**9. Language**

Language deficits are occasionally found in the early stages of the disease. (Abrahams, et al. 2004).

The spectrum of language impairment in MND is wider than simply a problem in speech production due to dysarthria, but it is yet to be fully characterized. Reduced verbal output (adynamism) evolving into mutism has been reported, as well as echolalia. Perseverations, stereotypical expressions, (Bak and Hodges. 2004), true non-fluent aphasia with phonological and/or syntactic deficits and comprehension impairment have been reported in isolated cases. (Tsuchiya, et al. 2000)

MND has also been associated with apraxia of speech, in which there is breakdown in articulatroy planning, producing slowed, effortful and dysprosodic speech with problems repeating multisyllabic words. Apraxia of speech is often accompanied by orobuccal apraxia but not necessarily with aphasia.(Duffy, et al ,2007).
