BACKGROUND: Research on the possible influence of lateralised basal ganglia dysfunction on speech in Parkinson's disease is scarce. This study aimed to compare speech in de-novo, drug-naive patients with Parkinson's disease (PD) with asymmetric nigral dopaminergic dysfunction, predominantly in either the right or left hemisphere. METHODS: Acoustic analyses of reading passages were performed. Asymmetry of nigral dysfunction was defined using dopamine transporter-single-photon emission CT (DAT-SPECT). RESULTS: From a total of 135 de novo patients with PD assessed, 47 patients had a lower right and 36 lower left DAT availability in putamen based on DAT-SPECT. Patients with PD with lower left DAT availability had higher dysarthria severity via composite dysarthria index compared with patients with lower right DAT availability (p=0.01). CONCLUSION: Our data support the crucial role of DAT availability in the left putamen in speech. This finding might provide important clues for managing speech following deep brain stimulation.
- MeSH
- bazální ganglia * patofyziologie diagnostické zobrazování MeSH
- dysartrie patofyziologie diagnostické zobrazování etiologie MeSH
- funkční lateralita * fyziologie MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- Parkinsonova nemoc * patofyziologie diagnostické zobrazování komplikace MeSH
- proteiny přenášející dopamin přes plazmatickou membránu metabolismus MeSH
- putamen diagnostické zobrazování metabolismus patofyziologie MeSH
- řeč * fyziologie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- biologické markery * MeSH
- biomedicínský výzkum MeSH
- diagnostické služby trendy MeSH
- lidé MeSH
- neurodegenerativní nemoci diagnóza prevence a kontrola MeSH
- Parkinsonova nemoc prevence a kontrola MeSH
- řeč MeSH
- vyvíjení léků * trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Bazální ganglia hrají zásadní roli v řízení motoriky řeči, včetně výběru motorických programů, provádění řeči a mechanismů senzorické zpětné vazby. Multidimenzionální poškození řeči, způsobené dysfunkcí bazálních ganglií, je proto detekovatelné až u 90% pacientů s Parkinsonovou nemocí (PN) již v době stanovení diagnózy. Cílem tohoto projektu je stanovení řečových fenotypů s pomocí objektivních akustických analýz u velkého souboru nově diagnostikovaných pacientů s PN, před nasazením dopaminergní medikace. Dalším cílem je vyhodnocení vlivu nasazení dopaminergní léčby na změny řečových parametrů a dalších klinických příznaků. Výzkum efektu levodopy v závislosti na různých řečových a klinických fenotypech u nově diagnostikovaných pacientů s PN může nejen významně posílit naše chápání specifických patofyziologických mechanismů zodpovědných za poruchy řeči u PN, ale může také pomoci při výběru optimální léčby a přispět tak ke zlepšení kvality života pacientů s PN. Výsledky projektu lze také využít k monitorování stavu pacientů v klinické péči i pacientů zařazených v klinických studiích.; Basal ganglia play an essential role in speech control including the selection of motor programs, speech execution, and sensory feedback mechanisms. Therefore, multidimensional speech impairment due to basal ganglia dysfunction is detectable in up to 90% of patients with Parkinson’s disease (PD) at the time of diagnosis. This project aims to objectively examine and establish speech phenotypes in a large sample of newly diagnosed, drug-naive PD patients using objective acoustic analyses. In addition, we aim to analyze the effect of dopaminergic therapy initiation on changes in speech parameter and other clinical signs. Investigation of the efficacy of levodopa in de-novo PD subjects concerning different speech and clinical phenotypes may not only considerably advance our understanding of specific pathophysiological mechanisms responsible for speech disorders in PD but may also help in choosing optimal therapy management and improve the quality of patients' life. The results of the project can also be used for monitoring the condition of patients in clinical care and clinical trials.
- Klíčová slova
- Parkinsonova nemoc, Parkinson's disease, dysartrie, dysarthria, poruchy hlasu a řeči, akustické analýzy, levodopa, speech and voice disorders, acoustic analyses, levodopa,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
AIM: To investigate the presence and relationship of temporal speech and gait parameters in patients with postural instability/gait disorder (PIGD) and tremor-dominant (TD) motor subtypes of Parkinson's disease (PD). METHODS: Speech samples and instrumented walkway system assessments were acquired from a total of 60 de-novo PD patients (40 in TD and 20 in PIGD subtype) and 40 matched healthy controls. Objective acoustic vocal assessment of seven distinct speech timing dimensions was related to instrumental gait measures including velocity, cadence, and stride length. RESULTS: Compared to controls, PIGD subtype showed greater consonant timing abnormalities by prolonged voice onset time (VOT) while also shorter stride length during both normal walking and dual task, while decreased velocity and cadence only during dual task. Speaking rate was faster in PIGD than TD subtype. In PIGD subtype, prolonged VOT correlated with slower gait velocity (r = -0.56, p = 0.01) and shorter stride length (r = -0.59, p = 0.008) during normal walking, whereas relationships were also found between decreased cadence in dual task and irregular alternating motion rates (r = -0.48, p = 0.04) and prolonged pauses (r = -0.50, p = 0.03). No correlation between speech and gait was detected in TD subtype. CONCLUSION: Our findings suggest that speech and gait rhythm disorder share similar underlying pathomechanisms specific for PIGD subtype.
- MeSH
- chůze (způsob) MeSH
- chůze MeSH
- lidé MeSH
- neurologické poruchy chůze * etiologie MeSH
- Parkinsonova nemoc * komplikace MeSH
- posturální rovnováha MeSH
- řeč MeSH
- tremor MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Impairments of olfactory and speech function are likely early prodromal symptoms of α-synucleinopathy. OBJECTIVE: The aim of this study is to assess whether dysprosody is present in isolated rapid eye movement sleep behavior disorder (iRBD) with hyposmia/anosmia and a normal nigrostriatal system. METHODS: Pitch variability during speech was investigated in 17 iRBD subjects with normal olfactory function (iRBD-NOF), 30 iRBD subjects with abnormal olfactory function (iRBD-AOF), and 50 healthy controls. iRBD subjects were evaluated using the University of Pennsylvania Smell Identification Test and [123I]-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane dopamine transporter single-photon emission computed tomography (DAT-SPECT). All iRBD subjects completed the 24-month follow-up with DAT-SPECT, speech, and olfactory testing. RESULTS: At baseline, only iRBD-AOF showed monopitch when compared to iRBD-NOF (P = 0.04) and controls (P = 0.03), with no difference between iRBD-NOF and controls (P = 1). At follow-up, dysprosody progressed only in iRBD-AOF with abnormal DAT-SPECT (P = 0.03). CONCLUSION: Prosody is impaired in hyposmic but not in normosmic iRBD subjects before the nigrostriatal dopaminergic transmission is affected (Braak stage 2). © 2021 International Parkinson and Movement Disorder Society.
BACKGROUND: The mechanisms underlying speech abnormalities in Parkinson's disease (PD) remain poorly understood, with most of the available evidence based on male patients. This study aimed to estimate the occurrence and characteristics of speech disorder in early, drug-naive PD patients with relation to gender and dopamine transporter imaging. METHODS: Speech samples from 60 male and 40 female de novo PD patients as well as 60 male and 40 female age-matched healthy controls were analyzed. Quantitative acoustic vocal assessment of 10 distinct speech dimensions related to phonation, articulation, prosody, and speech timing was performed. All patients were evaluated using [123]I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single-photon emission computed tomography and Montreal Cognitive Assessment. RESULTS: The prevalence of speech abnormalities in the de novo PD cohort was 56% for male and 65% for female patients, mainly manifested with monopitch, monoloudness, and articulatory decay. Automated speech analysis enabled discrimination between PD and controls with an area under the curve of 0.86 in men and 0.93 in women. No gender-specific speech dysfunction in de novo PD was found. Regardless of disease status, females generally showed better performance in voice quality, consonant articulation, and pauses production than males, who were better only in loudness variability. The extent of monopitch was correlated to nigro-putaminal dopaminergic loss in men (r = 0.39, p = 0.003) and the severity of imprecise consonants was related to cognitive deficits in women (r = -0.44, p = 0.005). CONCLUSIONS: Speech abnormalities represent a frequent and early marker of motor abnormalities in PD. Despite some gender differences, our findings demonstrate that speech difficulties are associated with nigro-putaminal dopaminergic deficits.
- MeSH
- dopamin MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé MeSH
- Parkinsonova nemoc * komplikace diagnostické zobrazování MeSH
- poruchy řeči diagnostické zobrazování etiologie MeSH
- řeč * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech subsystems. There is widespread cross-discipline use of speech recordings for diagnostic and research purposes, despite which there are no specific guidelines for a standardized method. This review aims to combine the specific clinical presentations of patients with movement disorders, existing acoustic assessment protocols, and technological advances in capturing speech to provide a basis for future research in this field and to improve the consistency of clinical assessments. We considered 3 areas: the recording environment (room, seating, background noise), the recording process (instrumentation, vocal tasks, elicitation of speech samples), and the acoustic outcome data. Four vocal tasks, namely, sustained vowel, sequential and alternating motion rates, reading passage, and monologues, are integral aspects of motor speech assessment. Fourteen acoustic vocal speech features, including their hypothesized pathomechanisms with regard to typical occurrences in hypokinetic or hyperkinetic dysarthria, are hereby recommended for quantitative exploratory analysis. Using these acoustic features and experimental speech data, we demonstrated that the hyperkinetic dysarthria group had more affected speech dimensions compared with the healthy controls than had the hypokinetic speakers. Several contrasting speech patterns between both dysarthrias were also found. This article is the first attempt to provide initial recommendations for a standardized way of recording the voice and speech of patients with hypokinetic or hyperkinetic dysarthria; thus allowing clinicians and researchers to reliably collect, acoustically analyze, and compare vocal data across different centers and patient cohorts. © 2020 International Parkinson and Movement Disorder Society.
- MeSH
- akustika řeči MeSH
- akustika MeSH
- dysartrie * diagnóza MeSH
- lidé MeSH
- Parkinsonova nemoc * MeSH
- poruchy řeči MeSH
- řeč MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
Substantial variability and severity of dysarthric patterns across Parkinson's disease (PD) patients may reflect distinct phenotypic differences. We aimed to compare patterns of speech disorder in early-onset PD (EOPD) and late-onset PD (LOPD) in drug-naive patients at early stages of disease. Speech samples were acquired from a total of 96 participants, including two subgroups of 24 de-novo PD patients and two subgroups of 24 age- and sex-matched young and old healthy controls. The EOPD group included patients with age at onset below 51 (mean 42.6, standard deviation 6.1) years and LOPD group patients with age at onset above 69 (mean 73.9, standard deviation 3.0) years. Quantitative acoustic vocal assessment of 10 unique speech dimensions related to respiration, phonation, articulation, prosody, and speech timing was performed. Despite similar perceptual dysarthria severity in both PD subgroups, EOPD showed weaker inspirations (p = 0.03), while LOPD was characterized by decreased voice quality (p = 0.02) and imprecise consonant articulation (p = 0.03). In addition, age-independent occurrence of monopitch (p < 0.001), monoloudness (p = 0.008), and articulatory decay (p = 0.04) was observed in both PD subgroups. The worsening of consonant articulation was correlated with the severity of axial gait symptoms (r = 0.38, p = 0.008). Speech abnormalities in EOPD and LOPD share common features but also show phenotype-specific characteristics, likely reflecting the influence of aging on the process of neurodegeneration. The distinct pattern of imprecise consonant articulation can be interpreted as an axial motor symptom of PD.
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND OBJECTIVES: Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy. METHODS: We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis. RESULTS: Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002). DISCUSSION: Distinct speech phenotypes in de novo PD reflect divergent underlying mechanisms and allow prediction of response of speech impairment to levodopa therapy. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, in patients with newly diagnosed PD with speech impairment, speech phenotype is associated with levodopa responsiveness.
