Hypokinetic dysarthria (HD) is common in Parkinson’s disease (PD) patients and it responds only partially to pharmacotherapy and surgery of PD. We will explore short-term effects of repetitive transcranial magnetic stimulation (rTMS) applied over pre-defined brain regions using both high and low frequency TMS protocols on HD and micrographia in PD, and on related brain plasticity changes. To achieve our goal we will combine acoustic analysis and functional MRI with rTMS. The objective is to identify an optimal rTMS protocol and stimulation site to improve HD and micrographia in PD patients on dopaminergic medication. Based on these results a repeated-sessions rTMS study will be designed to investigate long-term effects of rTMS on HD in PD and related changes in brain structure and function. The project results will allow for the identification of potential therapeutic effects of rTMS as a tool that could contribute to the speech therapy of HD in PD patients. The results will also enhance our understanding of brain mechanisms underlying specific long-term effects of rTMS.

Hypokinetická dysartrie (HD) se často vyskytuje u pacientů s Parkinsonovou nemocí (PN) a jen částečně reaguje na farmakologickou a chirurgickou léčbu. Budeme zkoumat krátkodobý efekt repetitivní transkraniální magnetické stimulace (rTMS) předem definovaných oblastí mozku pomocí vysoko- i nízko-frekvenční TMS na HD a mikrografii u PN, a na odpovídající změny plasticity mozku. K dosažení našeho záměru použijeme kombinaci akustické analýzy a funkční MRI aplikované po rTMS. Cílem je identifikovat optimální rTMS protokol a stimulovanou oblast tak, aby se u pacientů na dopaminerní léčbě zlepšil dopad na HD a mikrografii. Na základě těchto pilotních výsledků bude navržena studie opakované rTMS a bude proveden výzkum jejího dlouhodobého efektu na HD a na změnu struktury a funkci mozku. Výsledky projektu pomohou identifikovat terapeutický potenciál rTMS, jakožto nástroje, který může přispět k léčbě HD u pacientů s PN. Výsledky rovněž umožní lepší pochopení dlouhodobého efektu rTMS na vnitřní mechanizmy mozku.

• MeSH
• akustika MeSH
• dysartrie terapie   MeSH
• klinické protokoly MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• neuroplasticita MeSH
• Parkinsonova nemoc terapie   MeSH
• pilotní projekty MeSH
• transkraniální magnetická stimulace metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

INTRODUCTION: Hypokinetic dysarthria (HD) is a common symptom of Parkinson's disease (PD) which does not respond well to PD treatments. We investigated acute effects of repetitive transcranial magnetic stimulation (rTMS) of the motor and auditory feedback area on HD in PD using acoustic analysis of speech. METHODS: We used 10 Hz and 1 Hz stimulation protocols and applied rTMS over the left orofacial primary motor area, the right superior temporal gyrus (STG), and over the vertex (a control stimulation site) in 16 PD patients with HD. A cross-over design was used. Stimulation sites and protocols were randomised across subjects and sessions. Acoustic analysis of a sentence reading task performed inside the MR scanner was used to evaluate rTMS-induced effects on motor speech. Acute fMRI changes due to rTMS were also analysed. RESULTS: The 1 Hz STG stimulation produced significant increases of the relative standard deviation of the 2nd formant (p = 0.019), i.e. an acoustic parameter describing the tongue and jaw movements. The effects were superior to the control site stimulation and were accompanied by increased resting state functional connectivity between the stimulated region and the right parahippocampal gyrus. The rTMS-induced acoustic changes were correlated with the reading task-related BOLD signal increases of the stimulated area (R = 0.654, p = 0.029). CONCLUSION: Our results demonstrate for the first time that low-frequency stimulation of the temporal auditory feedback area may improve articulation in PD and enhance functional connectivity between the STG and the cortical region involved in an overt speech control.

• MeSH
• akustika řeči MeSH
• dysartrie diagnostické zobrazování   etiologie   patofyziologie   MeSH
• gyrus parahippocampalis diagnostické zobrazování   patofyziologie   MeSH
• konektom * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• motorické korové centrum diagnostické zobrazování   patofyziologie   MeSH
• nervová síť diagnostické zobrazování   patofyziologie   MeSH
• Parkinsonova nemoc komplikace   diagnostické zobrazování   patofyziologie   MeSH
• senioři MeSH
• senzorická zpětná vazba fyziologie   MeSH
• spánkový lalok diagnostické zobrazování   patofyziologie   MeSH
• transkraniální magnetická stimulace * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Speech articulation is produced by the movements of muscles in the larynx, pharynx, mouth and face. Therefore speech shows acoustic features as formants which are directly related with neuromotor actions of these muscles. The first two formants are strongly related with jaw and tongue muscular activity. Speech can be used as a simple and ubiquitous signal, easy to record and process, either locally or on e-Health platforms. This fact may open a wide set of applications in the study of functional grading and monitoring neurodegenerative diseases. A relevant question, in this sense, is how far speech correlates and neuromotor actions are related. This preliminary study is intended to find answers to this question by using surface electromyographic recordings on the masseter and the acoustic kinematics related with the first formant. It is shown in the study that relevant correlations can be found among the surface electromyographic activity (dynamic muscle behavior) and the positions and first derivatives of the first formant (kinematic variables related to vertical velocity and acceleration of the joint jaw and tongue biomechanical system). As an application example, it is shown that the probability density function associated to these kinematic variables is more sensitive than classical features as Vowel Space Area (VSA) or Formant Centralization Ratio (FCR) in characterizing neuromotor degeneration in Parkinson's Disease.

• MeSH
• biomechanika MeSH
• čelisti fyziologie   MeSH
• dospělí MeSH
• dysartrie diagnóza   etiologie   MeSH
• elektromyografie metody   MeSH
• jazyk fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření tvorby řeči metody   MeSH
• modely neurologické * MeSH
• musculus masseter fyziologie   MeSH
• Parkinsonova nemoc komplikace   diagnóza   MeSH
• řeč fyziologie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Neurodegenerative pathologies as Parkinson's Disease (PD) show important distortions in speech, affecting fluency, prosody, articulation and phonation. Classically, measurements based on articulation gestures altering formant positions, as the Vocal Space Area (VSA) or the Formant Centralization Ratio (FCR) have been proposed to measure speech distortion, but these markers are based mainly on static positions of sustained vowels. The present study introduces a measurement based on the mutual information distance among probability density functions of kinematic correlates derived from formant dynamics. An absolute kinematic velocity associated to the position of the jaw and tongue articulation gestures is estimated and modeled statistically. The distribution of this feature may differentiate PD patients from normative speakers during sustained vowel emission. The study is based on a limited database of 53 male PD patients, contrasted to a very selected and stable set of eight normative speakers. In this sense, distances based on Kullback-Leibler divergence seem to be sensitive to PD articulation instability. Correlation studies show statistically relevant relationship between information contents based on articulation instability to certain motor and nonmotor clinical scores, such as freezing of gait, or sleep disorders. Remarkably, one of the statistically relevant correlations point out to the time interval passed since the first diagnostic. These results stress the need of defining scoring scales specifically designed for speech disability estimation and monitoring methodologies in degenerative diseases of neuromotor origin.

• MeSH
• biomechanika fyziologie   MeSH
• čelisti patofyziologie   MeSH
• datové soubory jako téma MeSH
• dysartrie etiologie   patofyziologie   MeSH
• jazyk patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• Parkinsonova nemoc komplikace   diagnóza   MeSH
• poruchy artikulace etiologie   patofyziologie   MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Hypokinetic dysarthria (HD) and freezing of gait (FOG) are both axial symptoms that occur in patients with Parkinson's disease (PD). It is assumed they have some common pathophysiological mechanisms and therefore that speech disorders in PD can predict FOG deficits within the horizon of some years. The aim of this study is to employ a complex quantitative analysis of the phonation, articulation and prosody in PD patients in order to identify the relationship between HD and FOG, and establish a mathematical model that would predict FOG deficits using acoustic analysis at baseline. We enrolled 75 PD patients who were assessed by 6 clinical scales including the Freezing of Gait Questionnaire (FOG-Q). We subsequently extracted 19 acoustic measures quantifying speech disorders in the fields of phonation, articulation and prosody. To identify the relationship between HD and FOG, we performed a partial correlation analysis. Finally, based on the selected acoustic measures, we trained regression models to predict the change in FOG during a 2-year follow-up. We identified significant correlations between FOG-Q scores and the acoustic measures based on formant frequencies (quantifying the movement of the tongue and jaw) and speech rate. Using the regression models, we were able to predict a change in particular FOG-Q scores with an error of between 7.4 and 17.0 %. This study is suggesting that FOG in patients with PD is mainly linked to improper articulation, a disturbed speech rate and to intelligibility. We have also proved that the acoustic analysis of HD at the baseline can be used as a predictor of the FOG deficit during 2 years of follow-up. This knowledge enables researchers to introduce new cognitive systems that predict gait difficulties in PD patients.

• Publikační typ
• časopisecké články MeSH

Aim: The research described is intended to give a description of articulation dynamics as a correlate of the kinematic behavior of the jaw-tongue biomechanical system, encoded as a probability distribution of an absolute joint velocity. This distribution may be used in detecting and grading speech from patients affected by neurodegenerative illnesses, as Parkinson Disease. Hypothesis: The work hypothesis is that the probability density function of the absolute joint velocity includes information on the stability of phonation when applied to sustained vowels, as well as on fluency if applied to connected speech. Methods: A dataset of sustained vowels recorded from Parkinson Disease patients is contrasted with similar recordings from normative subjects. The probability distribution of the absolute kinematic velocity of the jaw-tongue system is extracted from each utterance. A Random Least Squares Feed-Forward Network (RLSFN) has been used as a binary classifier working on the pathological and normative datasets in a leave-one-out strategy. Monte Carlo simulations have been conducted to estimate the influence of the stochastic nature of the classifier. Two datasets for each gender were tested (males and females) including 26 normative and 53 pathological subjects in the male set, and 25 normative and 38 pathological in the female set. Results: Male and female data subsets were tested in single runs, yielding equal error rates under 0.6% (Accuracy over 99.4%). Due to the stochastic nature of each experiment, Monte Carlo runs were conducted to test the reliability of the methodology. The average detection results after 200 Montecarlo runs of a 200 hyperplane hidden layer RLSFN are given in terms of Sensitivity (males: 0.9946, females: 0.9942), Specificity (males: 0.9944, females: 0.9941) and Accuracy (males: 0.9945, females: 0.9942). The area under the ROC curve is 0.9947 (males) and 0.9945 (females). The equal error rate is 0.0054 (males) and 0.0057 (females). Conclusions: The proposed methodology avails that the use of highly normalized descriptors as the probability distribution of kinematic variables of vowel articulation stability, which has some interesting properties in terms of information theory, boosts the potential of simple yet powerful classifiers in producing quite acceptable detection results in Parkinson Disease.

• Publikační typ
• časopisecké články MeSH

Hypokinetic dysarthria (HD) occurs in 90% of Parkinson's disease (PD) patients. It manifests specifically in the areas of articulation, phonation, prosody, speech fluency, and faciokinesis. We aimed to systematically review papers on HD in PD with a special focus on (1) early PD diagnosis and monitoring of the disease progression using acoustic voice and speech analysis, and (2) functional imaging studies exploring neural correlates of HD in PD, and (3) clinical studies using acoustic analysis to evaluate effects of dopaminergic medication and brain stimulation. A systematic literature search of articles written in English before March 2016 was conducted in the Web of Science, PubMed, SpringerLink, and IEEE Xplore databases using and combining specific relevant keywords. Articles were categorized into three groups: (1) articles focused on neural correlates of HD in PD using functional imaging (n = 13); (2) articles dealing with the acoustic analysis of HD in PD (n = 52); and (3) articles concerning specifically dopaminergic and brain stimulation-related effects as assessed by acoustic analysis (n = 31); the groups were then reviewed. We identified 14 combinations of speech tasks and acoustic features that can be recommended for use in describing the main features of HD in PD. While only a few acoustic parameters correlate with limb motor symptoms and can be partially relieved by dopaminergic medication, HD in PD seems to be mainly related to non-dopaminergic deficits and associated particularly with non-motor symptoms. Future studies should combine non-invasive brain stimulation with voice behavior approaches to achieve the best treatment effects by enhancing auditory-motor integration.

• MeSH
• antiparkinsonika terapeutické užití   MeSH
• časná diagnóza MeSH
• hluboká mozková stimulace MeSH
• lidé MeSH
• mozek diagnostické zobrazování   patofyziologie   MeSH
• Parkinsonova nemoc komplikace   diagnóza   patofyziologie   terapie   MeSH
• poruchy řeči diagnóza   etiologie   patofyziologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Impairment of speech prosody is characteristic for Parkinson's disease (PD) and does not respond well to dopaminergic treatment. OBJECTIVES: We assessed whether baseline acoustic parameters, alone or in combination with other predominantly non-dopaminergic symptoms may predict global cognitive decline as measured by the Addenbrooke's cognitive examination (ACE-R) and/or worsening of cognitive status as assessed by a detailed neuropsychological examination. METHODS: Forty-four consecutive non-depressed PD patients underwent clinical and cognitive testing, and acoustic voice analysis at baseline and at the two-year follow-up. Influence of speech and other clinical parameters on worsening of the ACE-R and of the cognitive status was analyzed using linear and logistic regression. RESULTS: The cognitive status (classified as normal cognition, mild cognitive impairment and dementia) deteriorated in 25% of patients during the follow-up. The multivariate linear regression model consisted of the variation in range of the fundamental voice frequency (F0VR) and the REM Sleep Behavioral Disorder Screening Questionnaire (RBDSQ). These parameters explained 37.2% of the variability of the change in ACE-R. The most significant predictors in the univariate logistic regression were the speech index of rhythmicity (SPIR; p = 0.012), disease duration (p = 0.019), and the RBDSQ (p = 0.032). The multivariate regression analysis revealed that SPIR alone led to 73.2% accuracy in predicting a change in cognitive status. Combining SPIR with RBDSQ improved the prediction accuracy of SPIR alone by 7.3%. CONCLUSIONS: Impairment of speech prosody together with symptoms of RBD predicted rapid cognitive decline and worsening of PD cognitive status during a two-year period.

• MeSH
• kognitivní poruchy diagnóza   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• neparametrická statistika MeSH
• neuropsychologické testy MeSH
• Parkinsonova nemoc komplikace   MeSH
• poruchy řeči etiologie   MeSH
• řeč fyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statistika jako téma MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH