Dysprosody is a change in dialectal and idiosyncratic voice quality that can give rise to ‘foreign accent syndrome’ or other strange pitch, intonation and emotional speech effects (Ross, 1993) This syndrome was first convincingly described in a single case (Astrid L.) by Monrad-Krohn in 1947. The patient’s speech was characterised by a “completely changed melody of accent” following head injury from a bomb fragment in Oslo in 1941. Dysprosody in dementia has not been widely described.

Case Description:

MM presented in 2009 with dis-inhibited behaviour and word finding difficulties that slowly progressed over a ten year period. In the latter 5 years, the intonation and pitch of her speech changed, eventually morphing into a bizarre dysprosodic, high-pitched, ‘screeching’, amelodic voice, which persisted until her death a few months ago.

Results of Investigations:

The MRI Brain showed bitemporal atrophy. A pathological diagnosis of TDP43 positive frontotemporal dementia was confirmed on autopsy.

The term dysprosody is often used to describe disorders of emotion in speech. (Ross, 1993) Sutherland-Foggio et al (2017) describe selective deficits in prosody after right hemisphere stroke. However, dysprosody also includes disorders of intonation that affect semantic aspects of speech. fMRI studies have pointed to specific brain regions on both sides of the brain for intonation processing. (Doherty et al, 2004) The clinical presentation of a dysprosodic, high-pitched, amelodic voice in this lady is suggestive of bilateral speech deficits with both emotional and linguistic aspects of prosody. The prominence of dysprosody in a degenerative disease other than Parkinson’s disease, to our knowledge, has not previously been described.