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Vogel AP, Sobanska A, Gupta A, Vasco G, Grobe-Einsler M, Summa S, Borel S. Quantitative Speech Assessment in Ataxia-Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Markers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1128-1134. [PMID: 37897626 PMCID: PMC11102369 DOI: 10.1007/s12311-023-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
Dysarthria is a common and debilitating symptom of many neurodegenerative diseases, including those resulting in ataxia. Changes to speech lead to significant reductions in quality of life, impacting the speaker in most daily activities. Recognition of its importance as an objective outcome measure in clinical trials for ataxia is growing. Its viability as an endpoint across the disease spectrum (i.e. pre-symptomatic onwards) means that trials can recruit ambulant individuals and later-stage individuals who are often excluded because of difficulty completing lower limb tasks. Here we discuss the key considerations for speech testing in clinical trials including hardware selection, suitability of tasks and their role in protocols for trials and propose a core set of tasks for speech testing in clinical trials. Test batteries could include forms suitable for remote short, sensitive and easy to use, with norms available in several languages. The use of artificial intelligence also could improve accuracy and automaticity of analytical pipelines in clinic and trials.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia.
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Tübingen, Germany.
- Redenlab Inc., Melbourne, Australia.
| | - Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anoopum Gupta
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gessica Vasco
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Susanna Summa
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Stephanie Borel
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, F-75013, Paris, France
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Vogel AP, Spencer C, Burke K, de Bruyn D, Gibilisco P, Blackman S, Vojtech JM, Kathiresan T. Optimizing Communication in Ataxia: A Multifaceted Approach to Alternative and Augmentative Communication (AAC). CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01675-0. [PMID: 38448793 DOI: 10.1007/s12311-024-01675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
The progression of multisystem neurodegenerative diseases such as ataxia significantly impacts speech and communication, necessitating adaptive clinical care strategies. With the deterioration of speech, Alternative and Augmentative Communication (AAC) can play an ever increasing role in daily life for individuals with ataxia. This review describes the spectrum of AAC resources available, ranging from unaided gestures and sign language to high-tech solutions like speech-generating devices (SGDs) and eye-tracking technology. Despite the availability of various AAC tools, their efficacy is often compromised by the physical limitations inherent in ataxia, including upper limb ataxia and visual disturbances. Traditional speech-to-text algorithms and eye gaze technology face challenges in accuracy and efficiency due to the atypical speech and movement patterns associated with the disease.In addressing these challenges, maintaining existing speech abilities through rehabilitation is prioritized, complemented by advances in digital therapeutics to provide home-based treatments. Simultaneously, projects incorporating AI driven solutions aim to enhance the intelligibility of dysarthric speech through improved speech-to-text accuracy.This review discusses the complex needs assessment for AAC in ataxia, emphasizing the dynamic nature of the disease and the importance of regular reassessment to tailor communication strategies to the changing abilities of the individual. It also highlights the necessity of multidisciplinary involvement for effective AAC assessment and intervention. The future of AAC looks promising with developments in brain-computer interfaces and the potential of voice banking, although their application in ataxia requires further exploration.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia.
- Redenlab Inc, Melbourne, Australia.
- Department of Neurodegenerative Diseases, & Center for Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, University Hospital Tübingen, Tübingen, Germany.
| | - Caroline Spencer
- Department of Speech, Language, and Hearing Sciences, Indiana University, Bloomington, USA
| | - Katie Burke
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
| | - Daniella de Bruyn
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
| | - Peter Gibilisco
- Social and Political Sciences, The University of Melbourne, Melbourne, Australia
| | - Scott Blackman
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
| | - Jennifer M Vojtech
- Delsys, Inc, Natick, MA, 01760, USA
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - Thayabaran Kathiresan
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
- Redenlab Inc, Melbourne, Australia
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van Prooije T, Knuijt S, Oostveen J, Kapteijns K, Vogel AP, van de Warrenburg B. Perceptual and Acoustic Analysis of Speech in Spinocerebellar ataxia Type 1. CEREBELLUM (LONDON, ENGLAND) 2024; 23:112-120. [PMID: 36633828 PMCID: PMC10864471 DOI: 10.1007/s12311-023-01513-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/13/2023]
Abstract
This study characterizes the speech phenotype of spinocerebellar ataxia type 1 (SCA1) using both perceptual and objective acoustic analysis of speech in a cohort of SCA1 patients. Twenty-seven symptomatic SCA1 patients in various disease stages (SARA score range: 3-32 points) and 18 sex and age matched healthy controls underwent a clinical assessment addressing ataxia severity, non-ataxia signs, cognitive functioning, and speech. Speech samples were perceptually rated by trained speech therapists, and acoustic metrics representing speech timing, vocal control, and voice quality were extracted. Perceptual analysis revealed reduced intelligibility and naturalness in speech samples of SCA1 patients. Acoustically, SCA1 patients presented with slower speech rate and diadochokinetic rate as well as longer syllable duration compared to healthy controls. No distinct abnormalities in voice quality in the acoustic analysis were detected at group level. Both the affected perceptual and acoustic variables correlated with ataxia severity. Longitudinal assessment of speech is needed to place changes in speech in the context of disease progression and potential response to treatment.
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Affiliation(s)
- Teije van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Judith Oostveen
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kirsten Kapteijns
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia
- Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tubingen, Germany
- Redenlab Inc., Melbourne, Australia
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
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Nunes AS, Pawlik M, Mishra RK, Waddell E, Coffey M, Tarolli CG, Schneider RB, Dorsey ER, Vaziri A, Adams JL. Digital assessment of speech in Huntington disease. Front Neurol 2024; 15:1310548. [PMID: 38322583 PMCID: PMC10844459 DOI: 10.3389/fneur.2024.1310548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Background Speech changes are an early symptom of Huntington disease (HD) and may occur prior to other motor and cognitive symptoms. Assessment of HD commonly uses clinician-rated outcome measures, which can be limited by observer variability and episodic administration. Speech symptoms are well suited for evaluation by digital measures which can enable sensitive, frequent, passive, and remote administration. Methods We collected audio recordings using an external microphone of 36 (18 HD, 7 prodromal HD, and 11 control) participants completing passage reading, counting forward, and counting backwards speech tasks. Motor and cognitive assessments were also administered. Features including pausing, pitch, and accuracy were automatically extracted from recordings using the BioDigit Speech software and compared between the three groups. Speech features were also analyzed by the Unified Huntington Disease Rating Scale (UHDRS) dysarthria score. Random forest machine learning models were implemented to predict clinical status and clinical scores from speech features. Results Significant differences in pausing, intelligibility, and accuracy features were observed between HD, prodromal HD, and control groups for the passage reading task (e.g., p < 0.001 with Cohen'd = -2 between HD and control groups for pause ratio). A few parameters were significantly different between the HD and control groups for the counting forward and backwards speech tasks. A random forest classifier predicted clinical status from speech tasks with a balanced accuracy of 73% and an AUC of 0.92. Random forest regressors predicted clinical outcomes from speech features with mean absolute error ranging from 2.43-9.64 for UHDRS total functional capacity, motor and dysarthria scores, and explained variance ranging from 14 to 65%. Montreal Cognitive Assessment scores were predicted with mean absolute error of 2.3 and explained variance of 30%. Conclusion Speech data have the potential to be a valuable digital measure of HD progression, and can also enable remote, frequent disease assessment in prodromal HD and HD. Clinical status and disease severity were predicted from extracted speech features using random forest machine learning models. Speech measurements could be leveraged as sensitive marker of clinical onset and disease progression in future clinical trials.
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Affiliation(s)
| | - Meghan Pawlik
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Emma Waddell
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Madeleine Coffey
- Donald and Barbara Zucker School of Medicine, Uniondale, NY, United States
| | - Christopher G. Tarolli
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Ruth B. Schneider
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Jamie L. Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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Mirkoska V, Antonsson M, Hartelius L, Nylén F. Detection of Subclinical Motor Speech Deficits after Presumed Low-Grade Glioma Surgery. Brain Sci 2023; 13:1631. [PMID: 38137079 PMCID: PMC10741922 DOI: 10.3390/brainsci13121631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Motor speech performance was compared before and after surgical resection of presumed low-grade gliomas. This pre- and post-surgery study was conducted on 15 patients (mean age = 41) with low-grade glioma classified based on anatomic features. Repetitions of /pa/, /ta/, /ka/, and /pataka/ recorded before and 3 months after surgery were analyzed regarding rate and regularity. A significant reduction (6 to 5.6 syllables/s) pre- vs. post-surgery was found in the rate for /ka/, which is comparable to the approximate average decline over 10-15 years of natural aging reported previously. For all other syllable types, rates were within normal age-adjusted ranges in both preoperative and postoperative sessions. The decline in /ka/ rate might reflect a subtle reduction in motor speech production, but the effects were not severe. All but one patient continued to perform within normal ranges post-surgery; one performed two standard deviations below age-appropriate norms pre- and post-surgery in all syllable tasks. The patient experienced motor speech difficulties, which may be related to the tumor's location in an area important for speech. Low-grade glioma may reduce maximum speech-motor performance in individual patients, but larger samples are needed to elucidate how often the effect occurs.
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Affiliation(s)
- Vesna Mirkoska
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, 40530 Gothenburg, Sweden; (M.A.); (L.H.)
| | - Malin Antonsson
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, 40530 Gothenburg, Sweden; (M.A.); (L.H.)
| | - Lena Hartelius
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, 40530 Gothenburg, Sweden; (M.A.); (L.H.)
| | - Fredrik Nylén
- Department of Clinical Sciences, Umeå University, 90736 Umeå, Sweden
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Nguyen TM, Leow AD, Ajilore O. A Review on Smartphone Keystroke Dynamics as a Digital Biomarker for Understanding Neurocognitive Functioning. Brain Sci 2023; 13:959. [PMID: 37371437 DOI: 10.3390/brainsci13060959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Can digital technologies provide a passive unobtrusive means to observe and study cognition outside of the laboratory? Previously, cognitive assessments and monitoring were conducted in a laboratory or clinical setting, allowing for a cross-sectional glimpse of cognitive states. In the last decade, researchers have been utilizing technological advances and devices to explore ways of assessing cognition in the real world. We propose that the virtual keyboard of smartphones, an increasingly ubiquitous digital device, can provide the ideal conduit for passive data collection to study cognition. Passive data collection occurs without the active engagement of a participant and allows for near-continuous, objective data collection. Most importantly, this data collection can occur in the real world, capturing authentic datapoints. This method of data collection and its analyses provide a more comprehensive and potentially more suitable insight into cognitive states, as intra-individual cognitive fluctuations over time have shown to be an early manifestation of cognitive decline. We review different ways passive data, centered around keystroke dynamics, collected from smartphones, have been used to assess and evaluate cognition. We also discuss gaps in the literature where future directions of utilizing passive data can continue to provide inferences into cognition and elaborate on the importance of digital data privacy and consent.
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Affiliation(s)
- Theresa M Nguyen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Alex D Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
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Genetic aetiologies for childhood speech disorder: novel pathways co-expressed during brain development. Mol Psychiatry 2022; 28:1647-1663. [PMID: 36117209 DOI: 10.1038/s41380-022-01764-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Childhood apraxia of speech (CAS), the prototypic severe childhood speech disorder, is characterized by motor programming and planning deficits. Genetic factors make substantive contributions to CAS aetiology, with a monogenic pathogenic variant identified in a third of cases, implicating around 20 single genes to date. Here we aimed to identify molecular causation in 70 unrelated probands ascertained with CAS. We performed trio genome sequencing. Our bioinformatic analysis examined single nucleotide, indel, copy number, structural and short tandem repeat variants. We prioritised appropriate variants arising de novo or inherited that were expected to be damaging based on in silico predictions. We identified high confidence variants in 18/70 (26%) probands, almost doubling the current number of candidate genes for CAS. Three of the 18 variants affected SETBP1, SETD1A and DDX3X, thus confirming their roles in CAS, while the remaining 15 occurred in genes not previously associated with this disorder. Fifteen variants arose de novo and three were inherited. We provide further novel insights into the biology of child speech disorder, highlighting the roles of chromatin organization and gene regulation in CAS, and confirm that genes involved in CAS are co-expressed during brain development. Our findings confirm a diagnostic yield comparable to, or even higher, than other neurodevelopmental disorders with substantial de novo variant burden. Data also support the increasingly recognised overlaps between genes conferring risk for a range of neurodevelopmental disorders. Understanding the aetiological basis of CAS is critical to end the diagnostic odyssey and ensure affected individuals are poised for precision medicine trials.
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Gallezot C, Riad R, Titeux H, Lemoine L, Montillot J, Sliwinski A, Bagnou JH, Cao XN, Youssov K, Dupoux E, Bachoud Levi AC. Emotion expression through spoken language in Huntington Disease. Cortex 2022; 155:150-161. [DOI: 10.1016/j.cortex.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
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An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis. THE CEREBELLUM 2022:10.1007/s12311-022-01435-y. [PMID: 35761144 PMCID: PMC9244122 DOI: 10.1007/s12311-022-01435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
Multiple sclerosis (MS) is a progressive disease that often affects the cerebellum. It is characterised by demyelination, inflammation, and neurodegeneration within the central nervous system. Damage to the cerebellum in MS is associated with increased disability and decreased quality of life. Symptoms include gait and balance problems, motor speech disorder, upper limb dysfunction, and oculomotor difficulties. Monitoring symptoms is crucial for effective management of MS. A combination of clinical, neuroimaging, and task-based measures is generally used to diagnose and monitor MS. This paper reviews the present and new tools used by clinicians and researchers to assess cerebellar impairment in people with MS (pwMS). It also describes recent advances in digital and home-based monitoring for people with MS.
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Riad R, Lunven M, Titeux H, Cao XN, Hamet Bagnou J, Lemoine L, Montillot J, Sliwinski A, Youssov K, Cleret de Langavant L, Dupoux E, Bachoud-Lévi AC. Predicting clinical scores in Huntington's disease: a lightweight speech test. J Neurol 2022; 269:5008-5021. [PMID: 35567614 PMCID: PMC9363375 DOI: 10.1007/s00415-022-11148-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/19/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Using brief samples of speech recordings, we aimed at predicting, through machine learning, the clinical performance in Huntington's Disease (HD), an inherited Neurodegenerative disease (NDD). METHODS We collected and analyzed 126 samples of audio recordings of both forward and backward counting from 103 Huntington's disease gene carriers [87 manifest and 16 premanifest; mean age 50.6 (SD 11.2), range (27-88) years] from three multicenter prospective studies in France and Belgium (MIG-HD (ClinicalTrials.gov NCT00190450); BIO-HD (ClinicalTrials.gov NCT00190450) and Repair-HD (ClinicalTrials.gov NCT00190450). We pre-registered all of our methods before running any analyses, in order to avoid inflated results. We automatically extracted 60 speech features from blindly annotated samples. We used machine learning models to combine multiple speech features in order to make predictions at individual levels of the clinical markers. We trained machine learning models on 86% of the samples, the remaining 14% constituted the independent test set. We combined speech features with demographics variables (age, sex, CAG repeats, and burden score) to predict cognitive, motor, and functional scores of the Unified Huntington's disease rating scale. We provided correlation between speech variables and striatal volumes. RESULTS Speech features combined with demographics allowed the prediction of the individual cognitive, motor, and functional scores with a relative error from 12.7 to 20.0% which is better than predictions using demographics and genetic information. Both mean and standard deviation of pause durations during backward recitation and clinical scores correlated with striatal atrophy (Spearman 0.6 and 0.5-0.6, respectively). INTERPRETATION Brief and examiner-free speech recording and analysis may become in the future an efficient method for remote evaluation of the individual condition in HD and likely in other NDD.
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Affiliation(s)
- Rachid Riad
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Laboratoire de Sciences Cognitives et Psycholinguistique, CNRS 8554, PSL University, 29 rue d'Ulm, 75005, Paris, France.,INRIA, Cognitive Machine Learning Team, 2 Rue Simone IFF, 75012, Paris, France.,EHESS, 54 boulevard Raspail, 75006, Paris, France
| | - Marine Lunven
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Hadrien Titeux
- Laboratoire de Sciences Cognitives et Psycholinguistique, CNRS 8554, PSL University, 29 rue d'Ulm, 75005, Paris, France.,INRIA, Cognitive Machine Learning Team, 2 Rue Simone IFF, 75012, Paris, France.,EHESS, 54 boulevard Raspail, 75006, Paris, France
| | - Xuan-Nga Cao
- Laboratoire de Sciences Cognitives et Psycholinguistique, CNRS 8554, PSL University, 29 rue d'Ulm, 75005, Paris, France.,INRIA, Cognitive Machine Learning Team, 2 Rue Simone IFF, 75012, Paris, France.,EHESS, 54 boulevard Raspail, 75006, Paris, France
| | - Jennifer Hamet Bagnou
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Laurie Lemoine
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Justine Montillot
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Agnes Sliwinski
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Katia Youssov
- Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Laurent Cleret de Langavant
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France.,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France.,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Emmanuel Dupoux
- Laboratoire de Sciences Cognitives et Psycholinguistique, CNRS 8554, PSL University, 29 rue d'Ulm, 75005, Paris, France.,INRIA, Cognitive Machine Learning Team, 2 Rue Simone IFF, 75012, Paris, France.,EHESS, 54 boulevard Raspail, 75006, Paris, France
| | - Anne-Catherine Bachoud-Lévi
- Département d'Études Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France. .,Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France. .,Inserm U955, Institut Mondor de Recherche Biomédicale, Équipe E01 NeuroPsychologie Interventionnelle, 94000, Créteil, France. .,Centre de Référence Maladie de Huntington, Service de Neurologie, AP-HP, Hôpital Henri Mondor-Albert Chenevier, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
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Chan JCS, Stout JC, Shirbin CA, Vogel AP. Listener Detection of Objectively Validated Acoustic Features of Speech in Huntington's Disease. J Huntingtons Dis 2022; 11:71-79. [PMID: 34974436 DOI: 10.3233/jhd-210501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Subtle progressive changes in speech motor function and cognition begin prior to diagnosis of Huntington's disease (HD). OBJECTIVE To determine the nature of listener-rated speech differences in premanifest and early-stage HD (i.e., PreHD and EarlyHD), compared to neurologically healthy controls. METHODS We administered a speech battery to 60 adults (16 people with PreHD, 14 with EarlyHD, and 30 neurologically healthy controls), and conducted a cognitive test of processing speed/visual attention, the Symbol Digit Modalities Test (SDMT) on participants with HD. Voice recordings were rated by expert listeners and analyzed for acoustic and perceptual speech features. RESULTS Listeners perceived subtle differences in the speech of PreHD compared to controls, including abnormal pitch level and speech rate, reduced loudness and loudness inflection, altered voice quality, hypernasality, imprecise articulation, and reduced naturalness of speech. Listeners detected abnormal speech rate in PreHD compared to healthy speakers on a reading task, which correlated with slower speech rate from acoustic analysis and a lower cognitive performance score. In early-stage HD, continuous speech was characterized by longer pauses, a higher proportion of silence, and slower rate. CONCLUSION Differences in speech and voice acoustic features are detectable in PreHD by expert listeners and align with some acoustically-derived objective speech measures. Slower speech rate in PreHD suggests altered oral motor control and/or subtle cognitive deficits that begin prior to diagnosis. Speakers with EarlyHD exhibited more silences compared to the PreHD and control groups, raising the likelihood of a link between speech and cognition that is not yet well characterized in HD.
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Affiliation(s)
- Jess C S Chan
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Christopher A Shirbin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia.,Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany.,Redenlab, Australia
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12
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Ivanova O, Meilán JJG, Martínez-Sánchez F, Martínez-Nicolás I, Llorente TE, González NC. Discriminating speech traits of Alzheimer's disease assessed through a corpus of reading task for Spanish language. COMPUT SPEECH LANG 2022. [DOI: 10.1016/j.csl.2021.101341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Kent RD, Kim Y, Chen LM. Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:574-623. [PMID: 34958599 DOI: 10.1044/2021_jslhr-21-00396] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis. METHOD Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate. RESULTS Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions. DISCUSSION A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.
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Affiliation(s)
- Ray D Kent
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Yunjung Kim
- School of Communication Sciences & Disorders, Florida State University, Tallahassee
| | - Li-Mei Chen
- Department of Foreign Languages and Literature, National Cheng Kung University, Tainan, Taiwan
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14
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Vogel AP, Pearson-Dennett V, Magee M, Wilcox RA, Esterman A, Thewlis D, White JM, Todd G. Adults with a history of recreational cannabis use have altered speech production. Drug Alcohol Depend 2021; 227:108963. [PMID: 34419853 DOI: 10.1016/j.drugalcdep.2021.108963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
Stereotypical depictions of speech in cannabis users often suggest slow, laboured output, yet objective evidence supporting this assumption is extremely limited. We know that depressants or hallucinogenic drugs such as cannabis can cause acute changes in communication and speech rate, but the long-lasting effects of cannabis use on speech are not well described. The aim of this study was to investigate speech in individuals with a history of recreational cannabis use compared to non-drug-using healthy controls. Speech samples were collected from a carefully described cohort of 31 adults with a history of cannabis use (but not use of illicit stimulant drugs) and 40 non-drug-using controls. Subjects completed simple and complex speech tasks including a monologue, a sustained vowel, saying the days of the week, and reading a phonetically balanced passage. Audio samples were analysed objectively using acoustic analysis for measures of timing, vocal control, and quality. Subtle differences in speech timing, vocal effort, and voice quality may exist between cannabis and control groups, however data remain equivocal. After controlling for lifetime alcohol and tobacco use and applying a false discovery rate, only spectral tilt (vocal effort and intensity) differed between groups and appeared to change in line with duration of abstinence from cannabis use. Differences between groups may reflect longer term changes to the underlying neural control of speech. Our digital analysis of speech shows there may be a signal differentiating individuals with a history of recreational cannabis use from healthy controls, in line with similar findings from gait and hand function studies.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, VIC, 3010, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, 72076, Germany; Redenlab, Melbourne, Australia.
| | - Verity Pearson-Dennett
- UniSA Clinical & Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Michelle Magee
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, VIC, 3010, Australia; Redenlab, Melbourne, Australia
| | - Robert A Wilcox
- UniSA Clinical & Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Department of Neurology, Flinders Medical Centre, Bedford Park, SA, 5042, Australia; Human Physiology, Medical School, Flinders University, Bedford Park, SA, 5042, Australia
| | - Adrian Esterman
- UniSA Clinical & Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Jason M White
- UniSA Clinical & Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Gabrielle Todd
- UniSA Clinical & Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health & Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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15
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Moorman S, Ahn JR, Kao MH. Plasticity of stereotyped birdsong driven by chronic manipulation of cortical-basal ganglia activity. Curr Biol 2021; 31:2619-2632.e4. [PMID: 33974850 PMCID: PMC8222193 DOI: 10.1016/j.cub.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Cortical-basal ganglia (CBG) circuits are critical for motor learning and performance, and are a major site of pathology. In songbirds, a CBG circuit regulates moment-by-moment variability in song and also enables song plasticity. Studies have shown that variable burst firing in LMAN, the output nucleus of this CBG circuit, actively drives acute song variability, but whether and how LMAN drives long-lasting changes in song remains unclear. Here, we ask whether chronic pharmacological augmentation of LMAN bursting is sufficient to drive plasticity in birds singing stereotyped songs. We show that altered LMAN activity drives cumulative changes in acoustic structure, timing, and sequencing over multiple days, and induces repetitions and silent pauses reminiscent of human stuttering. Changes persisted when LMAN was subsequently inactivated, indicating plasticity in song motor regions. Following cessation of pharmacological treatment, acoustic features and song sequence gradually recovered to their baseline values over a period of days to weeks. Together, our findings show that augmented bursting in CBG circuitry drives plasticity in well-learned motor skills, and may inform treatments for basal ganglia movement disorders.
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Affiliation(s)
- Sanne Moorman
- Psychology Department, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands; Biology Department, Tufts University, 200 Boston Avenue, Medford, MA 02155, USA.
| | - Jae-Rong Ahn
- Biology Department, Tufts University, 200 Boston Avenue, Medford, MA 02155, USA
| | - Mimi H Kao
- Biology Department, Tufts University, 200 Boston Avenue, Medford, MA 02155, USA; Neuroscience Graduate Program, Tufts University, Boston, MA 02111, USA.
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16
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Jacquemot C, Bachoud-Lévi AC. Striatum and language processing: Where do we stand? Cognition 2021; 213:104785. [PMID: 34059317 DOI: 10.1016/j.cognition.2021.104785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
More than a century ago, Broca (1861), Wernicke (1874) and Lichteim (1885) laid the foundations for the first anatomo-functional model of language, secondarily enriched by Geschwind (1967), leading to the Broca-Wernicke-Lichteim-Geschwind model. This model included the frontal, parietal, and temporal cortices as well as a subcortical structure, which could be the striatum, whose nature and role have remained unclear. Although the emergence of language deficits in patients with striatal injury has challenged the cortical language models developed over the past 30 years, the integration of the striatum into language processing models remains rare. The main argument for not including the striatum in language processing is that the disorders observed in patients with striatal dysfunction may result from the striatal role in cognitive functions beyond language, and not from the impairment of language itself. Indeed, unraveling the role of the striatum and the frontal cortex, linked by the fronto-striatal pathway, is a challenge. Here, we first reviewed the studies that explored the link between striatal functions and the different levels of language (phonetics, phonology, morphology, syntax, and lexico-semantics). We then looked at the language models, which included the striatum, and found that none of them captured the diversity of experimental data in this area. Finally, we propose an integrative anatomo-functional model of language processing combining traditional language processing levels and some "executive" functions, known to improve the efficiency and fluidity of language: control, working memory, and attention. We argue that within this integrative model, the striatum is a central node of a verbal executive network that regulates, monitors, and controls the allocations of limited cognitive resources (verbal working memory and verbal attention), whatever the language level. This model combines data from neurology, psycholinguistics, and cognitive science.
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Affiliation(s)
- Charlotte Jacquemot
- Département d'Etudes Cognitives, École normale supérieure, PSL University, 75005 Paris, France; Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, 94000 Créteil, France; Université Paris-Est Créteil, Faculté de médecine, 94000 Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- Département d'Etudes Cognitives, École normale supérieure, PSL University, 75005 Paris, France; Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, 94000 Créteil, France; Université Paris-Est Créteil, Faculté de médecine, 94000 Créteil, France; Assistance Publique-Hôpitaux de Paris, National Reference Center for Huntington's Disease, Neurology Department, Henri Mondor-Albert Chenevier Hospital, Créteil, France.
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17
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Carlozzi NE, Boileau NR, Roberts A, Dayalu P, Hanifan DL, Miner JA, Claassen D, Provost EM. Understanding speech and swallowing difficulties in individuals with Huntington disease: Validation of the HDQLIFE Speech Difficulties and Swallowing Difficulties Item Banks. Qual Life Res 2021; 30:251-265. [PMID: 32839864 PMCID: PMC7854808 DOI: 10.1007/s11136-020-02608-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE As Huntington disease (HD) progresses, speech and swallowing difficulties become more profound. These difficulties have an adverse effect on health-related quality of life (HRQOL), thus psychometrically robust measures of speech and swallowing are needed to better understand the impact of these domains across the course of the disease. Therefore, the purpose of this study is to establish the clinical utility of two new patient-reported outcome measures (PROs), HDQLIFE Speech Difficulties and HDQLIFE Swallowing Difficulties. METHODS Thirty-one participants with premanifest or manifest HD, and 31 age- and sex-matched healthy control participants were recruited for this study. Participants completed several PROs [HDQLIFE Speech Difficulties, HDQLIFE Swallowing Difficulties, Communication Participation Item Bank (CPIB)], as well as several clinician-rated assessments of speech and functioning. A computational algorithm designed to detect features of spoken discourse was also examined. Analyses were focused on establishing the reliability and validity of these new measures. RESULTS Internal consistency was good for Swallowing (Cronbach's alpha = 0.89) and excellent for Speech and the CPIB (both Cronbach's alpha ≥ 0.94), and convergent/discriminant validity was supported. Known groups validity for the PROs was supported by significant group differences among control participants and persons with different stages of HD (all p < 0.0001). All PROs were able to distinguish those with and without clinician-rated dysarthria (likelihood ratios far exceeded the threshold for clinical decision making [all ≥ 3.28]). CONCLUSIONS Findings support the clinical utility of the HDQLIFE Speech and Swallowing PROs and the CPIB for use across the HD disease spectrum. These PROs also have the potential to be clinically useful in other populations.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Angela Roberts
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Dana L Hanifan
- Department of Speech-Language Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Daniel Claassen
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Emily Mower Provost
- Department of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
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18
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Cepeda C, Levine MS. Synaptic Dysfunction in Huntington's Disease: Lessons from Genetic Animal Models. Neuroscientist 2020; 28:20-40. [PMID: 33198566 DOI: 10.1177/1073858420972662] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The understanding of the functional and structural changes occurring in the cerebral cortex and basal ganglia in Huntington's disease (HD) has benefited considerably from the generation of genetic animal models. Most studies of synaptic alterations in HD models have focused on the striatum, but a more complete picture of synaptic dysfunction in the cortico-basal ganglia-cortical loop is emerging. Here, we provide a review and analysis of current developments in the study of synaptic alterations in these areas using HD rodent models. Recent evidence indicates that cortical maldevelopment plays a role in synaptic dysfunction along the corticostriatal pathway that may have its roots in the way mutant huntingtin interacts with synaptic proteins. Furthermore, a progressive disconnection in the corticostriatal pathway leads to abnormal function engaging extrasynaptic N-methyl-D-aspartate glutamate receptors that contribute to eventual cell degeneration. In addition, biphasic increases followed by decreases in glutamate and dopamine release in the striatum could explain contrasting symptomatology in early and late stages of the disease. Changes in striatal output regions also are beginning to be examined. Finally, we highlight some therapeutic avenues aimed at rescuing synaptic dysfunction.
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Affiliation(s)
- Carlos Cepeda
- IDDRC, Jane and Terry Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michael S Levine
- IDDRC, Jane and Terry Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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19
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Noffs G, Boonstra FMC, Perera T, Butzkueven H, Kolbe SC, Maldonado F, Cofre Lizama LE, Galea MP, Stankovich J, Evans A, van der Walt A, Vogel AP. Speech metrics, general disability, brain imaging and quality of life in multiple sclerosis. Eur J Neurol 2020; 28:259-268. [PMID: 32916031 DOI: 10.1111/ene.14523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/30/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Objective measurement of speech has shown promising results to monitor disease state in multiple sclerosis. In this study, we characterize the relationship between disease severity and speech metrics through perceptual (listener based) and objective acoustic analysis. We further look at deviations of acoustic metrics in people with no perceivable dysarthria. METHODS Correlations and regression were calculated between speech measurements and disability scores, brain volume, lesion load and quality of life. Speech measurements were further compared between three subgroups of increasing overall neurological disability: mild (as rated by the Expanded Disability Status Scale ≤2.5), moderate (≥3 and ≤5.5) and severe (≥6). RESULTS Clinical speech impairment occurred majorly in people with severe disability. An experimental acoustic composite score differentiated mild from moderate (P < 0.001) and moderate from severe subgroups (P = 0.003), and correlated with overall neurological disability (r = 0.6, P < 0.001), quality of life (r = 0.5, P < 0.001), white matter volume (r = 0.3, P = 0.007) and lesion load (r = 0.3, P = 0.008). Acoustic metrics also correlated with disability scores in people with no perceivable dysarthria. CONCLUSIONS Acoustic analysis offers a valuable insight into the development of speech impairment in multiple sclerosis. These results highlight the potential of automated analysis of speech to assist in monitoring disease progression and treatment response.
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Affiliation(s)
- G Noffs
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - F M C Boonstra
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - T Perera
- The Bionics Institute, Melbourne, VIC, Australia.,Department of Medical Bionics, University of Melbourne, Melbourne, VIC, Australia
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - S C Kolbe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - F Maldonado
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia
| | - L Euardo Cofre Lizama
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Australia Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia.,School of Allied Health, Human Services and Sports, La Trobe University, Melbourne, VIC, Australia
| | - M P Galea
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Australia Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - A Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia
| | - A van der Walt
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia
| | - A P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Redenlab, Melbourne, VIC, Australia
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20
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Martinez-Horta S, Sampedro F, Horta-Barba A, Perez-Perez J, Pagonabarraga J, Gomez-Anson B, Kulisevsky J. Structural brain correlates of dementia in Huntington's disease. NEUROIMAGE-CLINICAL 2020; 28:102415. [PMID: 32979842 PMCID: PMC7519361 DOI: 10.1016/j.nicl.2020.102415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
Dementia may occur in the early stages of HD and with independence of disease burden. More severe posterior-cortical atrophy is associated with dementia in HD. Neuropsychological alterations of dementia in HD extends beyond executive dysfunction. CAG-independent neuropathological mechanisms may contribute to dementia in HD.
Background Huntington’s disease (HD) is a fatal genetic neurodegenerative disorder with no effective treatment currently available. Progressive basal ganglia and whole-brain atrophy and concurrent cognitive deterioration are prototypical aspects of HD. However, the specific patterns of brain atrophy underlying cognitive impairment of different severity in HD are poorly understood. The aim of this study was to investigate the specific structural brain correlates of major cognitive deficits in HD and to explore its association with neuropsychological indicators. Participants Thirty-five symptomatic early-to-mild HD patients and 15 healthy controls (HC) with available T1-MRI imaging were included in this study. Methods In this cross-sectional study, HD patients were classified as patients with (HD-Dem) and without (HD-ND) major cognitive impairment in the range of dementia. This classification was based on previously validated PD-CRS cutoff scores for HD. Differences in brain atrophy across groups were studied by means of grey-matter volume voxel-based morphometry (GMV-VBM) and cortical thickness (Cth). Voxelwise and vertexwise general linear models were used to assess the group comparisons, controlling for the effects of age, sex, education, CAG repeat length and severity of motor symptoms. Clusters surviving p < 0.05 and family-wise error (FWE) correction were considered statistically significant. In order to characterize the impact on cognitive performance of the observed brain differences across groups, GMV and Cth values in the set of significant regions were computed and correlated with specific neuropsychological tests. Results All groups had similar sociodemographic profiles, and the HD groups did not significantly differ in terms of CAG repeat length. Compared to HC, both HD groups exhibited significant atrophy in multiple subcortical and parietal brain regions. However, compared to HC and HD-ND groups, HD-Dem patients showed a more prominent pattern of reduced GMV and cortical thinning. Importantly, this thinning was restricted to regions of the parietal-temporal and occipital cortices. Furthermore, these brain alterations were further associated with poorer cognitive performance in tasks assessing frontal-executive and attention domains as well as memory, language and constructional abilities. Conclusions Major cognitive impairment in the range of dementia in HD is associated with brain and cognitive alterations exceeding the prototypical frontal-executive deficits commonly recognized in HD. The observed posterior-cortical damage identified by MRI and its association with memory, language, and visuoconstructive dysfunction suggest a strong involvement of extra-striatal atrophy in the onset of severe cognitive dysfunction in HD patients. Critically, major cognitive impairment in this sample was not associated with CAG repeat length, age or education. This finding could support a possible involvement of additional neuropathological mechanisms aggravating cognitive deterioration in HD.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; European Huntington's Disease Network (EHDN), Spain
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Beatriz Gomez-Anson
- Neuroradiology, Radiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain.
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21
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Burnip E, Wallace E, Gozdzikowska K, Huckabee ML. A Systematic Review of Rehabilitation for Corticobulbar Symptoms in Adults with Huntington's Disease. J Huntingtons Dis 2019; 9:1-12. [PMID: 31744013 PMCID: PMC7081106 DOI: 10.3233/jhd-190384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Corticobulbar symptoms have been reported in all stages of Huntington’s disease (HD); aspiration pneumonia associated with swallowing impairment has been identified as the most common cause of death. Whilst recent research has described positive effects of corticobulbar rehabilitation in other neurodegenerative conditions, it is unclear if this is similarly effective in HD. Preliminary evidence in corticospinal rehabilitation has revealed physical therapy and exercise could be beneficial for individuals with HD. Objective: This systematic review will explore the literature relative to rehabilitation of corticobulbar symptoms in adults with HD. Methods: Two investigators independently searched relevant electronic databases for literature related to corticobulbar rehabilitation in HD, published in English until October 2019. Included studies were critically appraised using the Oxford Centre for Evidence-based Medicine Levels of Evidence, Cochrane Risk of Bias Tool and Scottish Intercollegiate Guidelines Network checklists. Study outcomes included measurements of function, quality of life or neuromuscular physiology. Results: Seventy-seven publications were screened with eight studies meeting the inclusion criteria – two randomised control trials and six intervention studies. Validated and objective outcome measures of corticobulbar symptoms were infrequently used. There was a high risk of bias identified in 7/8 studies. The data suggested positive clinical outcomes, no adverse effects and no deterioration observed across longitudinal studies. Conclusions: This systematic review documented a lack of high-quality evidence to support the use of rehabilitation to treat corticobulbar symptoms in HD. However, the suggestion of potential positive effects based on available, albeit limited, studies provides justification for further research in this area.
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Affiliation(s)
- Emma Burnip
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Emma Wallace
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Kristin Gozdzikowska
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,Laura Fergusson Trust, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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