trial and error, and their errors are inconsistent. When patients are asked to repeat a phrase exactly, especially a polysyllabic word (eg, television), different errors are noted in each attempt. Isolated apraxia of speech is rare; it is usually seen with aphasia. Imaging might show lesions in the dominant insula and Broca’s area. [34]

Aphasia is a language impairment. Depending on the location, language comprehension or production may be impaired. Patients also have difficulty writing and reading. [35]

Aphemia is a motor speech disorder resulting in near muteness. Patients have normal comprehension, reading, and writing.

Dysarthria is described as chronic if persistent for greater than 5 years. Dysarthia is considered stable in patients with nonprogressive etiologies.

Recovery also appears to be dependent on the etiology. One study evaluating dysarthria following stroke showed recovery in about half of the patients. [36]  No estimates of the long-term prognosis of various diseases are available. However, from various anecdotal reports, it is evident that dysarthria is progressive in most neurodegenerative diseases.

Functional Communication Measures (FCMs) refer to rating scales used to define an individual’s functional abilities. They are seven-point rating scales, ranging from least functional (Level 1) to most functional (Level 7). They help measure a patient’s functional communication and swallowing abilities throughout speech-language pathology intervention.

• Complications

Speech difficulty can have a significant impact on the patient’s psychosocial life. Patients report stigmatization, changes in self-identity, and social and emotional disturbances due to post-stroke dysarthria. In children, behavioral problems and lack of access to education can lead to decreased future employment opportunities. Tools such as the Dysarthria Impact Profile (DIP) are available to assess the psychosocial impact of dysarthria. [37]  Given the possibility of far-reaching effects, timely intervention should be the goal.

Dysarthria Impact Profile is used to assess the psychosocial impact of dysarthria. [38] Patients report how their condition hinders them in multiple circumstances, such as talking to people they do not know and ordering a meal in a restaurant. The tool is used for outcome measurement and for planning interventions. Communicative Participation Item Bank (CPIB) is a self-reported tool designed for adults with various communication disorders; this tool has clinical and research applications. [39] Patients report how their condition hinders them in multiple circumstances, such as talking to people they do not know and ordering a meal in a restaurant.

• Consultations
• Neurologist
• Speech and language pathologists
• Physiatrist (physical medicine and rehabilitation)
• Deterrence and Patient Education

When the patient or family first notices dysarthria, they should immediately bring it to the attention of an appropriate medical practitioner. Acute onset might be a symptom of stroke; hence, rapid evaluation in the hospital is warranted. If symptoms are progressive, patients are typically assessed by a primary care clinician and referred to specialists. Patient and caregiver strategies help during rehabilitation. [40]  

Paying attention to the speaker, speaking in a quiet area with good lighting, repeating phrases that are not understood, and clarifying unclear statements by asking yes-or-no questions are some valuable strategies for caregivers. Patients should begin with one word or phrase before proceeding to complete sentences. Speaking slowly with frequent pauses helps ensure understanding. Frequently ensuring listeners understand and using pictures and writing are also helpful strategies. When tired and frustrated, dysarthria worsens. When necessary, using alternative methods of communication is warranted. Educating the listener about dysarthria improves recognition of the condition and their attitude toward the patients. [41]

• Pearls and Other Issues

The International Classification of Functioning, disability, and Health (ICF) is a classification system of health and health-related conditions developed by the World Health Organization (WHO) and published in 2001. It is a framework that addresses functioning and disability related to a health condition within the context of the individual’s activities and participation in everyday life.

The table below maps a patient with ataxic dysarthria due to a cerebellar stroke:

Activities and Participation Environmental and Personal Factors

• Enhancing Healthcare Team Outcomes

Dysarthria is among the most common neurological complaints and can arise from many primary neurological and nonneurological conditions. Collecting detailed history, including onset, progression, associated neurological symptoms, and collateral history from family and friends, is essential.

If dysarthria is a presenting symptom, extensive workup may be required to diagnose the underlying cause. Nurses are often the first to recognize speech difficulties in an inpatient who develops dysarthria and should inform the clinician and make recommendations for interventions. An interprofessional team, including a neurologist, physiatrist, nurses, and speech–language pathologist, must make the diagnosis and formulate a treatment plan. Social workers may assist in locating support groups and local resources for patients and families.

Conventional speech therapy and high-tech AAC devices can assist with functional communication when natural speech is not understandable. The Academy of Neurologic Communication Disorders and Sciences (ANCDS) and the American Speech–Language–Hearing Association (ASHA) published four practice guidelines between 2001–2004 to support the treatment of dysarthria. Various societies, such as the ANCDS, the National Parkinson’s Foundation, the Multiple Sclerosis Society, and the ALS Association, have practical guidelines for managing patients with dysarthria.

The Speech–Language Pathology Medical Review Guidelines published by ASHA focus on specific components of the speech production process, such as improving muscle strength and control, reducing consonant imprecision, and improving respiration for producing an adequate voice. [Level 5] ASHA has an evidence maps section highlighting the most recent evidence-based research in dysarthria. Emerging evidence suggests TR improves costs and patient satisfaction compared to traditional in-person therapy. The study evaluated post-stroke patients’ quality of life and motor, speech, and cognitive function. [32] [Level 1]

The prognosis of dysarthria depends on the cause. Proper consultation with specialists and education of family members and friends is required to optimize patient treatment and allow patients to regain their most significant level of independence. The treatment regimen is highly individualized and requires an extensive interprofessional team. Hence, prompt consultation with interprofessional specialists is recommended to improve outcomes.

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Disclosure: Dilip Kumar Jayaraman declares no relevant financial relationships with ineligible companies.

Disclosure: Joe Das declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Jayaraman DK, Das JM. Dysarthria. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Review Disorders of communication: dysarthria. [Handb Clin Neurol. 2013] Review Disorders of communication: dysarthria. Enderby P. Handb Clin Neurol. 2013; 110:273-81.
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• Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version. [Int J Lang Commun Disord. 2022] Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version. Icht M, Bergerzon-Bitton O, Ben-David BM. Int J Lang Commun Disord. 2022 Sep; 57(5):1023-1049. Epub 2022 Jun 17.
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10 Most Common Causes Of Slurred Speech

Clear speech relies upon the precise coordination of various muscular subsystems involved in respiration (breath), phonation (voice/vocal fold vibration), articulation, and resonance. Any changes or disturbances to the muscles engaged in these processes can potentially disrupt the synchronicity of the motor-speech mechanism leading to instances of slurred speech.

Slurred speech is a term used to describe imprecise articulation or decreased articulatory accuracy and clarity when speaking. It can arise due to various underlying factors. In this post, we explore common causes of slurred speech, emphasizing the importance of understanding these factors for obtaining effective intervention.

Neurological Disorders

One of the leading causes of slurred speech is the presence of a neurological disorder. Any condition that disrupts typical brain function such as a stroke, traumatic brain injury, tumor, or progressive neurological condition such as Parkinson’s disease, can disrupt the strength and coordination of the muscles required for speech.  Neurological changes interfere with the communication signals between the brain and the muscles responsible for speech. This makes it challenging to precisely coordinate these muscles leading to slurred or unclear pronunciation.

When slurred speech arises in face of neurological conditions that affect how muscles control and coordinate the organs required for speaking, it’s termed dysarthria. Speech therapy is a cornerstone of dysarthria treatment. For more information on dysarthria and dysarthria treatment see our posts on Slurred Speech: What Causes Dysarthria? and The Impact of Stroke on Communication: Unveiling Aphasia and Dysarthria and A Guide to Speech Therapy for Parkinson’s Disease and How Brain Injuries Affect Your Speaking Ability

Medication Side Effects

Certain medications, known for their impact on the central nervous system, may cause slurred speech as a side effect. These may include drugs prescribed for pain management, muscle relaxants, or medications that induce sedation. It is crucial for individuals to communicate openly with physicians and attending healthcare professionals about any changes in speech patterns while taking medications to ensure safety and assess and adjust treatment plans accordingly.

Alcohol and Substance Use

Excessive alcohol consumption and substance use can impair cognitive function and motor skills, leading to slurred speech. Alcohol and various substances have an impact on the central nervous system which can alter the muscular control and precise coordination of organs involved in speech production. 

Dehydration and Overhydration (Hyponatremia)

Inadequate hydration can affect various bodily and neurological functions, including speech. Dehydration reduces saliva production, leading to dryness in the mouth and difficulties easily executing fine motor movements needed to articulate words clearly.  In severe cases, dehydration may induce harmful neurological consequences including delirium and confusion resulting in incoherent thoughts and overall reduced control and coordination of the subsystems of speech which are required to produce crisp clear words. 

Overhydration, a condition medically termed hyponatremia, can affect the balance of electrolytes in the body, more often leading to low sodium levels. These imbalances may also alter neurological function and impact clarity and precision of speech sounds. 

Fatigue and Exhaustion

Prolonged periods of fatigue and exhaustion can compromise muscle strength, control, and coordination, including those responsible for speech. Individuals experiencing extreme tiredness may find their speech becoming effortful and slurred due to muscular fatigue affecting articulatory precision. 

Infections and Illnesses

Certain infections affecting the respiratory system or causing generalized muscular weakness can contribute to slurred speech. Conditions such as the flu, pneumonia, or other illnesses that lead to fatigue and weakness may impact the body’s ability to optimally coordinate the substems of breath, phonation (voice), articulation, and resonance with enough strength and precision to articulate words crisply. 

Anxiety and Stress

Emotional factors, particularly anxiety and stress, can manifest physically and affect speech. Individuals experiencing heightened stress levels may find themselves struggling with slurred speech due to increased muscle tension affecting breath patterns as well as the function of the larynx or orofacial muscles. Speech therapy can provide training in exercises and strategies to increase strength and coordination involved in healthy voice production, reducing tension and improving vocal health and comfort.

Structural Issues in the Mouth or Throat

Physical differences or structural issues in the mouth and tongue can contribute to slurred speech. Conditions such as a tongue-tie or structural differences in the lips, tongue, or palate can affect the timing, range of motion, and strength of speech muscle movements. In such cases, decreased articulatory precision may be observed.  Sometimes medical or surgical interventions may be considered along with speech therapy interventions to address the underlying structural concerns.

Allergic Reactions

Severe allergic reactions, especially those leading to swelling or inflammation in the mouth and throat, can result in slurred speech. Anaphylaxis, a life-threatening allergic reaction, can cause rapid swelling of the tongue and difficulty in breathing, impacting speech clarity. Immediate medical attention is crucial in such situations.

Migraines and Seizures

Certain neurological events, such as migraines or seizures, can temporarily affect speech patterns. In the case of migraines, the associated aura may involve language disturbances, including slurred speech. Seizures, which affect the electrical activity in the brain, can also lead to alterations in speech.

Understanding the many underlying causes of slurred speech is essential for accurate diagnosis and effective intervention. Whether stemming from neurological issues, medication side effects, or emotional factors, addressing the root cause is key to restoring clear speech. Intensive speech programs for neurological disorders from Open Lines offer individuals facing neurological changes a pathway to improved communication and enhanced quality of life. Open Lines Voice Therapy Programs for Adults offers speech therapy for adults looking for lasting solutions to a variety of speech and voice needs.

Contact us today to find out more.

Our trained speech-language pathologists have years of experience to help treat your speech conditions.

Contact Open Lines® today by phone at 212-430-6800 , by email at [email protected] , or through our contact form to schedule a treatment.

If you’re struggling with communication difficulties, it’s time to turn to Open Lines ® . Contact us via phone ( 212-430-6800 ), email  [email protected] , or by filling out our convenient  contact form . Improve your communication skills and unlock your potential with Open Lines ®  Speech and Communication in New York today!

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• Anxiety Guide
• Help & Advice

Other Symptoms

Slurred speech from anxiety: causes and treatments, fact checked.

Micah Abraham, BSc

Last updated October 10, 2020

Many anxiety symptoms can make a person feel like there is something wrong with their brain. Our brains are arguably the most important part of our bodies, and deep down many people with anxiety have a fear that their brain may fail them. They worry that something is wrong with their brain, like a tumor or multiple sclerosis, and that worry causes them even more anxiety.

Slurred speech is an example of an anxiety symptom that can be incredibly frightening. But it's common with those suffering from anxiety attacks, and in most cases it says nothing about the health of your brain.

Causes of Anxiety Slurred Speech

Slurred speech, also known as dysarthria, is when a person’s words become jumbled together and may be difficult to understand. This is caused by the muscles that are used to create speech not functioning properly or to their best ability.

Slurred speech without alcohol is linked to a variety of diagnoses that are cause for concern, including:

• Multiple Sclerosis
• Brain Tumors
• Lyme Disease
• Head Injury
• Cerebral Palsy

If you think there's any chance that you may suffer from these or any related conditions, see a doctor. You should never leave your brain's health up to chance, because your brain is simply too important to take those types of risks.

However, it should be noted that in most cases where slurred speech is caused by the diagnoses above, the slurred speech is long lasting. It may fade in and out over the course of a lifespan, but rarely a few hours or less. It's possible, which is why this isn't a risk you should take to chance, but it's uncommon.

For some people, anxiety can cause slurred speech, as well as issues that resemble slurred speech. All of the following are potential links between stress/anxiety and slurring of words:

• Overactive Thoughts One of the key reasons that some people slur their words is because anxiety makes it hard to focus. Stress can affect recall and mental accuracy, and extreme anxiety can cause you to be so far "in your head" that it is extremely difficult to get words out. In a way, anxiety makes your brain work too hard, and when it does some of the other things your brain needs to do don't work as well - like speaking.
• Muscle Tension Anxiety also causes significant muscle tension. Muscle tension can make it harder to move mouth muscles, which of course is the main cause of slurred speech in most other conditions.
• Over-Awareness An interesting problem with anxiety is the way it makes you over-aware of what would otherwise be subconscious/automatic behaviors. It's seen in other areas of life as well - for example, anxiety can make it harder for some people to walk because they're more aware of the movements in their legs. It can affect the mouth and speech as well. Speech is an automatic movement, and during intense anxiety your mouth movements may be controlled by you rather than your subconscious mind, making them much harder to do.
• Anxiety Medications Slurred speech is the side effect of many different anxiety medications. Most often it's because these medications also act as muscle relaxants and make it harder to move the muscles in your mouth and face.
• Tiredness, Caffeine, and More Several fairly normal issues can also affect speech. For example, those that are very tired may be more prone to slurred speech because their brain is not functioning as well as normal. Tiredness (as well as a lack of caffeine for those with caffeine addiction and other issues that may affect alertness) slows the brain down to the point where muscles may work less effectively.

These are just some of the reasons that anxiety may be responsible for slurred speech. It should also be noted that some slurred speech once in a while is normal even in those without anxiety. But when you have anxiety, it's easy to feel as though your problems speaking mean "something more" than what someone without anxiety would think.

Slurred Speech From Anxiety Isn't Dangerous

While it's important to talk with your doctor about the cause of your slurred speech, slurred speech caused by anxiety is not dangerous. It's not a sign that you have something else coming, or that your brain will somehow be inefficient for handling life tasks in the future.

There isn't a specific treatment for slurred speech because slurred speech is simply a response to anxiety. One thing you should do, however, is avoid forcing the words out. If your speech is slurring, forcing yourself to speak is going to add more stress. The more you try to force out words that aren't coming out naturally, the more you'll find that the words become more troubling as your brain becomes more stressed as a result.

The best course of action is to learn how to cope with anxiety and learn to properly manage it.

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

Where can I go to learn more about Jacobson’s relaxation technique and other similar methods? – Anonymous patient

You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process. – Timothy J. Legg, PhD, CRNP

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Scanning Speech: Everything You Need to Know

Multiple sclerosis and speech issues, frequently asked questions.

Scanning speech is an abnormal speech pattern involving long, abnormal pauses between words or syllables. It occurs as a result of muscle weakness. The problem often happens with multiple sclerosis (MS) .

Scanning speech changes the normal flow and pattern of speech. This change in speech rhythm makes it hard to understand a person with this problem.

There is no cure for scanning speech. Some drugs used to treat MS may improve the problem. Speech therapy can also help you adjust to speaking with scanning speech.

This article discusses scanning speech, its causes, and treatment.

Solskin / Verywell Health

What Is Scanning Speech?

Scanning speech is a type of dysarthria , a speech problem related to the muscles that control speech.

Scanning speech results in the inability to achieve proper word formation and speech rhythm. Long, unnecessary pauses interrupt the normal flow of speech, breaking up sentences or words. When it occurs with MS, it can also involve slurred speech.

Scanning speech is sometimes referred to as "explosive speech" since the speech segments can involve erratic periods of loud, rapid speech.

This problem makes it hard to communicate. A person with scanning speech can say the words in a sentence or thought. However, the unnatural pauses make it hard for the listener to put together the fragments and comprehend the speaker's meaning.

Scanning Speech Example

People with scanning speech may vary in the way their speech sounds based on the degree of nerve damage. However, long pauses between words or syllables, as in this example, are typical:

I live on the four ( pause) teenth floor of an apart ( pause) ment build ( pause ) ing.

Scanning speech results from damage to the nerves that stimulate your lower face, tongue, lips, and throat muscles to talk. Typically, this is a result of damage to an area of the brain called the cerebellum , which is responsible for speech and muscle coordination.

Damage often occurs due to the formation of lesions on the cerebellum, a common effect of MS. This, and any other type of damage, causes muscle weakness that interferes with the ability to form words, even though the brain knows the right words to say.

Damage to the cerebellum can be present at birth or occur later in life. It is linked to the onset of scanning speech due to the following causes:

• Multiple sclerosis (MS)
• Brain tumors
• Brain injury
• Parkinson's disease
• Amyotrophic lateral sclerosis (ALS)
• Huntington's disease
• Cerebral palsy
• Muscular dystrophy

Multiple sclerosis interferes with speech by damaging the nerves that control the muscles needed for normal speech. Problems like scanning speech and other dysarthrias result and make communication difficult.

Scanning speech is just one of the speech issues linked to MS. Speech issues in MS are typically classified as forms of dysarthria or dysphonia . Symptoms include:

• Slurred speech
• Nasal speech
• Extremely low or high volume
• Harsh voice quality
• Distorted articulation
• Damaged pitch control
• Abnormal emphasis on phrases or intonation
• Lower than normal breath support and control

A Common Problem

Speech issues are a common problem for people with MS. Up to 40% of people with MS have a speech disorder linked to the disease. Scanning speech and other types of dysarthria are considered the most common forms.

While there is no cure for scanning speech, there are ways to manage symptoms and improve communication. People with scanning speech may benefit from one or more of the following approaches:

• Speech therapy to learn how to compensate for the problem
• Exercises to strengthen muscles that control speech
• Alternative means of speech production, like a computer board
• Medications that relieve MS symptoms such as spasticity , tremors , or fatigue
• Assistive devices that can amplify the voice

Individualized Treatment

Treatment for scanning speech can vary by individual. Factors such as the degree of nerve damage mean that every person has different needs. Having other speech problems, such as slurred speech or explosive speech, can make treatment for scanning speech more challenging.

Scanning speech is a common speech problem. It involves the use of unnecessary pauses between words or syllables. It can also involve voice tremors or the uneven emphasis of words or phrases.

The problem occurs when the cerebellum is damaged. This can occur from lesions, injury, or diseases of the nervous system. It is commonly linked with MS.

Scanning speech can be a challenge for those who have it. Being unable to speak clearly can be lonely. While there are no cures, there are ways to manage the problem and improve speech.

Speech therapy and drugs to relieve common MS symptoms can increase speech control and quality. In addition, assistive devices and smartphone apps can often replace the need for flawless speech.

A Word From Verywell

Living with scanning speech can affect your quality of life. It can be isolating to know that you can't always communicate clearly. When combined with the other challenges MS can cause, the onset of scanning speech can feel overwhelming.

It's important to know that you're not alone in dealing with this problem. Many people living with MS deal with some type of speech disorder.

Participating in speech therapy can help you learn ways to slow and change your speech to make it more understandable. A speech-language pathologist can also help you strengthen damaged muscles and recommend technologies that can help others understand you better.

Talk to your healthcare provider to determine if you can benefit from medications to correct MS symptoms that may be making your problem worse.

Don't be afraid to let others know about your challenges in speaking clearly. This can prepare your listener for the types of problems that may arise.

Multiple sclerosis can affect the different muscles used in speaking. It can also damage the brain stem, the area that connects the spinal cord and brain. These problems make it hard to speak normally, even when the brain knows the right words to say.

Scanning speech usually involves unnecessary pauses between words or syllables. It can sometimes involve slurring, which can complicate the condition. An example of scanning speech is, "The yel ( pause) low build ( pause) ing is at the cor ( pause) ner."

While both disorders can interfere with normal speech, the two conditions produce different problems. Scanning speech results in long, unnecessary pauses between words or syllables. Stuttering causes the repetition or stretching out of a sound.

National Multiple Sclerosis Society. Speech problems .

Multiple Sclerosis Society of America. Speech difficulties .

American Speech-Language-Hearing Association (ASHA). Dysarthria .

National Multiple Sclerosis Society. Dysarthria in multiple sclerosis .

MS Focus Magazine. Getting the word out: speech difficulties and MS .

National Multiple Sclerosis Society. A resource for healthcare professionals: dysarthria in multiple sclerosis .

By Anna Giorgi Giorgi is a freelance writer with more than 25 years of experience writing health and wellness-related content.

Home » Blog » Blood Alcohol Content Chart: Blood Alcohol Levels Explained

Blood Alcohol Content Chart: Blood Alcohol Levels Explained

• Written By: Alicia Schultz
• Updated: May 23, 2024

Table of Contents

When it comes to alcohol and safety, blood alcohol content (BAC) is an important metric that helps determine a person’s level of impairment. When you drink, your BAC is influenced not just by how much alcohol you’ve had in the past several hours, but by other factors like your sex, weight, and how your unique body processes alcohol .

But what exactly is BAC, and what do different BAC levels feel like? Below, find a simple blood alcohol content chart, symptoms of each blood alcohol level, and how to accurately test your BAC.

What Is Blood Alcohol Content (BAC)?

Blood alcohol content (BAC) is a number that reflects the alcohol concentration in a person’s body, calculated by the amount of alcohol (in grams) per 100 mL of blood. As an example, a BAC test showing 0.06 would mean that 0.06% of your blood’s volume is alcohol.

When you think of BAC, breathalyzers, drunk driving , or legal trouble might be the first things that come to mind. However, it can also be used in other situations where safety or health are important. For instance, employers might test for BAC in certain workplace settings, and nurses or doctors will check BAC when treating a person for alcohol poisoning .

What Factors Affect BAC?

BAC isn’t one-size-fits-all, and you might end up with a different BAC than someone else even if you’re drinking the same amount. With that in mind, the main factors that affect BAC include:

• How many drinks you’ve had 
• How long it’s been since you drank
• The speed at which you’re drinking
• Your weight
• Whether or not you’ve eaten prior to drinking alcohol
• Any medications that impact your body’s ability to process alcohol

Schedule a private call with a Ria Health team member and we can help you get started.

Blood Alcohol Levels Explained

BAC can range anywhere from 0.01% (slightly “feeling it”) to 0.30%+, which is dangerously high. After a couple of drinks at a party or out with friends, many people find themselves in moderate or semi-high BAC ranges of 0.04%–0.10%. 

Although these percentages might seem small, tiny variations in your BAC can greatly affect your body’s systems, cognition, and how drunk you feel — whether that’s tipsy or blackout drunk. At moderate-to-high BAC levels, it’s also common to experience exaggerated emotions like excitement, sadness, happiness, or even rage .

What Is a High BAC?

The definition of a “high” BAC can vary in different contexts. In legal situations, being too drunk to drive (over 0.08%) is a high BAC, but in medical settings, a high blood alcohol level might mean blacking out or having symptoms of alcohol poisoning.

Does Tolerance Affect BAC?

In short, no. It’s a common myth that having a high tolerance can affect your BAC. In fact, many heavy drinkers believe that because they have a high tolerance, they will have a lower BAC than someone of a similar size drinking the same amount of alcohol — simply because their body is more “used to it.”

The truth is that tolerance does not affect BAC , but instead makes your body and mind more resistant to the effects of alcohol, even at high BAC levels. If you’ve developed a high tolerance and want to better gauge whether your drinking is normal, you can take a brief 11-question quiz or sign up for a Ria Health consultation to learn more.

Blood Alcohol Content Chart

This blood alcohol chart can help you understand roughly what each blood alcohol level feels like (many of these effects can “stack” onto each other as BAC rises).:

How Do You Test Your BAC?

Knowing how to accurately test your BAC can help you abide by laws and stay safe, and it’s especially important if you plan on driving when the alcohol wears off. However, calculating exactly how drunk you are can be challenging, even if you’re counting your drinks or using tools like blood alcohol content charts.

Because your BAC is impacted by many factors unique to you, the only 100% concrete way to know your BAC is through tests like:

• Breathalyzers , which determine your BAC based on the amount of alcohol expelled from your lungs while breathing.
• Blood tests , which directly measure the amount of alcohol in your bloodstream.

Because most people won’t have easy access to tools like these, a general rule of thumb is to not drive if you feel buzzed or tipsy . It can also be helpful to remember that, on average, your body can process one drink per hour, but this can vary based on other factors that affect your alcohol metabolism .

What About BAC Calculators?

For a more specific BAC estimate, you can use a BAC calculator that factors in your weight, sex, the number of standard-sized drinks you’ve had, and the time that’s passed since your last drink. 

Disclaimer: These tools have limitations and are not a foolproof way to know your BAC, so they should not be used to decide whether or not to drive.

Feeling Concerned About Your BAC?

If you drink heavily or have been worrying about your BAC often, it might be a sign that you’re struggling with alcohol abuse or dependence. While you might feel like it’s under control — or that you can manage it on your own — know that you don’t have to do it alone.

Programs like Ria Health can connect you with comprehensive support including one-on-one coaching , access to mental health professionals , and anti-craving prescriptions , all from the comfort of your home. Because you can access all of these resources from the Ria app , you won’t have to sign up for inpatient treatment, miss work, or rearrange your life to get support.

Get in touch with the Ria Health team to start better understanding and managing your drinking today, or learn more about how the program works.

or call (800) 504-5360

Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol. 

Doctors Explain What It Means When You Have Chills But No Fever

WHEN YOU START coming down with a cold or the flu , you might feel chilly and get the shivers. Usually, these symptoms accompany a fever . However, sometimes you might feel cold and have chills without a fever.

It’s not very common, though, says Robert Biernbaum, D.O. , chief medical officer at WellNow Urgent Care. “Chills and fever are usually correlated unless there are other medical conditions or circumstances at play.”

This might include thyroid conditions, malnutrition, or low blood sugar, he explains.

When you get the chills and don’t have a fever , you should see a doctor, especially when it happens frequently, says Hannah Cohan, N.P. , a board-certified nurse practitioner with Medical Offices of Manhattan.

“There could be a link to infections, long-term illnesses, or problems with the immune system ,” she explains. Your doctor may run some tests to rule out any major health problems.

Sometimes, having chills without a fever isn’t much to worry about—maybe you’re just cold -natured, or you spent too much time outside in the cold.

Your body contains systems that tightly regulate your body temperature, keeping it in a healthy zone of about 97 to 99 degrees Fahrenheit. When something minor or severe interferes with that process, it can leave you trembling or feeling like you suddenly stepped into a walk-in freezer.

If you seem to get the chills often without running a fever, you may wonder what’s up. There are actually several health issues or environmental factors that could be to blame.

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What causes chills but no fever?

“If you're having recurrent chills, in particular, and there's no other real reason for them, that's a reason to see your physician, because it could be a number of things,” says Jeffrey Quinlan, M.D. , chair and department executive officer of the Department of Family Medicine at the University of Iowa Carver College of Medicine.

Here’s an overview of some things that can cause chills but no fever:

1. Being in a Cold Environment

It may sound obvious, but the most common reason for chills with no fever is that you’re actually cold. Maybe you didn’t realize your air conditioning kicked on so high, or you stayed outside for too long on a freezing day.

Here’s what happens: Your skin has special receptors that sense the cold and send messages to your brain telling you it’s time to warm up. As a result, you might adjust your behavior by moving to a warmer environment or layering on a blanket or more clothes, says Andrej A. Romanovsky, M.D., Ph.D. , an Arizona State University professor and researcher who studies body temperature regulation.

However, if you stay in that cold environment, your blood vessels can start to constrict to limit heat loss. Next, you might start shivering. Your muscles contract to increase your body’s heat production and raise your temperature.

“Shivering is very expensive because it involves burning energy,” says Dr. Romanovsky. “These dis-coordinated, high-frequency movements interfere with your performance, and so shivering is turned on usually relatively late during cold exposure.”

(Receptors in our skin also respond to certain chemicals by making us feel chilly, he says. That’s why a toothpaste or muscle rub with menthol can give you goosebumps.)

2. Cold-Weather Workouts

A workout in cold temperatures can also induce chills quickly, especially when you push hard and then stop. Active muscles produce heat, but once you stop exercising, that heat dissipates and can ultimately lower your body temperature, Dr. Quinlan says. You might even develop muscle cramps, nausea, or vomiting as a result.

What can you do? Warm up and dry off, if necessary. Wet clothing can send you into the shiver zone especially fast.

“As your body heats up, your body heat will cause evaporation of the water in your clothes, and so that just takes more heat from your body and makes you more likely to have more chills if your clothes are wet versus dry,” says Dr. Quinlan.

3. Malnutrition

When your body doesn’t get the nutrients it needs, you might get chills, says Dr. Biernbaum. Malnutrition could be linked to an eating disorder such as anorexia, a lack of access to nutritious foods, or a health condition like celiac disease where your body isn’t able to absorb some nutrients.

Malnutrition can affect your body’s ability to function normally. Along with chills, you might experience fatigue, lightheadedness, heart palpitations, and tingling in your fingers or toes.

4. Dehydration

Dehydration happens when your body loses too many fluids from sweating, vomiting, or diarrhea. You can also lose water if you go out running on a hot day or just spend time outdoors when the temperatures rise. In extreme cases, Cohan says dehydration can cause your body temperature to drop, which might make you feel cold, intolerant to heat, or get the chills. Essentially, dehydration may lead to hyperthermia because overheating can alter your body’s normal temperature. (See more about your body's response to heat and what happens when you sweat here .)

5. Hypothermia

When you’re exposed to cold temperatures for a period of time, you can be at risk for hypothermia, Dr. Biernbaum says. Exposure to the cold causes your body to lose heat more quickly than it can produce heat, causing you to use up your heat stores and your body temperature to drop, according to the Centers for Disease Control and Prevention .

Chills and shivering can be a first sign of hypothermia, Dr. Biernbaum says. You also might feel confused, drowsy, exhausted, or have slurred speech.

You also don’t need to be in extremely cold temperatures to experience hypothermia. According to the CDC, it can happen in temperatures of 40 degrees Fahrenheit or above if you get cold from rain, sweat, or being in cold water.

6. Viral Infections

Infections can cause chills with or without a fever. A virus can act directly on your nervous system and indirectly influence it through protein molecules that tell neural cells that your body temperature is too low, says Dr. Romanovsky. The result: You feel cold, and your body kicks in with shivering and other natural mechanisms to heat up.

“The infection might only be in one part of the body and not affect the core temperature enough to cause a fever,” Cohan says. “Other things, like how sensitive each person is to temperature, the type of virus, and the stage of an illness, can also affect whether or not a person has a fever.”

Although fever is a common symptom of Covid-19 , some people infected with the virus report chills without a fever. So, if you have chills along with other common Covid symptoms, such as a sore throat, runny nose, nausea and vomiting, fatigue, cough, or diarrhea, it’s worth taking a Covid test, says Dr. Quinlan.

7. Bacterial Infections

If a bacterial infection goes untreated for too long, it can make you really sick. Often, this results in a fever, but chills sans fever have been reported in people with a range of infections, too. Typically, chills won’t be your only symptom of a bacterial infection, says Dr. Quinlan.

One potentially life-threatening example is meningitis, which can cause chills with or without a fever, along with symptoms like a stiff neck, sensitivity to light and sound, and lethargy. Those symptoms warrant a trip to the emergency department, Dr. Quinlan says.

Malaria is another example. This condition can make people feel chilly and shivering one minute and hot and sweaty the next. Consult a doctor if you’ve recently traveled to a destination where malaria is common—the CDC website maintains a list.

Sometimes, people with Lyme disease also report chills with no fever, says Dr. Quinlan. If you have a history of a tick bite, especially if you’ve seen a bullseye-shaped rash at the site of the bite, contact your doctor.

With bacterial infections, prompt treatment with the right antibiotic is critical. If you suspect this is the cause of your chills, see a healthcare provider right away.

8. Anxiety or Fear

That surge of adrenaline that happens when you’re scared or super stressed? It can make you feel cold or give you the chills, Cohan says.

That’s because adrenergic nerves are part of a loop of chemical and electrical signals that temporarily activate your body’s shivering response when you experience anxiety or fear, Dr. Romanovsky. Through similar pathways, strong positive feelings can also give you chills.

9. Panic Attack

Fear or anxiety that leads to a panic attack can cause shivering or chills. Cohan says feeling anxious or scared activates your body’s fight-or-flight response, triggering the release of hormones like adrenaline.

The stress hormones can narrow blood vessels, sending blood to areas of the body that need it most and causing the temperature of your extremities to drop, she explains. “This change in the body can cause shaking or chills, among other things.”

Also, during a panic attack, your breathing might become shallow or quick, throwing off the body’s balance of oxygen and carbon dioxide, making the heart beat faster, and this might make you sweat or give you chills, Cohan says.

10. Low Blood Sugar

Low blood sugar, or hypoglycemia, can make you feel cold and shaky. “If your body doesn't have enough sugar, it is going to look for ways to try to get more energy and activate things,” says Dr. Quinlan.

One of those things it activates is the sympathetic nervous system, resulting in symptoms like chills, sweating, heart palpitations, and blurred vision. Your primary care doctor can check your blood sugar and help you determine what’s up.

11. Blood Pressure Changes

Chills might happen with a sudden blood pressure drop, Cohan says. When your blood pressure gets too low, your organs aren’t getting enough oxygen and nutrients, which can lead to shock, according to the National Heart, Lung, and Blood Institute . Signs of shock include cold, sweaty skin, as well as rapid breathing and a weak, rapid pulse. Call 911 if you notice signs of shock, as it needs immediate medical attention.

12. Hypothyroidism

“Your thyroid hormone is what's really responsible for regulating your metabolism in your body, and ultimately, your metabolism helps control how cold or how warm you feel,” says Dr. Quinlan. In hypothyroidism, your thyroid gland is underactive, and your metabolism slows down, sometimes leaving you with chills.

Other common symptoms include tiredness, weight gain, constipation, dry skin and hair, and a slowed heart rate, says Dr. Quinlan. Your primary care doctor can order a blood test to check your thyroid hormone levels.

If you’re anemic, you aren’t producing enough red blood cells, and as a result, your body isn’t moving around as much oxygen as you need, says Dr. Quinlan.

You can also be short on iron and other important electrolytes. As a result, your sympathetic nervous system might kick in with shivering to warm you up and give you some energy. Your primary care provider can check for anemia—and prescribe treatment or iron supplements to reverse it.

14. Leukemia

Leukemia, a cancer of the blood-forming cells, can make some people feel chilly, especially at nighttime. The culprit? Overproduction of certain kinds of white blood cells that produce hormones and other factors that mimic or activate your body’s sympathetic nervous system to give you the sensation of chills.

Other common leukemia symptoms include fatigue, frequent infections, shortness of breath, pale skin, unexplained weight loss, pain or tenderness in your bones or joints, pain under your ribs on your left side, swollen lymph nodes, and bruising and bleeding easily, according to the Cleveland Clinic. Blood tests, imaging tests, and biopsies can help your doctor determine whether this is the culprit behind your symptoms.

15. Autoimmune Conditions

Some autoimmune illnesses, such as lupus or Crohn’s disease, can interfere with your body’s temperature control mechanism, Cohan says. So you might experience chills as an early sign of these conditions. That’s why getting any symptom that seems to appear out of nowhere checked out is crucial.

16. Reactions to Medication

“Chills can frequently be related to medication reactions, and sometimes can be a sign of some pretty serious allergies,” says Dr. Quinlan. “And so if you recently started a new medication and start developing recurrent chills, that's a reason to talk to your doctor right away.”

Diabetes medications, general anesthesia for surgery, and chemotherapy medications are more likely to cause chills.

Some people experience chills after blood transfusions and certain radiology procedures, too, he says. Drug withdrawal can also cause chills in people who use narcotics or antidepressants chronically and then suddenly stop.

17. Kidney Stones

Kidney stones happen when hard deposits of minerals and salts form inside your kidneys, according to the National Kidney Foundation . They can be caused by foods you eat, extra body weight, certain medical conditions, and some types of supplements.

Some kidney stones can be small, and you won't even know you have them. Larger ones can cause a range of symptoms, including chills. Sometimes, you might have a fever, too. Other signs of kidney stones include pain on either side of your lower back, bloody or cloudy urine, and nausea and vomiting.

18. Extreme Physical Activity

Intense physical activity can affect your core body temperature , which can cause chills. Muscle cramps, dizziness, fatigue, nausea, and vomiting might happen, as well.

When the weather is warm, you might get dehydrated or end up with heat exhaustion, which triggers chills. This symptom is also likely in cold weather when you could be at risk for hypothermia and also dehydration.

Staying hydrated when you exercise is crucial for preventing chills and other effects of body temperature shifts.

19. Other Medical Conditions

Respiratory illnesses, allergies, and the early stages of sepsis may also cause chills, Cohan says.

But there's always one more thing to consider with chills—a fever could still be on the horizon. “At the beginning of a fever, we typically feel cold because our bodies want to increase body temperature,” says Dr. Romanovsky, adding that this can take several minutes, depending on a few factors, including your body size. “Shivering is like turning on the heater, but it takes time for the water in a pot to really become warm."

Home Remedies for Chills With No Fever

There are several things you can do to prevent chills, according to the Cleveland Clinic , including:

• Wearing warm clothing and dressing in layers, if you’ll be out in the cold
• Staying dry—change out of sweaty or wet clothing as soon as you can to keep your body temperature from dropping
• Drinking plenty of water to prevent dehydration
• Taking medications and following your doctor’s treatment plan for any medical conditions

When to Worry About Having Chills Without a Fever

Chills that go away quickly on their own likely shouldn’t be concerning. But, if they keep coming back and persist, it’s time to call your doctor, Cohan urges.

Also, if you have any of these symptoms, in addition to chills, seek medical attention:

• Chest discomfort or pain
• Severe fatigue and body aches
• Swelling or hives
• Rapid heart rate
• Change in urine color, odor, or frequency

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