A 70-year-old man had worsening speech over 18 months, with increased effort required to enunciate words. His wife described him as speaking with a monotone voice, and the overall rate of speech was slow. He paused frequently between and in the middle of words, especially during long and complex sentences. He denied problems with finding words, forming sentences, or comprehending spoken or written language. His writing mirrored the slowness in speaking, but there were no abnormalities in its appearance or spelling. On exam, his speech exhibited increased intersegment duration between words, as well as aprosodia. No sound distortions were noticed, except for one false start. Subtle agrammatism was detected early in the interview, though grammar appeared normal during the remainder of the examination (Video 21.1). The rest of his language evaluation and neurological exam was unremarkable. An MRI of the brain demonstrated asymmetric atrophy, predominantly affecting the left premotor cortex.