This discussion examines how speaker pauses, both filled and silent, are keyed to functions within a conversation and to functions within narration. In Alzheimer's discourse, pause-fillers can be both placeholders and hesitation markers; they may be ohs and ums or longer formulaic phrases. Extracts from the speech of 4 older women from the United States and from New Zealand are reviewed for changes in syntactic complexity, for retention of story components, and for pauses. The extracts illustrate these functions for silent pauses: as word-finding; as planning at word, phrase, and narrative component levels; and as pragmatic compensation as other interactional and narrative skills decrease.