Le débit de parole du patient wilsonien dysarthrique peut-il être amélioré en condition de double tâche ?

Attention in post-lexical processes of utterance production: Dual-task cost in younger and older adults

There is a general agreement that speaking requires attention at least for conceptual and lexical processes of utterance production. However, conflicting results have been obtained with dual-task paradigms using either repetition tasks or more generally tasks involving limited loading of lexical selection. This study aimed to investigate whether post-lexical processes recruit attentional resources. We used a new dual-task paradigm in a set of experiments where a continuous verbal production task involved either high or low demand on lexical selection processes. Experiment 1 evaluates lexical and post-lexical processes with a semantic verbal fluency task, whereas Experiments 2 and 3 focus on post-lexical processes with a non-propositional speech task. In each experiment, two types of non-verbal secondary tasks were used: processing speed (simple manual reaction times) or inhibition (Go/No-go). In Experiment 1, a dual-task cost was observed on the semantic verbal fluency task and each non-verbal task. In Experiment 2, a dual-task cost appeared on the non-verbal tasks but not on the speech task. The same paradigm was used with older adults (Experiment 3), as increased effort in post-lexical processes has been associated with ageing. For older adults, a dual-task cost was also observed on the non-propositional verbal task when speech was produced with the inhibition non-verbal task. The results suggest an attentional cost on post-lexical processes and strategic effects in the resolution of the dual-task.

Dystonic Dysarthria in Wilson Disease: Efficacy of Zolpidem

Wilson disease (WD) is a rare genetic disorder characterized by copper overload in the liver and the brain. Neurological presentations are mainly related to the accumulation of copper in the basal ganglia, the brainstem, and the cerebellum. Dysarthria is a frequent symptom, with dystonic, spastic, or parkinsonian components and is usually resistant to medical or voice rehabilitation therapies. Here, we report the case of a patient with WD diagnosed at the age of 12, who presented a severe and constant dysarthria from dystonic origin which was unresponsive to benzodiazepines and anticholinergic drugs. When she was 25-year-old, she tried zolpidem at bedtime for sleeping difficulties and reported a paradoxical effect of this drug on her voice. To confirm the effect of zolpidem on her dystonic dysarthria, we realized a full evaluation of her dysarthria at baseline without zolpidem and after 4 days of treatment by 10 mg twice a day. Lexical access was evaluated by the semantic fluency; dysarthria by the Intelligibility Score, the spontaneous speech and reading rates, the maximum phonation time on the sustained vowel [a] and by a perceptive evaluation. Two hours after the intake of zolpidem, improvement of all the parameters tested, with the exception of the maximum phonation time, was observed. Semantic fluency increased by 59%, the spontaneous speech rate by 88% and the reading rate by 76%. General dystonia remained unchanged and the tolerance of zolpidem was satisfactory. Since then, the patient takes zolpidem 5 mg five times a day, and 4 years later shows persistent improvement in oral communication and a good drug tolerance. In this single-case study, we showed that regular daytime intake of zolpidem could have a persisting effect on a complex dystonic dysarthria that was resistant to usual medical treatments.

Hypersialorrhea in Wilson's Disease

Hypersialorrhea, corresponding to excessive salivation is a symptom frequently reported in Wilson's disease, especially in its neurological form. The prevalence of this frequent complaint has not been often evaluated. During a 7-month period, 87 consecutive Wilson's disease patients answered to the simple question "do you have the sensation of excess saliva in your mouth?" to evaluate the frequency of this symptom. A sub-sample of 10 consecutive Wilson's disease patients with drooling was recruited to undergo quantitative and qualitative measures to evaluate the mechanism of hypersialorrhea. Excessive drooling or excess saliva was found in 46 % of patients followed at the French Reference Centre. Ninety-eight percent of them presented neurological symptoms and drooling was found in only one patient without neurological symptoms. Our study showed that patients with a complaint of excessive saliva produced significantly higher quantities of saliva at rest than controls. Endoscopic examination was abnormal in six patients. A significant decrease of swallowing frequency, longer swallow latencies, and poor swallowing capacities may partly explain the salivary stasis. Oropharyngeal sensitivity disorders were present in 50 % of our patients. The decrease of the swallowing frequency observed in all patients could be related to cognitive and behavioral abnormalities with initiation difficulties objectified by longer latencies triggered by all the ingested volumes. This study confirmed the hypothesis of a multifactorial origin of hypersialorrhea in patients who have been diagnosed in Wilson's disease. It was essential to evaluate drooling with a multidisciplinary consultation to better identify the underlying mechanisms and to implement strategies for speech therapy and therapeutic adaptation.