The purpose of this study was to determine whether the presence or absence of digitized 1-2 word voice output on a direct selection, customized augmentative and alternative communication (AAC) device would affect the impoverished conversations of persons with dementia. Thirty adults with moderate Alzheimer's disease participated in two personally relevant conversations with an AAC device. For 12 of the participants the AAC device included voice output. The AAC device was the Flexiboard™ containing 16 messages needed to discuss a favorite autobiographical topic chosen by the participant and his/her family caregivers. Ten-minute conversations were videotaped in participants' residences and analyzed for four conversational measures related to the participants' communicative behavior. Results show that AAC devices with digitized voice output depress conversational performance and distract participants with moderate Alzheimer's disease as compared to similar devices without voice output. There were significantly more 1-word utterances and fewer total utterances when AAC devices included voice output, and the rate of topic elaborations/initiations was significantly lower when voice output was present. Discussion about the novelty of voice output for this population of elders and the need to train elders to use this technology is provided.