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Mračková M, Mareček R, Mekyska J, Košťálová M, Rektorová I. Levodopa may modulate specific speech impairment in Parkinson's disease: an fMRI study. J Neural Transm (Vienna) 2024; 131:181-187. [PMID: 37943390 DOI: 10.1007/s00702-023-02715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
Hypokinetic dysarthria (HD) is a difficult-to-treat symptom affecting quality of life in patients with Parkinson's disease (PD). Levodopa may partially alleviate some symptoms of HD in PD, but the neural correlates of these effects are not fully understood. The aim of our study was to identify neural mechanisms by which levodopa affects articulation and prosody in patients with PD. Altogether 20 PD patients participated in a task fMRI study (overt sentence reading). Using a single dose of levodopa after an overnight withdrawal of dopaminergic medication, levodopa-induced BOLD signal changes within the articulatory pathway (in regions of interest; ROIs) were studied. We also correlated levodopa-induced BOLD signal changes with the changes in acoustic parameters of speech. We observed no significant changes in acoustic parameters due to acute levodopa administration. After levodopa administration as compared to the OFF dopaminergic condition, patients showed task-induced BOLD signal decreases in the left ventral thalamus (p = 0.0033). The changes in thalamic activation were associated with changes in pitch variation (R = 0.67, p = 0.006), while the changes in caudate nucleus activation were related to changes in the second formant variability which evaluates precise articulation (R = 0.70, p = 0.003). The results are in line with the notion that levodopa does not have a major impact on HD in PD, but it may induce neural changes within the basal ganglia circuitries that are related to changes in speech prosody and articulation.
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Affiliation(s)
- Martina Mračková
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Radek Mareček
- Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic
| | - Jiří Mekyska
- Department of Telecommunications, Brno University of Technology, Brno, Czech Republic
| | - Milena Košťálová
- Department of Neurology, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Brno, Czech Republic
| | - Irena Rektorová
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic.
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2
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Jiang L, Zhuo J, Furman A, Fishman PS, Gullapalli R. Cerebellar functional connectivity change is associated with motor and neuropsychological function in early stage drug-naïve patients with Parkinson's disease. Front Neurosci 2023; 17:1113889. [PMID: 37425003 PMCID: PMC10324581 DOI: 10.3389/fnins.2023.1113889] [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: 12/01/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Parkinson's Disease (PD) is a progressive neurodegenerative disorder affecting both motor and cognitive function. Previous neuroimaging studies have reported altered functional connectivity (FC) in distributed functional networks. However, most neuroimaging studies focused on patients at an advanced stage and with antiparkinsonian medication. This study aims to conduct a cross-sectional study on cerebellar FC changes in early-stage drug-naïve PD patients and its association with motor and cognitive function. Methods Twenty-nine early-stage drug-naïve PD patients and 20 healthy controls (HCs) with resting-state fMRI data and motor UPDRS and neuropsychological cognitive data were extracted from the Parkinson's Progression Markers Initiative (PPMI) archives. We used seed-based resting-state fMRI (rs-fMRI) FC analysis and the cerebellar seeds were defined based on the hierarchical parcellation of the cerebellum (AAL atlas) and its topological function mapping (motor cerebellum and non-motor cerebellum). Results The early stage drug-naïve PD patients had significant differences in cerebellar FC when compared with HCs. Our findings include: (1) Increased intra-cerebellar FC within motor cerebellum, (2) increase motor cerebellar FC in inferior temporal gyrus and lateral occipital gyrus within ventral visual pathway and decreased motor-cerebellar FC in cuneus and dorsal posterior precuneus within dorsal visual pathway, (3) increased non-motor cerebellar FC in attention, language, and visual cortical networks, (4) increased vermal FC in somatomotor cortical network, and (5) decreased non-motor and vermal FC within brainstem, thalamus and hippocampus. Enhanced FC within motor cerebellum is positively associated with the MDS-UPDRS motor score and enhanced non-motor FC and vermal FC is negatively associated with cognitive function test scores of SDM and SFT. Conclusion These findings provide support for the involvement of cerebellum at an early stage and prior to clinical presentation of non-motor features of the disease in PD patients.
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Affiliation(s)
- Li Jiang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Advanced Imaging Research (CAIR), University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jiachen Zhuo
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Advanced Imaging Research (CAIR), University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrew Furman
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Advanced Imaging Research (CAIR), University of Maryland School of Medicine, Baltimore, MD, United States
| | - Paul S. Fishman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rao Gullapalli
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for Advanced Imaging Research (CAIR), University of Maryland School of Medicine, Baltimore, MD, United States
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3
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Wiesman AI, Donhauser PW, Degroot C, Diab S, Kousaie S, Fon EA, Klein D, Baillet S. Aberrant neurophysiological signaling associated with speech impairments in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:61. [PMID: 37059749 PMCID: PMC10104849 DOI: 10.1038/s41531-023-00495-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/16/2023] [Indexed: 04/16/2023] Open
Abstract
Difficulty producing intelligible speech is a debilitating symptom of Parkinson's disease (PD). Yet, both the robust evaluation of speech impairments and the identification of the affected brain systems are challenging. Using task-free magnetoencephalography, we examine the spectral and spatial definitions of the functional neuropathology underlying reduced speech quality in patients with PD using a new approach to characterize speech impairments and a novel brain-imaging marker. We found that the interactive scoring of speech impairments in PD (N = 59) is reliable across non-expert raters, and better related to the hallmark motor and cognitive impairments of PD than automatically-extracted acoustical features. By relating these speech impairment ratings to neurophysiological deviations from healthy adults (N = 65), we show that articulation impairments in patients with PD are associated with aberrant activity in the left inferior frontal cortex, and that functional connectivity of this region with somatomotor cortices mediates the influence of cognitive decline on speech deficits.
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Affiliation(s)
- Alex I Wiesman
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Peter W Donhauser
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
- Ernst Strüngmann Institute for Neuroscience, Frankfurt, Germany
| | - Clotilde Degroot
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Sabrina Diab
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Shanna Kousaie
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Denise Klein
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada.
- Center for Research on Brain, Language and Music, McGill University, Montreal, QC, Canada.
| | - Sylvain Baillet
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada.
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Gombaut C, Holmes SA. Sensorimotor Integration and Pain Perception: Mechanisms Integrating Nociceptive Processing. A Systematic Review and ALE-Meta Analysis. Front Integr Neurosci 2022; 16:931292. [PMID: 35990591 PMCID: PMC9390858 DOI: 10.3389/fnint.2022.931292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Pain treatment services and clinical indicators of pain chronicity focus on afferent nociceptive projections and psychological markers of pain perception with little focus on motor processes. Research supports a strong role for the motor system both in terms of pain related disability and in descending pain modulation. However, there is little understanding of the neurological regions implicated in pain-motor interactions and how the motor and sensory systems interact under conditions of pain. We performed an ALE meta-analysis on two clinical cohorts with atypical sensory and motor processes under conditions of pain and no pain. Persons with sensory altered processing (SAP) and no pain presented with greater activity in the precentral and supplementary motor area relative to persons with self-reported pain. In persons with motor altered processing (MAP), there appeared to be a suppression of activity in key pain regions such as the insula, thalamus, and postcentral gyrus. As such, activation within the motor system may play a critical role in dampening pain symptoms in persons with SAP, and in suppressing activity in key pain regions of the brain in persons with MAP. Future research endeavors should focus on understanding how sensory and motor processes interact both to understand disability and discover new treatment avenues.
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Affiliation(s)
- Cindy Gombaut
- Pediatric Pain Pathway Lab, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- *Correspondence: Cindy Gombaut
| | - Scott A. Holmes
- Department of Anesthesia, Harvard Medical School, Boston, MA, United States
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5
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Maas JJL, De Vries NM, Bloem BR, Kalf JG. Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial). Trials 2022; 23:274. [PMID: 35395953 PMCID: PMC8990485 DOI: 10.1186/s13063-022-06160-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech. Background Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage. Methods We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden. Results The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022. Conclusions We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages. Trial registration ClinicalTrials.govNCT03963388. Registered on May 24, 2019
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Affiliation(s)
- J J L Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - N M De Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J G Kalf
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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Tykalova T, Novotny M, Ruzicka E, Dusek P, Rusz J. Short-term effect of dopaminergic medication on speech in early-stage Parkinson's disease. NPJ Parkinsons Dis 2022; 8:22. [PMID: 35256614 PMCID: PMC8901688 DOI: 10.1038/s41531-022-00286-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
The effect of dopaminergic medication on speech has rarely been examined in early-stage Parkinson’s disease (PD) and the respective literature is inconclusive and limited by inappropriate design with lack of PD control group. The study aims to examine the short-term effect of dopaminergic medication on speech in PD using patients with good motor responsiveness to levodopa challenge compared to a control group of PD patients with poor motor responsiveness. A total of 60 early-stage PD patients were investigated before (OFF) and after (ON) acute levodopa challenge and compared to 30 age-matched healthy controls. PD patients were categorised into two clinical subgroups (PD responders vs. PD nonresponders) according to the comparison of their motor performance based on movement disorder society-unified Parkinson’s disease rating scale, part III. Seven distinctive parameters of hypokinetic dysarthria were examined using quantitative acoustic analysis. We observed increased monopitch (p > 0.01), aggravated monoloudness (p > 0.05) and longer duration of stop consonants (p > 0.05) in PD compared to healthy controls, confirming the presence of hypokinetic dysarthria in early PD. No speech alterations from OFF to ON state were revealed in any of the two PD groups and speech dimensions investigated including monopitch, monoloudness, imprecise consonants, harsh voice, slow sequential motion rates, articulation rate, or inappropriate silences, although a subgroup of PD responders manifested obvious improvement in motor function after levodopa intake (p > 0.001). Since the short-term usage of levodopa does not easily affect voice and speech performance in PD, speech assessment may provide a medication state-independent motor biomarker of PD.
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Affiliation(s)
- Tereza Tykalova
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | - Michal Novotny
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.,Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Narayana S, Franklin C, Peterson E, Hunter EJ, Robin DA, Halpern A, Spielman J, Fox PT, Ramig LO. Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial. Hum Brain Mapp 2022; 43:2328-2347. [PMID: 35141971 PMCID: PMC8996348 DOI: 10.1002/hbm.25790] [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: 06/24/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, Lansing, Michigan, USA
| | - Donald A Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, New Hampshire, USA
| | - Angela Halpern
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA
| | - Jennifer Spielman
- National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Front Range Voice Care, Denver, Colorado, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA.,Audie L. Murphy South Texas Veterans Administration Medical Center, San Antonio, Texas, USA
| | - Lorraine O Ramig
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Columbia University, New York, New York, USA
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Rusz J, Tykalova T, Novotny M, Zogala D, Sonka K, Ruzicka E, Dusek P. Defining Speech Subtypes in De Novo Parkinson Disease: Response to Long-term Levodopa Therapy. Neurology 2021; 97:e2124-e2135. [PMID: 34607922 DOI: 10.1212/wnl.0000000000012878] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Jan Rusz
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Tereza Tykalova
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michal Novotny
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Zogala
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Sonka
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evzen Ruzicka
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Manes JL, Herschel E, Aveni K, Tjaden K, Parrish T, Simuni T, Corcos DM, Roberts AC. The effects of a simulated fMRI environment on voice intensity in individuals with Parkinson's disease hypophonia and older healthy adults. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106149. [PMID: 34543846 PMCID: PMC8627501 DOI: 10.1016/j.jcomdis.2021.106149] [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] [Received: 06/04/2020] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Functional magnetic resonance imaging (fMRI) has promise for understanding neural mechanisms of neurogenic speech and voice disorders. However, performing vocal tasks within the fMRI environment may not always be analogous to performance outside of the scanner. Using a mock MRI scanner, this study examines the effects of a simulated scanning environment on vowel intensity in individuals with Parkinson's disease (PD) and hypophonia and older healthy control (OHC) participants. METHOD Thirty participants (15 PD, 15 OHC) performed a sustained /ɑ/ vowel production task in three conditions: 1) Upright, 2) Mock Scanner + No Noise, and 3) Mock Scanner + MRI noise. We used a linear mixed-effects (multi-level) model to evaluate the contributions of group and recording environment to vowel intensity. A second linear mixed-effects model was also used to evaluate the contributions of PD medication state (On vs. Off) to voice intensity. RESULTS Vowel intensity was significantly lower for PD compared to the OHC group. The intensity of vowels produced in the Upright condition was significantly lower compared to the Mock Scanner + No Noise condition, while vowel intensity in the Mock Scanner + MRI Noise condition was significantly higher compared to the Mock Scanner + No Noise condition. A group by condition interaction also indicated that the addition of scanner noise had a greater impact on the PD group. A second analysis conducted within the PD group showed no effects of medication state on vowel intensity. CONCLUSION Our findings demonstrate that performance on voice production tasks is altered for PD and OHC groups when translated into the fMRI environment, even in the absence of acoustic scanner noise. For fMRI studies of voice in PD hypophonia, careful thought should be given to how the presence of acoustic noise may differentially affect PD and OHC, for both group and task comparisons.
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Affiliation(s)
- Jordan L Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA.
| | - Ellen Herschel
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA
| | - Katharine Aveni
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY
| | - Todd Parrish
- Department of Radiology, Northwestern University, Chicago, IL
| | - Tanya Simuni
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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10
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Herz DM, Meder D, Camilleri JA, Eickhoff SB, Siebner HR. Brain Motor Network Changes in Parkinson's Disease: Evidence from Meta-Analytic Modeling. Mov Disord 2021; 36:1180-1190. [PMID: 33427336 PMCID: PMC8127399 DOI: 10.1002/mds.28468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Motor‐related brain activity in Parkinson's disease has been investigated in a multitude of functional neuroimaging studies, which often yielded apparently conflicting results. Our previous meta‐analysis did not resolve inconsistencies regarding cortical activation differences in Parkinson's disease, which might be related to the limited number of studies that could be included. Therefore, we conducted a revised meta‐analysis including a larger number of studies. The objectives of this study were to elucidate brain areas that consistently show abnormal motor‐related activation in Parkinson's disease and to reveal their functional connectivity profiles using meta‐analytic approaches. Methods We applied a quantitative meta‐analysis of functional neuroimaging studies testing limb movements in Parkinson's disease comprising data from 39 studies, of which 15 studies (285 of 571 individual patients) were published after the previous meta‐analysis. We also conducted meta‐analytic connectivity modeling to elucidate the connectivity profiles of areas showing abnormal activation. Results We found consistent motor‐related underactivation of bilateral posterior putamen and cerebellum in Parkinson's disease. Primary motor cortex and the supplementary motor area also showed deficient activation, whereas cortical regions localized directly anterior to these areas expressed overactivation. Connectivity modeling revealed that areas showing decreased activation shared a common pathway through the posterior putamen, whereas areas showing increased activation were connected to the anterior putamen. Conclusions Despite conflicting results in individual neuroimaging studies, this revised meta‐analytic approach identified consistent patterns of abnormal motor‐related activation in Parkinson's disease. The distinct patterns of decreased and increased activity might be determined by their connectivity with different subregions of the putamen. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Julia A Camilleri
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Simon B Eickhoff
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Shuai XX, Kong XC, Zou Y, Wang SQ, Wang YH. Global Functional Network Connectivity Disturbances in Parkinson's Disease with Mild Cognitive Impairment by Resting-State Functional MRI. Curr Med Sci 2021; 40:1057-1066. [PMID: 33428133 DOI: 10.1007/s11596-020-2287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
Examining the spontaneous BOLD activity to understand the neural mechanism of Parkinson's disease (PD) with mild cognitive impairment (MCI) is a focus in resting-state functional MRI (rs-fMRI) studies. This study aimed to investigate the alteration of brain functional connectivity in PD with MCI in a systematical way at two levels: functional connectivity analysis within resting state networks (RSNs) and functional network connectivity (FNC) analysis. Using group independent component analysis (ICA) on rs-fMRI data acquired from 30 participants (14 healthy controls and 16 PD patients with MCI), 16 RSNs were identified, and functional connectivity analysis within the RSNs and FNC analysis were carried out between groups. Compared to controls, patients with PD showed decreased functional connectivity within putamen network, thalamus network, cerebellar network, attention network, and self-referential network, and increased functional connectivity within execution network. Globally disturbed, mostly increased functional connectivity of FNC was observed in PD group, and insular network and execution network were the dominant network with extensively increased functional connectivity with other RSNs. Cerebellar network showed decreased functional connectivity with caudate network, insular network, and self-referential network. In general, decreased functional connectivity within RSNs and globally disturbed, mostly increased functional connectivity of FNC may be characteristics of PD. Increased functional connectivity within execution network may be an early marker of PD. The multi-perspective study based on RSNs may be a valuable means to assess functional changes corresponding to specific RSN, contributing to the understanding of the neural mechanism of PD.
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Affiliation(s)
- Xin-Xin Shuai
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiang-Chuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yan Zou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Si-Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yu-Hui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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12
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Mueller K, Urgošík D, Ballarini T, Holiga Š, Möller HE, Růžička F, Roth J, Vymazal J, Schroeter ML, Růžička E, Jech R. Differential effects of deep brain stimulation and levodopa on brain activity in Parkinson's disease. Brain Commun 2020; 2:fcaa005. [PMID: 32954278 PMCID: PMC7425344 DOI: 10.1093/braincomms/fcaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/21/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Levodopa is the first-line treatment for Parkinson’s disease, although the precise mechanisms mediating its efficacy remain elusive. We aimed to elucidate treatment effects of levodopa on brain activity during the execution of fine movements and to compare them with deep brain stimulation of the subthalamic nuclei. We studied 32 patients with Parkinson’s disease using functional MRI during the execution of finger-tapping task, alternating epochs of movement and rest. The task was performed after withdrawal and administration of a single levodopa dose. A subgroup of patients (n = 18) repeated the experiment after electrode implantation with stimulator on and off. Investigating levodopa treatment, we found a significant interaction between both factors of treatment state (off, on) and experimental task (finger tapping, rest) in bilateral putamen, but not in other motor regions. Specifically, during the off state of levodopa medication, activity in the putamen at rest was higher than during tapping. This represents an aberrant activity pattern probably indicating the derangement of basal ganglia network activity due to the lack of dopaminergic input. Levodopa medication reverted this pattern, so that putaminal activity during finger tapping was higher than during rest, as previously described in healthy controls. Within-group comparison with deep brain stimulation underlines the specificity of our findings with levodopa treatment. Indeed, a significant interaction was observed between treatment approach (levodopa, deep brain stimulation) and treatment state (off, on) in bilateral putamen. Our functional MRI study compared for the first time the differential effects of levodopa treatment and deep brain stimulation on brain motor activity. We showed modulatory effects of levodopa on brain activity of the putamen during finger movement execution, which were not observed with deep brain stimulation.
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Affiliation(s)
- Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Dušan Urgošík
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Štefan Holiga
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Harald E Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Filip Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Vymazal
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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13
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Prediction and Estimation of Parkinson’s Disease Severity Based on Voice Signal. J Voice 2020; 36:439.e9-439.e20. [DOI: 10.1016/j.jvoice.2020.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
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14
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Narayana S, Parsons MB, Zhang W, Franklin C, Schiller K, Choudhri AF, Fox PT, LeDoux MS, Cannito M. Mapping typical and hypokinetic dysarthric speech production network using a connected speech paradigm in functional MRI. NEUROIMAGE-CLINICAL 2020; 27:102285. [PMID: 32521476 PMCID: PMC7284131 DOI: 10.1016/j.nicl.2020.102285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/18/2022]
Abstract
We developed a task paradigm whereby subjects spoke aloud while minimizing head motion during functional MRI (fMRI) in order to better understand the neural circuitry involved in motor speech disorders due to dysfunction of the central nervous system. To validate our overt continuous speech paradigm, we mapped the speech production network (SPN) in typical speakers (n = 19, 10 females) and speakers with hypokinetic dysarthria as a manifestation of Parkinson disease (HKD; n = 21, 8 females) in fMRI. We then compared it with the SPN derived during overt speech production by 15O-water PET in the same group of typical speakers and another HKD cohort (n = 10, 2 females). The fMRI overt connected speech paradigm did not result in excessive motion artifacts and successfully identified the same brain areas demonstrated in the PET studies in the two cohorts. The SPN derived in fMRI demonstrated significant spatial overlap with the corresponding PET derived maps (typical speakers: r = 0.52; speakers with HKD: r = 0.43) and identified the components of the neural circuit of speech production belonging to the feedforward and feedback subsystems. The fMRI study in speakers with HKD identified significantly decreased activity in critical feedforward (bilateral dorsal premotor and motor cortices) and feedback (auditory and somatosensory areas) subsystems replicating previous PET study findings in this cohort. These results demonstrate that the overt connected speech paradigm is feasible during fMRI and can accurately localize the neural substrates of typical and disordered speech production. Our fMRI paradigm should prove useful for study of motor speech and voice disorders, including stuttering, apraxia of speech, dysarthria, and spasmodic dysphonia.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
| | - Megan B Parsons
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN 38152, USA
| | - Wei Zhang
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Katherine Schiller
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Asim F Choudhri
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA; Department of Radiology, Division of Neuroradiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Mark S LeDoux
- Veracity Neuroscience LLC, Memphis, TN 38157, USA; Department of Psychology and School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Michael Cannito
- Department of Communicative Disorders, University of Louisiana at Lafayette, USA
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15
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Liu Y, Gui Y, Hu J, Liang S, Mo S, Zhou Y, Li Y, Zhou F, Xu J. Attention/memory complaint is correlated with motor speech disorder in Parkinson's disease. BMC Neurol 2019; 19:309. [PMID: 31787082 PMCID: PMC6886194 DOI: 10.1186/s12883-019-1535-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/19/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The mechanisms underlying the online modulation of motor speech in Parkinson's disease (PD) have not been determined. Moreover, medical and rehabilitation interventions for PD-associated motor speech disorder (MSD) have a poor long-term prognosis. METHODS To compare risk factors in PD patients with MSD to those without MSD (non-MSD) and determine predictive independent risk factors correlated with the MSD phenotype, we enrolled 314 PD patients, including 250 with and 64 without MSD. We compared demographic, characteristic data, as well as PD-associated evaluations between the MSD group and non-MSD group. RESULTS Univariate analysis showed that demographic characteristics, including occupation, educational level, monthly income and speaking background; clinical characteristics, including lesions in the frontal and temporal lobes, and concurrent dysphagia; and PD-associated evaluations, including the activity of daily living (ADL) score, non-motor symptoms scale (NMSS) domain 4 score (perceptual problem), and NMSS domain 5 score (attention/memory) were all significantly different between the MSD and non-MSD group (all P < 0.05). Multivariate logistic regression analysis showed that educational level, frontal lesions, and NMSS domain 5 score (attention/memory) were independent risk factors for PD-associated MSD (all P < 0.005). CONCLUSIONS We determined an association between MSD phenotype and cognitive impairment, reflected by low-level education and related clinical profiles. Moreover, attention and memory dysfunction may play key roles in the progression of MSD in PD patients. Further studies are required to detail the mechanism underlying abnormal speech motor modulation in PD patients. Early cognitive intervention may enhance rehabilitation management and motor speech function in patients with PD-associated MSD.
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Affiliation(s)
- Ying Liu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yuchang Gui
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jincui Hu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shanshan Liang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Sixia Mo
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yuanfang Zhou
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yujian Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Fengkun Zhou
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jianwen Xu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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16
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Veverka T, Hok P, Otruba P, Zapletalová J, Kukolová B, Tüdös Z, Krobot A, Kaňovský P, Hluštík P. Botulinum Toxin Modulates Posterior Parietal Cortex Activation in Post-stroke Spasticity of the Upper Limb. Front Neurol 2019; 10:495. [PMID: 31143157 PMCID: PMC6521800 DOI: 10.3389/fneur.2019.00495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022] Open
Abstract
Post-stroke spasticity (PSS) is effectively treated with intramuscular botulinum toxin type A (BoNT-A), although the clinical improvement is likely mediated by changes at the central nervous system level. Using functional magnetic resonance imaging (fMRI) of the brain, this study aims to confirm and locate BoNT-A-related changes during motor imagery with the impaired hand in severe PSS. Temporary alterations in primary and secondary sensorimotor representation of the impaired upper limb were expected. Thirty chronic stroke patients with upper limb PSS undergoing comprehensive treatment including physiotherapy and indicated for BoNT treatment were investigated. A change in PSS of the upper limb was assessed with the modified Ashworth scale (MAS). fMRI and clinical assessments were performed before (W0) and 4 weeks (W4) and 11 weeks (W11) after BoNT-A application. fMRI data were acquired using 1.5-Tesla scanners during imagery of finger-thumb opposition sequences with the impaired hand. At the group level, we separately modeled (1) average activation at each time point with the MAS score and age at W0 as covariates; and (2) within-subject effect of BoNT-A and the effect of time since W0 as independent variables. Comprehensive treatment of PSS with BoNT-A significantly decreased PSS of the upper limb with a maximal effect at W4. Task-related fMRI prior to treatment (W0) showed extensive activation of bilateral frontoparietal sensorimotor cortical areas, bilateral cerebellum, and contralesional basal ganglia and thalamus. After BoNT-A application (W4), the activation extent decreased globally, mostly in the bilateral parietal cortices and cerebellum, but returned close to baseline at W11. The intra-subject contrast revealed a significant BoNT-A effect, manifesting as a transient decrease in the activation of the ipsilesional intraparietal sulcus and superior parietal lobule. We demonstrate that BoNT-A treatment of PSS of the upper limb is associated with transient changes in the ipsilesional posterior parietal cortex, possibly resulting from temporarily altered sensorimotor upper limb representations.
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Affiliation(s)
- Tomáš Veverka
- Department of Neurology, Palacký University and University Hospital, Olomouc, Czechia
| | - Pavel Hok
- Department of Neurology, Palacký University and University Hospital, Olomouc, Czechia
| | - Pavel Otruba
- Department of Neurology, Palacký University and University Hospital, Olomouc, Czechia
| | - Jana Zapletalová
- Department of Biophysics, Biometry and Statistics, Palacký University and University Hospital, Olomouc, Czechia
| | | | - Zbyněk Tüdös
- Department of Radiology, Palacký University and University Hospital, Olomouc, Czechia
| | - Alois Krobot
- Department of Physiotherapy, Palacký University and University Hospital, Olomouc, Czechia
| | - Petr Kaňovský
- Department of Neurology, Palacký University and University Hospital, Olomouc, Czechia
| | - Petr Hluštík
- Department of Neurology, Palacký University and University Hospital, Olomouc, Czechia
- Department of Radiology, Palacký University and University Hospital, Olomouc, Czechia
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17
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Polychronis S, Niccolini F, Pagano G, Yousaf T, Politis M. Speech difficulties in early de novo patients with Parkinson's disease. Parkinsonism Relat Disord 2019; 64:256-261. [PMID: 31078401 DOI: 10.1016/j.parkreldis.2019.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/20/2018] [Accepted: 04/30/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Speech difficulties are a common debilitating feature of Parkinson's disease and we aimed to investigate whether speech difficulties are associated with striatal dopaminergic deficits and faster disease progression. METHODS Using the Parkinson's Progression Markers Initiative database, 143 early de novo Parkinson's disease patients with speech difficulties were identified and matched 1:1 with 143 Parkinson's disease patients without speech difficulties for age, disease duration and motor symptom severity. We investigated differences in clinical features and striatal [123I]FP-CIT single photon emission computed tomography (SPECT) uptake in Parkinson's disease patients with and without speech difficulties. Cox proportional hazards analysis was carried out to investigate whether speech difficulties were predictive of a faster motor progression and cognitive decline. RESULTS Speech difficulties were more common in patients with an akinetic-rigid motor phenotype compared to those with a tremor-dominant phenotype. Parkinson's disease patients with speech difficulties had lower resting tremor (P = 0.027), higher autonomic dysfunction (P = 0.034), increased daytime sleepiness (ESS; P = 0.048), and a higher prevalence of REM sleep behaviour disorder (RBD) symptoms (P = 0.007) compared to those without speech difficulties. Parkinson's disease patients with speech difficulties had significantly lower [123I]FP-CIT uptake in the striatum (P < 0.001), caudate (P = 0.003) and putamen (P = 0.003) compared to those without speech difficulties. The presence of speech difficulties was a predictor of cognitive decline [Hazard Ratio (HR): 0.341, 95% Confidence Interval (CI): 0.153-0.759; Wald: 6.945; P = 0.008), whereas it had no influence on motor progression (HR: 0.885, 95% CI: 0.662-1.183; Wald: 0.680; P > 0.10). CONCLUSION Speech difficulties are associated with greater autonomic dysfunction, sleep disturbances and striatal dopaminergic deficit, and can serve as a predictor of faster cognitive decline in early Parkinson's disease.
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Affiliation(s)
- Sotirios Polychronis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Flavia Niccolini
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Gennaro Pagano
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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18
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Zham P, Kumar D, Viswanthan R, Wong K, Nagao KJ, Arjunan SP, Raghav S, Kempster P. Effect of levodopa on handwriting tasks of different complexity in Parkinson's disease: a kinematic study. J Neurol 2019; 266:1376-1382. [PMID: 30877380 DOI: 10.1007/s00415-019-09268-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
Levodopa treatment does improve Parkinson's disease (PD) dysgraphia, but previous research is not in agreement about which aspects are most responsive. This study investigated the effect of levodopa on the kinematics of writing. Twenty-four patients with PD of less than 10 years duration and 25 age-matched controls were recruited. A practically defined off state method was used to assess the levodopa motor response, measured on the Unified Parkinson's Disease Rating Scale Part III. The kinematic features for six handwriting tasks involving different levels of complexity were recorded from PD patients in off and on states and from the control group. Levodopa is effective for simple writing activities involving repetition of letters, denoting improved fine motor control. But the same benefit was not seen for copying a sentence and a written category fluency test, tasks that carry memory and cognitive loads. We also found significant differences in kinematic features between control participants and PD patients, for all tasks and in both on and off states. Serial testing of handwriting in patients known to be at risk for developing PD might prove to be an effective biomarker for cell loss in the substantia nigra and the associated dopamine deficiency. We recommend using a panel of writing tasks including sentence copying and memory dependence. Dual-task effects may make these activities more sensitive to early motor deficits, while their weaker levodopa responsiveness would cause them to be more stable indicators of motor progression once symptomatic treatment has been commenced.
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Affiliation(s)
- Poonam Zham
- School of Engineering, RMIT University, 3000, Melbourne, Australia
| | - Dinesh Kumar
- School of Engineering, RMIT University, 3000, Melbourne, Australia.
| | - Rekha Viswanthan
- School of Engineering, RMIT University, 3000, Melbourne, Australia
| | - Kit Wong
- Monash Medical Centre, Melbourne, Australia
| | | | | | - Sanjay Raghav
- School of Engineering, RMIT University, 3000, Melbourne, Australia.,Monash Medical Centre, Melbourne, Australia
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19
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Lu L, Jia H, Gao G, Duan C, Ren J, Li Y, Yang H. Pink1 Regulates Tyrosine Hydroxylase Expression and Dopamine Synthesis. J Alzheimers Dis 2018; 63:1361-1371. [DOI: 10.3233/jad-170832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Lingling Lu
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Huanzhen Jia
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Ge Gao
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Chunli Duan
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Jing Ren
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Yi Li
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
| | - Hui Yang
- Department of Neurobiology, Capital Medical University, Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing Center of Neural Regeneration and Repair, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing, China
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20
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Speech disorders in Parkinson’s disease: early diagnostics and effects of medication and brain stimulation. J Neural Transm (Vienna) 2017; 124:303-334. [PMID: 28101650 DOI: 10.1007/s00702-017-1676-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023]
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Goozee R, O'Daly O, Handley R, Reis Marques T, Taylor H, McQueen G, Hubbard K, Pariante C, Mondelli V, Reinders AATS, Dazzan P. Effects of aripiprazole and haloperidol on neural activation during a simple motor task in healthy individuals: A functional MRI study. Hum Brain Mapp 2016; 38:1833-1845. [PMID: 28009070 DOI: 10.1002/hbm.23485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022] Open
Abstract
The dopaminergic system plays a key role in motor function and motor abnormalities have been shown to be a specific feature of psychosis. Due to their dopaminergic action, antipsychotic drugs may be expected to modulate motor function, but the precise effects of these drugs on motor function remain unclear. We carried out a within-subject, double-blind, randomized study of the effects of aripiprazole, haloperidol and placebo on motor function in 20 healthy men. For each condition, motor performance on an auditory-paced task was investigated. We entered maps of neural activation into a random effects general linear regression model to investigate motor function main effects. Whole-brain imaging revealed a significant treatment effect in a distributed network encompassing posterior orbitofrontal/anterior insula cortices, and the inferior temporal and postcentral gyri. Post-hoc comparison of treatments showed neural activation after aripiprazole did not differ significantly from placebo in either voxel-wise or region of interest analyses, with the results above driven primarily by haloperidol. We also observed a simple main effect of haloperidol compared with placebo, with increased task-related recruitment of posterior cingulate and precentral gyri. Furthermore, region of interest analyses revealed greater activation following haloperidol compared with placebo in the precentral and post-central gyri, and the putamen. These diverse modifications in cortical motor activation may relate to the different pharmacological profiles of haloperidol and aripiprazole, although the specific mechanisms underlying these differences remain unclear. Evaluating healthy individuals can allow investigation of the effects of different antipsychotics on cortical activation, independently of either disease-related pathology or previous treatment. Hum Brain Mapp 38:1833-1845, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Rhianna Goozee
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Owen O'Daly
- Centre for Neuroimaging Sciences (CNS), King's College London, London, United Kingdom
| | | | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Heather Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Kathryn Hubbard
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
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Comparative analysis of speech impairment and upper limb motor dysfunction in Parkinson’s disease. J Neural Transm (Vienna) 2016; 124:463-470. [DOI: 10.1007/s00702-016-1662-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Dias AE, Limongi JCP, Hsing WT, Barbosa ER. Telerehabilitation in Parkinson's disease: Influence of cognitive status. Dement Neuropsychol 2016; 10:327-332. [PMID: 29213477 PMCID: PMC5619273 DOI: 10.1590/s1980-5764-2016dn1004012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Background The need for efficacy in voice rehabilitation in patients with Parkinson's
disease is well established. Given difficulties traveling from home to
treatment centers, the use of telerehabilitation may represent an invaluable
tool for many patients. Objective To analyze the influence of cognitive performance on acceptance of
telerehabilitation. Methods Fifty patients at stages 2-4 on the Hoehn-Yahr scale, aged 45-87 years old,
with cognitive scores of19-30 on the Mini-Mental State Examination, and 4-17
years of education were enrolled. All patients were submitted to evaluation
of voice intensity pre and post in-person treatment with the Lee Silverman
Voice Treatment (LSVT) and were asked to fill out a questionnaire regarding
their preferences between two options of treatment and evaluating basic
technological competence. Results Comparisons between pre and post-treatment values showed a mean increase of
14dBSPL in vocal intensity. When asked about potential acceptance to
participate in future telerehabilitation, 38 subjects agreed to take part
and 12 did not. For these two groups, 26% and 17% self-reported
technological competence, respectively. Agreement to engage in remote
therapy was positively associated with years of education and cognitive
status. Conclusion Responses to the questionnaire submitted after completion of traditional
in-person LSVT showed that the majority of patients (76%) were willing to
participate in future telerehabilitation. Age, gender, disease stage and
self-reported basic technological skills appeared to have no influence on
the decision, whereas other factors such as cognitive status and higher
school education were positively associated with acceptance of the new
therapy approach.
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Affiliation(s)
- Alice Estevo Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Wu Tu Hsing
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Egberto Reis Barbosa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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Atkinson-Clement C, Maillet A, LeBars D, Lavenne F, Redouté J, Krainik A, Pollak P, Thobois S, Pinto S. Subthalamic nucleus stimulation effects on single and combined task performance in Parkinson’s disease patients: a PET study. Brain Imaging Behav 2016; 11:1139-1153. [DOI: 10.1007/s11682-016-9588-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Motor symptoms in Parkinson’s disease: A unified framework. Neurosci Biobehav Rev 2016; 68:727-740. [DOI: 10.1016/j.neubiorev.2016.07.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/11/2016] [Indexed: 01/18/2023]
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Qiu MH, Yao QL, Vetrivelan R, Chen MC, Lu J. Nigrostriatal Dopamine Acting on Globus Pallidus Regulates Sleep. Cereb Cortex 2016; 26:1430-9. [PMID: 25316334 PMCID: PMC4785943 DOI: 10.1093/cercor/bhu241] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lesions of the globus pallidus externa (GPe) produce a profound sleep loss (∼45%) in rats, suggesting that GPe neurons promote sleep. As GPe neuronal activity is enhanced by dopamine (DA) from the substantia nigra pars compacta (SNc), we hypothesized that SNc DA via the GPe promotes sleep. To test this hypothesis, we selectively destroyed the DA afferents to the caudoputamen (CPu) using 6-hydroxydopamine and examined changes in sleep-wake profiles in rats. Rats with 80-90% loss of SNc neurons displayed a significant 33.7% increase in wakefulness (or sleep reduction). This increase significantly correlated with the extent of SNc DA neuron loss. Furthermore, these animals exhibited sleep-wake fragmentation and reduced diurnal variability of sleep. We then optogenetic-stimulated SNc DA terminals in the CPu and found that 20-Hz stimulation from 9 to 10 PM increased total sleep by 69% with high electroencephalograph (EEG) delta power. We finally directly optogenetic-stimulated GPe neurons and found that 20-Hz stimulation of the GPe from 9 to 10 PM increased total sleep by 66% and significantly increased EEG delta power. These findings elucidate a novel circuit for DA control of sleep and the mechanisms of abnormal sleep in BG disorders such as Parkinson's disease and Huntington's disease.
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Affiliation(s)
- Mei-Hong Qiu
- State key Laboratory of Medical Neurobiology and Department of Neurobiology, School of Basic Medical Science, Fudan University, Shanghai200032, China
- Department of Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Qiao-Ling Yao
- Department of Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Ramalingam Vetrivelan
- Department of Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Michael C. Chen
- Department of Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Jun Lu
- Department of Neurology and Division of Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
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Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson’s disease: longitudinal follow-up study on previously untreated patients. J Neural Transm (Vienna) 2016; 123:379-87. [DOI: 10.1007/s00702-016-1515-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Elfmarková N, Gajdoš M, Mračková M, Mekyska J, Mikl M, Rektorová I. Impact of Parkinson's disease and levodopa on resting state functional connectivity related to speech prosody control. Parkinsonism Relat Disord 2015; 22 Suppl 1:S52-5. [PMID: 26363673 DOI: 10.1016/j.parkreldis.2015.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Impaired speech prosody is common in Parkinson's disease (PD). We assessed the impact of PD and levodopa on MRI resting-state functional connectivity (rs-FC) underlying speech prosody control. METHODS We studied 19 PD patients in the OFF and ON dopaminergic conditions and 15 age-matched healthy controls using functional MRI and seed partial least squares correlation (PLSC) analysis. In the PD group, we also correlated levodopa-induced rs-FC changes with the results of acoustic analysis. RESULTS The PLCS analysis revealed a significant impact of PD but not of medication on the rs-FC strength of spatial correlation maps seeded by the anterior cingulate (p = 0.006), the right orofacial primary sensorimotor cortex (OF_SM1; p = 0.025) and the right caudate head (CN; p = 0.047). In the PD group, levodopa-induced changes in the CN and OF_SM1 connectivity strengths were related to changes in speech prosody. CONCLUSIONS We demonstrated an impact of PD but not of levodopa on rs-FC within the brain networks related to speech prosody control. When only the PD patients were taken into account, the association between treatment-induced changes in speech prosody and changes in rs-FC within the associative striato-prefrontal and motor speech networks was found.
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Affiliation(s)
- Nela Elfmarková
- Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, School of Medicine, Masaryk University and St. Anne's Hospital, Brno, Czech Republic
| | - Martin Gajdoš
- Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Martina Mračková
- Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, School of Medicine, Masaryk University and St. Anne's Hospital, Brno, Czech Republic
| | - Jiří Mekyska
- Department of Telecommunications, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Michal Mikl
- Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Irena Rektorová
- Brain and Mind Research Program, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, School of Medicine, Masaryk University and St. Anne's Hospital, Brno, Czech Republic.
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29
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Decreased Resting-State Interhemispheric Functional Connectivity in Parkinson's Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:692684. [PMID: 26180807 PMCID: PMC4477209 DOI: 10.1155/2015/692684] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/27/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Abnormalities in white matter integrity and specific functional network alterations have been increasingly reported in patients with Parkinson's disease (PD). However, little is known about the inter-hemispheric interaction in PD. METHODS Fifty-one drug naive patients with PD and 51 age- and gender-matched healthy subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. We compared the inter-hemispheric resting-state functional connectivity between patients with PD and healthy controls, using the voxel-mirrored homotopic connectivity (VMHC) approach. Then, we correlated the results from VMHC and clinical features in PD patients. RESULTS Relative to healthy subject, patients exhibited significantly lower VMHC in putamen and cortical regions associated with sensory processing and motor control (involving sensorimotor and supramarginal cortex), which have been verified to play a critical role in PD. In addition, there were inverse relationships between the UPDRS motor scores and VMHC in the sensorimotor, and between the illness duration and VMHC in the supramarginal gyrus in PD patients. CONCLUSIONS Our results suggest that the functional coordination between homotopic brain regions is impaired in PD patients, extending previous notions about the disconnection of corticostriatal circuit by providing new evidence supporting a disturbance in inter-hemispheric connections in PD.
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30
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Atkinson-Clement C, Sadat J, Pinto S. Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature. Neurodegener Dis Manag 2015; 5:233-48. [DOI: 10.2217/nmt.15.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARY Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Jasmin Sadat
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Serge Pinto
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
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31
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Moustafa AA. On the relationship among different motor processes: a computational modeling approach. Front Comput Neurosci 2015; 9:34. [PMID: 25852532 PMCID: PMC4364174 DOI: 10.3389/fncom.2015.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/03/2015] [Indexed: 11/13/2022] Open
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32
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Skodda S. Steadiness of syllable repetition in early motor stages of Parkinson's disease. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2014.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wight S, Miller N. Lee Silverman Voice Treatment for people with Parkinson's: audit of outcomes in a routine clinic. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:215-225. [PMID: 25469736 DOI: 10.1111/1460-6984.12132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Speaking louder/more intensely represents a longstanding technique employed to manage voice and intelligibility changes in people with Parkinson's. This technique has been formalized into a treatment approach and marketed as the Lee Silverman Voice Treatment (LSVT®) programme. Evidence for its efficacy has been published. Studies to date are dominated by research facility reports from the original LSVT® group or closely associated groups. Evidence for the efficacy of LSVT® in routine clinical settings is lacking. METHODS & PROCEDURES We conducted an audit of outcomes for consecutive people with Parkinson's who were offered and completed LSVT® in a routine hospital outpatient setting. In- and exclusion criteria, assessment and treatment protocols followed precisely the methods stipulated by LSVT® Global. Additionally, participants completed the Voice Handicap Index (VHI) and 23 carers completed a visual analogue scale (VAS) for items relating to functional outcomes. OUTCOMES & RESULTS Group data (n = 33) revealed statistically significant increases in all objective and subjective measures at the end of treatment, though outcomes on the different measures revealed variable individual responses. Mean intensity increases on prolonged vowel were 9.3 dB post-treatment. Significant gains of mean 7.5 and 6.8 dB were maintained at 12 (n = 25) and 24 months (n = 15) respectively for those available for follow-up. Significant intensity gains occurred for reading post-therapy (mean = 8.5 dB), but changes reverted to statistically non-significant at 12 and 24 months. Intensity increase (mean = 8.5 dB) was significant for monologues post-therapy, but not at 12 and 24 months. Median VHI improvement was statistically significant post-therapy and at 12 months, but not at 24 months. Carer VAS ratings all improved significantly post-therapy; at 12 months only perceived loudness, strain, mumbling and intelligibility remained statistically significantly above baseline. No significant gains persisted to 24 months. CONCLUSIONS & IMPLICATIONS LSVT® was successful for most individuals in this study. Not all patients attained significant changes by the end of treatment. Few patients who achieved significant gain at the end of treatment maintained this at 12 or 24 months. Implications for maintenance, interpretation of results in a degenerative condition and implications for further research are discussed.
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Affiliation(s)
- Sheila Wight
- Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, UK
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Maillet A, Thobois S, Fraix V, Redouté J, Le Bars D, Lavenne F, Derost P, Durif F, Bloem BR, Krack P, Pollak P, Debû B. Neural substrates of levodopa-responsive gait disorders and freezing in advanced Parkinson's disease: a kinesthetic imagery approach. Hum Brain Mapp 2015; 36:959-80. [PMID: 25411130 PMCID: PMC6869751 DOI: 10.1002/hbm.22679] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/18/2014] [Accepted: 10/21/2014] [Indexed: 11/06/2022] Open
Abstract
Gait disturbances, including freezing of gait, are frequent and disabling symptoms of Parkinson's disease. They often respond poorly to dopaminergic treatments. Although recent studies have shed some light on their neural correlates, their modulation by dopaminergic treatment remains quite unknown. Specifically, the influence of levodopa on the networks involved in motor imagery (MI) of parkinsonian gait has not been directly studied, comparing the off and on medication states in the same patients. We therefore conducted an [H2 (15) 0] Positron emission tomography study in eight advanced parkinsonian patients (mean disease duration: 12.3 ± 3.8 years) presenting with levodopa-responsive gait disorders and FoG, and eight age-matched healthy subjects. All participants performed three tasks (MI of gait, visual imagery and a control task). Patients were tested off, after an overnight withdrawal of all antiparkinsonian treatment, and on medication, during consecutive mornings. The order of conditions was counterbalanced between subjects and sessions. Results showed that imagined gait elicited activations within motor and frontal associative areas, thalamus, basal ganglia and cerebellum in controls. Off medication, patients mainly activated premotor-parietal and pontomesencephalic regions. Levodopa increased activation in motor regions, putamen, thalamus, and cerebellum, and reduced premotor-parietal and brainstem involvement. Areas activated when patients are off medication may represent compensatory mechanisms. The recruitment of these accessory circuits has also been reported for upper-limb movements in Parkinson's disease, suggesting a partly overlapping pathophysiology between imagined levodopa-responsive gait disorders and appendicular signs. Our results also highlight a possible cerebellar contribution in the pathophysiology of parkinsonian gait disorders through kinesthetic imagery.
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Affiliation(s)
- Audrey Maillet
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre de Neuroscience CognitiveUMR 5229 CNRSLyonFrance
| | - Stéphane Thobois
- Centre de Neuroscience CognitiveUMR 5229 CNRSLyonFrance
- Hospices Civils de LyonHôpital Neurologique Pierre WertheimerLyonFrance
- Faculté de médecine Lyon Sud Charles MérieuxUniversité Lyon ILyonFrance
| | - Valérie Fraix
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
| | | | - Didier Le Bars
- Hospices Civils de LyonHôpital Neurologique Pierre WertheimerLyonFrance
- CERMEPImagerie du VivantBronFrance
- Institut de Chimie et Biochimie Moléculaires et SupramoléculairesUniversité Claude BernardLyon ILyonFrance
| | | | - Philippe Derost
- Hôpital Gabriel MontpiedService de NeurologieClermont‐FerrandFrance
| | - Franck Durif
- Hôpital Gabriel MontpiedService de NeurologieClermont‐FerrandFrance
| | - Bastiaan R. Bloem
- Radboud University Medical CenterDonders Institute for BrainCognition and BehaviorDepartment of NeurologyNijmegenNetherlands
| | - Paul Krack
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
| | - Pierre Pollak
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
- Hôpitaux Universitaires de GenèveGenevaSwitzerland
| | - Bettina Debû
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
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Makashay MJ, Cannard KR, Solomon NP. Speech-related fatigue and fatigability in Parkinson's disease. CLINICAL LINGUISTICS & PHONETICS 2015; 29:27-45. [PMID: 25152085 PMCID: PMC4337875 DOI: 10.3109/02699206.2014.951901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study tested the assumption that speech is more susceptible to fatigue than normal in persons with dysarthria. After 1 h of speech-like exercises, participants with Parkinson's disease (PD) were expected to report increased perceptions of fatigue and demonstrate fatigability by producing less precise speech with corresponding acoustic changes compared to neurologically normal participants. Twelve adults with idiopathic PD and 13 neurologically normal adults produced sentences with multiple lingual targets before and after six 10-min blocks of fast syllable or word productions. Both groups reported increasing self-perceived fatigue over time, but trained listeners failed to detect systematic differences in articulatory precision or speech naturalness between sentences produced before and after speech-related exercises. Similarly, few systematic acoustic differences occurred. These findings do not support the hypothesis that dysarthric speakers are particularly susceptible to speech-related fatigue; instead, speech articulation generally appears to be resistant to fatigue induced by an hour of moderate functional exercises.
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Affiliation(s)
- Matthew J. Makashay
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kevin R. Cannard
- Neurology Department, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nancy Pearl Solomon
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Neural correlates of rate-dependent finger-tapping in Parkinson's disease. Brain Struct Funct 2014; 220:1637-48. [PMID: 24647755 DOI: 10.1007/s00429-014-0749-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
Functional imaging demonstrated hemodynamic activation within specific brain areas that contribute to frequency-dependent movement control. Previous investigations demonstrated a linear relationship between movement and hemodynamic response rates within cortical regions, whereas the basal ganglia displayed an inverse neural activation pattern. We now investigated neural correlates of frequency-related finger movements in patients with Parkinson's disease (PD) to further elucidate the neurofunctional alterations in cortico-subcortical networks in that disorder. We studied ten PD patients (under dopaminergic medication) and ten healthy subjects using a finger-tapping task at three different frequencies (1-4 Hz), implemented in an event-related, sparse sampling fMRI design. FMRI data were analyzed by means of a parametric approach to relate movement rates and regional BOLD signal alteration. Compared to healthy controls, PD patients showed higher tapping response rates only during the lower 1 Hz condition. FMRI analysis revealed a rate-dependent neural activity within the supplemental motor area, primary sensorimotor cortex, thalamus and the cerebellum with higher neural activity at higher frequency conditions in both groups. Within the putamen/pallidum, an inverse neural activity and frequency response correlation could be observed in healthy subjects with higher BOLD signal responses in slow frequencies, whereas this relationship was not evident in PD patients. We could demonstrate similar behavioral responses and neural activation patterns at the level both of frontal and cerebellar areas in PD compared to healthy controls, whereas regions like the putamen/pallidum appear to be still dysfunctional under medication regarding frequency-related neural activation. These findings may, potentially, serve as a neural signature of basal ganglia dysfunctions in frequency-related task requirements.
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37
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Arnold C, Gehrig J, Gispert S, Seifried C, Kell CA. Pathomechanisms and compensatory efforts related to Parkinsonian speech. Neuroimage Clin 2013; 4:82-97. [PMID: 24319656 PMCID: PMC3853351 DOI: 10.1016/j.nicl.2013.10.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/17/2013] [Accepted: 10/23/2013] [Indexed: 12/16/2022]
Abstract
Voice and speech in Parkinson's disease (PD) patients are classically affected by a hypophonia, dysprosody, and dysarthria. The underlying pathomechanisms of these disabling symptoms are not well understood. To identify functional anomalies related to pathophysiology and compensation we compared speech-related brain activity and effective connectivity in early PD patients who did not yet develop voice or speech symptoms and matched controls. During fMRI 20 PD patients ON and OFF levodopa and 20 control participants read 75 sentences covertly, overtly with neutral, or with happy intonation. A cue-target reading paradigm allowed for dissociating task preparation from execution. We found pathologically reduced striato-prefrontal preparatory effective connectivity in early PD patients associated with subcortical (OFF state) or cortical (ON state) compensatory networks. While speaking, PD patients showed signs of diminished monitoring of external auditory feedback. During generation of affective prosody, a reduced functional coupling between the ventral and dorsal striatum was observed. Our results suggest three pathomechanisms affecting speech in PD: While diminished energization on the basis of striato-prefrontal hypo-connectivity together with dysfunctional self-monitoring mechanisms could underlie hypophonia, dysarthria may result from fading speech motor representations given that they are not sufficiently well updated by external auditory feedback. A pathological interplay between the limbic and sensorimotor striatum could interfere with affective modulation of speech routines, which affects emotional prosody generation. However, early PD patients show compensatory mechanisms that could help improve future speech therapies.
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Key Words
- AC, auditory cortex
- CN, caudate nucleus
- COMT, catechol-O-methyltransferase
- CON, control participant
- DAT1, dopamine transporter
- DLPFC, dorsolateral prefrontal cortex
- Dysarthria
- Dysarthrophonia
- EPI, echo-planar imaging
- FWE, family-wise error
- Functional MRI
- GLM, general linear model
- HRF, hemodynamic response function
- Hypophonia
- IFG, inferior frontal gyrus
- LSVT, Lee Silverman Voice Treatment
- PD, Parkinson's disease
- PPI, psycho-physiological interaction
- PUT, putamen
- Parkinson's disease
- ROI, region of interest
- SEM, standard error of the mean
- SMA, supplementary motor area
- SPL, superior parietal lobule
- STS, superior temporal sulcus
- SVC, small volume correction
- Speech production
- T, Tesla
- UPDRS, Unified Parkinson's Disease Rating Scale
- dPMC, dorsal premotor cortex
- dstriatum, dorsal striatum
- fMRI, functional magnetic response imaging
- mPFC, medial prefrontal cortex
- vstriatum, ventral striatum
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Affiliation(s)
- Christiane Arnold
- Cognitive Neuroscience Group, Brain Imaging Center, Goethe University, Frankfurt, Germany
- Department of Neurology, Goethe University, Frankfurt, Germany
| | - Johannes Gehrig
- Cognitive Neuroscience Group, Brain Imaging Center, Goethe University, Frankfurt, Germany
- Department of Neurology, Goethe University, Frankfurt, Germany
| | - Suzana Gispert
- Experimental Neurology, Goethe University, Frankfurt, Germany
| | - Carola Seifried
- Department of Neurology, Goethe University, Frankfurt, Germany
| | - Christian A. Kell
- Cognitive Neuroscience Group, Brain Imaging Center, Goethe University, Frankfurt, Germany
- Department of Neurology, Goethe University, Frankfurt, Germany
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Herz DM, Eickhoff SB, Løkkegaard A, Siebner HR. Functional neuroimaging of motor control in Parkinson's disease: a meta-analysis. Hum Brain Mapp 2013; 35:3227-37. [PMID: 24123553 DOI: 10.1002/hbm.22397] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/07/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022] Open
Abstract
Functional neuroimaging has been widely used to study the activation patterns of the motor network in patients with Parkinson's disease (PD), but these studies have yielded conflicting results. This meta-analysis of previous neuroimaging studies was performed to identify patterns of abnormal movement-related activation in PD that were consistent across studies. We applied activation likelihood estimation (ALE) of functional neuroimaging studies probing motor function in patients with PD. The meta-analysis encompassed data from 283 patients with PD reported in 24 functional neuroimaging studies and yielded consistent alterations in neural activity in patients with PD. Differences in cortical activation between PD patients and healthy controls converged in a left-lateralized fronto-parietal network comprising the presupplementary motor area, primary motor cortex, inferior parietal cortex, and superior parietal lobule. Both, increases as well as decreases in motor cortical activity, which were related to differences in movement timing and selection in the applied motor tasks, were reported in these cortical areas. In the basal ganglia, PD patients expressed a decrease of motor activation in the posterior motor putamen, which improved with dopaminergic medication. The likelihood of detecting a decrease in putaminal activity increased with motor impairment. This reduced motor activation of the posterior putamen across previous neuroimaging studies indicates that nigrostriatal dopaminergic denervation affects neural processing in the denervated striatal motor territory. In contrast, fronto-parietal motor areas display both increases as well as decreases in movement related activation. This points to a more complex relationship between altered cortical physiology and nigrostriatal dopaminergic denervation in PD.
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Affiliation(s)
- Damian M Herz
- Danish Research Center for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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