Approximately 90% of Parkinson's patients (PD) suffer from dysarthria. However, there is currently a lack of research on acoustic measurements and speech impairment patterns among Mandarin-speaking individuals with PD. This study aims to assess the diagnosis and disease monitoring possibility in Mandarin-speaking PD patients through the recommended speech paradigm for non-tonal languages, and to explore the anatomical and functional substrates. We examined total of 160 native Mandarin-speaking Chinese participants consisting of 80 PD patients, 40 healthy controls (HC), and 40 MRI controls. We screened the optimal acoustic metric combination for PD diagnosis. Finally, we used the objective metrics to predict the patient's motor status using the Naïve Bayes model and analyzed the correlations between cortical thickness, subcortical volumes, functional connectivity, and network properties. Comprehensive acoustic screening based on prosodic, articulation, and phonation abnormalities allows differentiation between HC and PD with an area under the curve of 0.931. Patients with slowed reading exhibited atrophy of the fusiform gyrus (FDR p = 0.010, R = 0.391), reduced functional connectivity between the fusiform gyrus and motor cortex, and increased nodal local efficiency (NLE) and nodal efficiency (NE) in bilateral pallidum. Patients with prolonged pauses demonstrated atrophy in the left hippocampus, along with decreased NLE and NE. The acoustic assessment in Mandarin proves effective in diagnosis and disease monitoring for Mandarin-speaking PD patients, generalizing standardized acoustic guidelines beyond non-tonal languages. The speech impairment in Mandarin-speaking PD patients not only involves motor aspects of speech but also encompasses the cognitive processes underlying language generation.

Beijing Key Laboratory of Neurostimulation Beijing China

Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Circuit Theory Faculty of Electrical Engineering Czech Technical University Prague Prague Czech Republic

Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing China

Zobrazit více v PubMed

Roytman S, et al. Cholinergic system correlates of postural control changes in Parkinson’s disease freezers. Brain. 2023;146:3243–3257. doi: 10.1093/brain/awad134. PubMed DOI PMC

Dorsey ER, et al. Projected number of people with Parkinson’s disease in the most populous nations, 2005 through 2030. Neurology. 2007;68:384–386. doi: 10.1212/01.wnl.0000247740.47667.03. PubMed DOI

Zhou X, et al. The Chinese Parkinsonas disease registry (CPDR): study design and baseline patient characteristics. Mov. Disord. 2022;37:1335–1345. doi: 10.1002/mds.29037. PubMed DOI

Qi S, et al. Prevalence of Parkinson’s disease: a community-based study in China. Mov. Disord. 2021;36:2940–2944. doi: 10.1002/mds.28762. PubMed DOI

Arnold C, Gehrig J, Gispert S, Seifried C, Kell CA. Pathomechanisms and compensatory efforts related to Parkinsonian speech. Neuroimage Clin. 2014;4:82–97. doi: 10.1016/j.nicl.2013.10.016. PubMed DOI PMC

Muller J, et al. Progression of dysarthria and dysphagia in postmortem-confirmed Parkinsonian disorders. Arch. Neurol. 2001;58:259–264. doi: 10.1001/archneur.58.2.259. PubMed DOI

Garcia AM, de Leon J, Tee BL, Blasi DE, Gorno-Tempini ML. Speech and language markers of neurodegeneration: a call for global equity. Brain. 2023;146:4870–4879. doi: 10.1093/brain/awad253. PubMed DOI PMC

Rusz J, et al. Speech biomarkers in rapid eye movement sleep behavior disorder and Parkinson disease. Ann. Neurol. 2021;90:62–75. doi: 10.1002/ana.26085. PubMed DOI PMC

Garcia AM, et al. Cognitive determinants of dysarthria in Parkinson’s disease: an automated machine learning approach. Mov. Disord. 2021;36:2862–2873. doi: 10.1002/mds.28751. PubMed DOI

Silbergleit AK, Schultz L, Hamilton K, LeWitt PA, Sidiropoulos C. Self-perception of voice and swallowing handicap in Parkinson’s disease. J. Parkinsons Dis. 2021;11:2027–2034. doi: 10.3233/JPD-212621. PubMed DOI

Rusz J, Tykalova T, Ramig LO, Tripoliti E. Guidelines for speech recording and acoustic analyses in dysarthrias of movement disorders. Mov. Disord. 2021;36:803–814. doi: 10.1002/mds.28465. PubMed DOI

Paulino CE, et al. Relationship between oropharyngeal geometry and vocal parameters in subjects With Parkinson’s disease. J. Voice. 2022;S0892-1997:00021–00022. PubMed

Burris C, Vorperian HK, Fourakis M, Kent RD, Bolt DM. Quantitative and descriptive comparison of four acoustic analysis systems: vowel measurements. J. Speech Lang. Hear. Res. 2014;57:26–45. doi: 10.1044/1092-4388(2013/12-0103). PubMed DOI PMC

Hlavnička, J. Automated Analysis of Speech Disorders in Neurodegenerative Diseases. Czech Technical University (2019).

Macari AT, et al. Association between facial length and width and fundamental frequency. J. Voice. 2017;31:410–415. doi: 10.1016/j.jvoice.2016.12.001. PubMed DOI

Daoudi K, Das B, Tykalova T, Klempir J, Rusz J. Speech acoustic indices for differential diagnosis between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. NPJ Parkinsons Dis. 2022;8:142. doi: 10.1038/s41531-022-00389-6. PubMed DOI PMC

Camerino I, et al. Systematic review and meta-analyses of word production abilities in dysfunction of the basal ganglia: stroke, small vessel disease, Parkinson’s disease, and Huntington’s disease. Neuropsychol. Rev. 2022;34:1–26. doi: 10.1007/s11065-022-09570-3. PubMed DOI

Chen Q, et al. Effects of intensive speech treatment on Mandarin speakers with Parkinson’s disease: a review. Medicine. 2023;102:e32900. doi: 10.1097/MD.0000000000032900. PubMed DOI PMC

Zhang, J., Chen, J. & Ding, G. Universality and language specificity of brain reading networks: a developmental perspective. Dev. Sci. e13379 (2023). PubMed

Zhang J, Meng Y, Wu C, Yuan Z. Spoken word recognition across language boundary: ERP evidence of prosodic transfer driven by pitch. Brain Sci. 2023;13:202. doi: 10.3390/brainsci13020202. PubMed DOI PMC

Chen W, van de Weijer J. The role of L1-L2 dissimilarity in L2 segment learning—implications from the acquisition of English post-alveolar fricatives by Mandarin and Mandarin/Wu speakers. Front. Psychol. 2022;13:1017724. doi: 10.3389/fpsyg.2022.1017724. PubMed DOI PMC

Rusz J, et al. Defining speech subtypes in de novo Parkinson disease: response to long-term levodopa therapy. Neurology. 2021;97:e2124–e2135. doi: 10.1212/WNL.0000000000012878. PubMed DOI

Pinto S, et al. Results of a randomized clinical trial of speech after early neurostimulation in Parkinson’s disease. Mov. Disord. 2023;38:212–222. doi: 10.1002/mds.29282. PubMed DOI

Tykalova T, Novotny M, Ruzicka E, Dusek P, Rusz J. Short-term effect of dopaminergic medication on speech in early-stage Parkinson’s disease. NPJ Parkinsons Dis. 2022;8:22. doi: 10.1038/s41531-022-00286-y. PubMed DOI PMC

McKee KE, Gilbert RM, Spigle WA, Tilley BC, Corcos DM. Inclusion of non-english-speaking participants in studies of Parkinson’s disease: a call to action. Mov. Disord. 2022;37:1990–1995. doi: 10.1002/mds.29179. PubMed DOI PMC

Gilbert RM, Standaert DG. Bridging the gaps: more inclusive research needed to fully understand Parkinson’s disease. Mov. Disord. 2020;35:231–234. doi: 10.1002/mds.27906. PubMed DOI

Siddiqi B, Koemeter-Cox A. A call to action: promoting diversity, equity, and inclusion in Parkinson’s research and care. J. Parkinsons Dis. 2021;11:905–908. doi: 10.3233/JPD-212593. PubMed DOI PMC

Tsuboi T, et al. Distinct phenotypes of speech and voice disorders in Parkinson’s disease after subthalamic nucleus deep brain stimulation. J. Neurol. Neurosurg. Psychiatry. 2015;86:856–864. doi: 10.1136/jnnp-2014-308043. PubMed DOI

Zhao X, Li P. An online database of phonological representations for Mandarin Chinese. Behav. Res. Methods. 2009;41:575–583. doi: 10.3758/BRM.41.2.575. PubMed DOI

Rusz J, et al. Speech and gait abnormalities in motor subtypes of de-novo Parkinson’s disease. CNS Neurosci. Ther. 2023;29:2101–2110. doi: 10.1111/cns.14158. PubMed DOI PMC

Pettorino, M., Gu, W., Półrola, P. & Fan, P. Rhythmic characteristics of Parkinsonian speech: a study on Mandarin and Polish, in Interspeech 2017. 3172–3176 (2017).

Fang, H., Gong, C., Zhang, C., Sui, Y. & Li. L. Parkinsonian Chinese speech analysis towards automatic classification of Parkinson’s disease. in Machine Learning for Health. PMLR (2020).

Grobe-Einsler M, et al. Development of SARA(home), a new video-based tool for the assessment of ataxia at home. Mov. Disord. 2021;36:1242–1246. doi: 10.1002/mds.28478. PubMed DOI

Tripoliti E, et al. Predictive factors of speech intelligibility following subthalamic nucleus stimulation in consecutive patients with Parkinson’s disease. Mov. Disord. 2014;29:532–538. doi: 10.1002/mds.25816. PubMed DOI PMC

Kluin KJ, et al. Motor speech effects in subthalamic deep brain stimulation for Parkinson’s disease. J. Neurosurg. 2022;37:722–728. doi: 10.3171/2021.12.JNS211729. PubMed DOI PMC

Hlavnicka J, et al. Automated analysis of connected speech reveals early biomarkers of Parkinson’s disease in patients with rapid eye movement sleep behaviour disorder. Sci. Rep. 2017;7:12. doi: 10.1038/s41598-017-00047-5. PubMed DOI PMC

Bonilha L, et al. Neural structures supporting spontaneous and assisted (entrained) speech fluency. Brain. 2019;142:3951–3962. doi: 10.1093/brain/awz309. PubMed DOI PMC

Moreau C, Pinto S. Misconceptions about speech impairment in Parkinson’s disease. Mov. Disord. 2019;34:1471–1475. doi: 10.1002/mds.27791. PubMed DOI

Piai V, et al. Direct brain recordings reveal hippocampal rhythm underpinnings of language processing. Proc. Natl Acad. Sci. USA. 2016;113:11366–11371. doi: 10.1073/pnas.1603312113. PubMed DOI PMC

Catheline G, et al. Semantic retrieval over time in the aging brain: structural evidence of hippocampal contribution. Hippocampus. 2015;25:1008–1016. doi: 10.1002/hipo.22423. PubMed DOI

Guo J, et al. Abnormal functional connectivity density in post-stroke aphasia. Brain Topogr. 2019;32:271–282. doi: 10.1007/s10548-018-0681-4. PubMed DOI

van de Ven V, Waldorp L, Christoffels I. Hippocampus plays a role in speech feedback processing. Neuroimage. 2020;223:117319. doi: 10.1016/j.neuroimage.2020.117319. PubMed DOI

Chen W, et al. Adaptation of melodic intonation therapy to a tone language: a pilot study of tone-rhythmic therapy in Chinese. Folia Phoniatr. Logop. 2022;75:104–116. doi: 10.1159/000527225. PubMed DOI

Wang HL, et al. Speech silence character as a diagnostic biomarker of early cognitive decline and its functional mechanism: a multicenter cross-sectional cohort study. BMC Med. 2022;20:380. doi: 10.1186/s12916-022-02584-x. PubMed DOI PMC

Krivokapic J, Styler W, Parrell B. Pause postures: the relationship between articulation and cognitive processes during pauses. J. Phon. 2020;79:100953. doi: 10.1016/j.wocn.2019.100953. PubMed DOI PMC

Manes JL, et al. Premotor cortex is hypoactive during sustained vowel production in individuals with Parkinson’s disease and hypophonia. Front. Hum. Neurosci. 2023;17:1250114. doi: 10.3389/fnhum.2023.1250114. PubMed DOI PMC

Klobusiakova P, et al. Articulatory network reorganization in Parkinson’s disease as assessed by multimodal MRI and acoustic measures. Parkinsonism Relat. Disord. 2021;84:122–128. doi: 10.1016/j.parkreldis.2021.02.012. PubMed DOI

Jobard G, Crivello F, Tzourio-Mazoyer N. Evaluation of the dual route theory of reading: a metanalysis of 35 neuroimaging studies. Neuroimage. 2003;20:693–712. doi: 10.1016/S1053-8119(03)00343-4. PubMed DOI

Lu J, et al. Functional maps of direct electrical stimulation-induced speech arrest and anomia: a multicentre retrospective study. Brain. 2021;144:2541–2553. doi: 10.1093/brain/awab125. PubMed DOI PMC

Manes JL, et al. Altered resting-state functional connectivity of the putamen and internal globus pallidus is related to speech impairment in Parkinson’s disease. Brain Behav. 2018;8:e01073. doi: 10.1002/brb3.1073. PubMed DOI PMC

Dastolfo-Hromack C, et al. Articulatory gain predicts motor cortex and subthalamic nucleus activity during speech. Cereb. Cortex. 2022;32:1337–1349. doi: 10.1093/cercor/bhab251. PubMed DOI PMC

Tankus A, Lustig Y, Fried I, Strauss I. Impaired timing of speech-related neurons in the subthalamic nucleus of Parkinson disease patients suffering speech disorders. Neurosurgery. 2021;89:800–809. doi: 10.1093/neuros/nyab293. PubMed DOI

Lipski WJ, et al. Subthalamic nucleus neurons differentially encode early and late aspects of speech production. J. Neurosci. 2018;38:5620–5631. doi: 10.1523/JNEUROSCI.3480-17.2018. PubMed DOI PMC

Albano L, et al. Functional connectivity in Parkinson’s disease candidates for deep brain stimulation. NPJ Parkinsons Dis. 2022;8:4. doi: 10.1038/s41531-021-00268-6. PubMed DOI PMC

Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of dysarthria. J. Speech Hear Res. 1969;12:246–269. doi: 10.1044/jshr.1202.246. PubMed DOI

Chrabaszcz A, et al. Subthalamic nucleus and sensorimotor cortex activity during speech production. J. Neurosci. 2019;39:2698–2708. doi: 10.1523/JNEUROSCI.2842-18.2019. PubMed DOI PMC

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J. Neurol. Neurosurg. Psychiatry. 1992;55:181–184. doi: 10.1136/jnnp.55.3.181. PubMed DOI PMC

Litvan I, et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement Disorder Society Task Force guidelines. Mov. Disord. 2012;27:349–356. doi: 10.1002/mds.24893. PubMed DOI PMC

Wang BR, et al. Comparative diagnostic accuracy of ACE-III and MoCA for detecting mild cognitive impairment. Neuropsychiatr. Dis. Treat. 2019;15:2647–2653. doi: 10.2147/NDT.S212328. PubMed DOI PMC

Fischer E, Goberman AM. Voice onset time in Parkinson disease. J. Commun. Disord. 2010;43:21–34. doi: 10.1016/j.jcomdis.2009.07.004. PubMed DOI

Tanaka Y, et al. Instability of speech in Parkinson disease patients with subthalamic nucleus deep brain stimulation. Parkinsonism Relat. Disord. 2021;93:8–11. doi: 10.1016/j.parkreldis.2021.10.029. PubMed DOI

Chen Y, et al. Brain morphological changes in hypokinetic dysarthria of Parkinson’s disease and use of machine learning to predict severity. CNS Neurosci. Ther. 2020;26:711–719. doi: 10.1111/cns.13304. PubMed DOI PMC

Chu C, et al. Subthalamic and pallidal stimulation in Parkinson’s disease induce distinct brain topological reconstruction. Neuroimage. 2022;255:119196. doi: 10.1016/j.neuroimage.2022.119196. PubMed DOI

Liu Z, et al. Resolving heterogeneity in schizophrenia through a novel systems approach to brain structure: individualized structural covariance network analysis. Mol. Psychiatry. 2021;26:7719–7731. doi: 10.1038/s41380-021-01229-4. PubMed DOI