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Hoffmeister JD, Broadfoot CK, Schaen-Heacock NE, Lechner SA, Krasko MN, Nisbet AF, Russell J, Szot J, Glass TJ, Connor NP, Kelm-Nelson CA, Ciucci MR. Vocal and tongue exercise in early to mid-stage Parkinson disease using the Pink1-/- rat. Brain Res 2024; 1837:148958. [PMID: 38685371 PMCID: PMC11166513 DOI: 10.1016/j.brainres.2024.148958] [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: 01/24/2024] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Vocal and swallowing deficits are common in Parkinson disease (PD). Because these impairments are resistant to dopamine replacement therapies, vocal and lingual exercise are the primary treatment, but not all individuals respond to exercise and neural mechanisms of treatment response are unclear. To explore putative mechanisms, we used the progressive Pink1-/- rat model of early to mid-stage PD and employed vocal and lingual exercises at 6- and 10-months of age in male Pink1-/- and wild type (WT) rats. We hypothesized that vocal and lingual exercise would improve vocal and tongue use dynamics and increase serotonin (5HT) immunoreactivity in related brainstem nuclei. Rats were tested at baseline and after 8 weeks of exercise or sham exercise. At early-stage PD (6 months), vocal exercise resulted in increased call complexity, but did not change intensity, while at mid-stage (10 months), vocal exercise no longer influenced vocalization complexity. Lingual exercise increased tongue force generation and reduced relative optical density of 5HT in the hypoglossal nucleus at both time points. The effects of vocal and lingual exercise at these time points are less robust than in prodromal stages observed in previous work, suggesting that early exercise interventions may yield greater benefit. Future work targeting optimization of exercise at later time points may facilitate clinical translation.
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Affiliation(s)
- J D Hoffmeister
- University of Minnesota, Dept. of Otolaryngology, 420 Delaware Street SE, Minneapolis, MN 55422, USA; University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA.
| | - C K Broadfoot
- University of South Alabama, Dept. of Speech Pathology and Audiology, 5721 USA Drive N, HAHN 1119, Mobile, AL 36688, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N E Schaen-Heacock
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - S A Lechner
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M N Krasko
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - A F Nisbet
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Russell
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Szot
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - T J Glass
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N P Connor
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - C A Kelm-Nelson
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M R Ciucci
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA; University of Wisconsin-Madison, Neuroscience Training Program, 9531 WIMR II, 1111 Highland Ave., Madison, WI 53705, USA.
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2
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Sackley CM, Rick C, Brady MC, Woolley R, Burton C, Patel S, Masterson-Algar P, Nicoll A, Smith CH, Jowett S, Ives N, Beaton G, Dickson S, Ottridge R, Sharp L, Nankervis H, Clarke CE. Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson's disease (PD COMM): pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. BMJ 2024; 386:e078341. [PMID: 38986549 PMCID: PMC11232530 DOI: 10.1136/bmj-2023-078341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson's disease. DESIGN Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. SETTING The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020. PARTICIPANTS 388 people with Parkinson's disease and dysarthria. INTERVENTIONS Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle. MAIN OUTCOME MEASURES The primary outcome was total score at three months of self-reported voice handicap index. RESULTS People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded. CONCLUSIONS LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy. TRIAL REGISTRATION ISRCTN registry ISRCTN12421382.
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Affiliation(s)
- Catherine M Sackley
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Applied Health Research Building, University Park, Nottingham, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christina H Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- NHS Lothian
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gillian Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sylvia Dickson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Helen Nankervis
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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3
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Pan X, Liang B, Cao T. A bibliometric analysis of speech and language impairments in Parkinson's disease based on Web of Science. Front Psychol 2024; 15:1374924. [PMID: 38962221 PMCID: PMC11220271 DOI: 10.3389/fpsyg.2024.1374924] [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: 01/23/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
Many individuals with Parkinson's disease suffer from speech and language impairments that significantly impact their quality of life. Despite several studies on these disorders, there is a lack of relevant bibliometric analyses. This paper conducted a bibliometric analysis of 3,610 papers on speech and language impairments in Parkinson's disease patients from January 1961 to November 2023, based on the Web of Science Core Collection database. Using Citespace software, the analysis focused on annual publication volume, cooperation among countries and institutions, author collaborations, journals, co-citation references, and keywords, aiming to explore the current research status, hotspots, and frontiers in this field. The number of annual publications related to speech and language impairment in Parkinson's disease have been increasing over the years. The USA leads in the number of publications. Research hotspots include the mechanism underlying speech and language impairments, clinical symptoms, automated diagnosis and classification of patients with PD using linguistic makers, and rehabilitation interventions.
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Affiliation(s)
- Xueyao Pan
- School of Foreign Languages and Literatures, Chongqing Normal University, Chongqing, China
| | - Bingqian Liang
- School of Foreign Studies, Anhui Xinhua University, Hefei, Anhui, China
| | - Ting Cao
- School of Foreign Languages and Literatures, Chongqing Normal University, Chongqing, China
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4
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Broadfoot CK, Hoffmeister JD, Lechner SA, Krasko MN, Lambert E, Russell JA, Szot JC, Glass TJ, Connor NP, Kelm-Nelson CA, Ciucci MR. Tongue and laryngeal exercises improve tongue strength and vocal function outcomes in a Pink1-/- rat model of early Parkinson disease. Behav Brain Res 2024; 460:114754. [PMID: 37981125 PMCID: PMC10872343 DOI: 10.1016/j.bbr.2023.114754] [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: 07/24/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
Parkinson disease (PD) causes voice and swallow dysfunction even in early stages of the disease. Treatment of this dysfunction is limited, and the neuropathology underlying this dysfunction is poorly defined. Targeted exercise provides the greatest benefit for offsetting voice and swallow dysfunction, and previous data suggest the hypoglossal nucleus and noradrenergic-locus coeruleus (LC) may be involved in its early pathology. To investigate relationships between targeted exercise and neuropathology of voice and swallow dysfunction, we implemented a combined exercise paradigm that included tongue force and vocalization exercises early in the Pink1-/- rat model. We tested the hypotheses that (1) tongue and vocal exercise improves tongue force and timing behaviors and vocalization outcomes, and (2) exercise increases optical density of serotonin (5-HT) in the hypoglossal nucleus, and tyrosine hydroxylase immunoreactive (Th-ir) cell counts in the LC. At two months of age Pink1-/- rats were randomized to exercise or non-exercise treatment. Age-matched wildtype (WT) control rats were assigned to non-exercise treatment. Tongue force and timing behaviors and ultrasonic vocalizations were measured at baseline (two months) and final (four months) timepoints. Optical density of 5-HT in the hypoglossal nucleus and TH-ir cell counts in the LC were obtained. Pink1-/- rats produced greater tongue forces, faster tongue contraction, and higher-intensity vocalization following exercise. There were no differences in LC TH-ir. The non-exercised Pink1-/- group had reduced density of 5-HT in the hypoglossal nucleus compared to the WT control group. The changes to tongue function and vocalization after targeted exercise suggests exercise intervention may be beneficial in early PD.
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Affiliation(s)
- Courtney K Broadfoot
- University of South Alabama, Department of Speech Pathology & Audiology, 36688, USA.
| | | | - Sarah A Lechner
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - Maryann N Krasko
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA; University of Wisconsin-Madison, Department of Communication Sciences and Disorders, 53706, USA
| | - Emily Lambert
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - John A Russell
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - John C Szot
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - Tiffany J Glass
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - Nadine P Connor
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA; University of Wisconsin-Madison, Department of Communication Sciences and Disorders, 53706, USA; University of Wisconsin-Madison, Neuroscience Training Program, 53706, USA
| | - Cynthia A Kelm-Nelson
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA
| | - Michelle R Ciucci
- University of Wisconsin-Madison Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, 53706, USA; University of Wisconsin-Madison, Department of Communication Sciences and Disorders, 53706, USA; University of Wisconsin-Madison, Neuroscience Training Program, 53706, USA
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5
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Costantini G, Cesarini V, Di Leo P, Amato F, Suppa A, Asci F, Pisani A, Calculli A, Saggio G. Artificial Intelligence-Based Voice Assessment of Patients with Parkinson's Disease Off and On Treatment: Machine vs. Deep-Learning Comparison. SENSORS (BASEL, SWITZERLAND) 2023; 23:2293. [PMID: 36850893 PMCID: PMC9962335 DOI: 10.3390/s23042293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Parkinson's Disease (PD) is one of the most common non-curable neurodegenerative diseases. Diagnosis is achieved clinically on the basis of different symptoms with considerable delays from the onset of neurodegenerative processes in the central nervous system. In this study, we investigated early and full-blown PD patients based on the analysis of their voice characteristics with the aid of the most commonly employed machine learning (ML) techniques. A custom dataset was made with hi-fi quality recordings of vocal tasks gathered from Italian healthy control subjects and PD patients, divided into early diagnosed, off-medication patients on the one hand, and mid-advanced patients treated with L-Dopa on the other. Following the current state-of-the-art, several ML pipelines were compared usingdifferent feature selection and classification algorithms, and deep learning was also explored with a custom CNN architecture. Results show how feature-based ML and deep learning achieve comparable results in terms of classification, with KNN, SVM and naïve Bayes classifiers performing similarly, with a slight edge for KNN. Much more evident is the predominance of CFS as the best feature selector. The selected features act as relevant vocal biomarkers capable of differentiating healthy subjects, early untreated PD patients and mid-advanced L-Dopa treated patients.
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Affiliation(s)
- Giovanni Costantini
- Department of Electronic Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Valerio Cesarini
- Department of Electronic Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Pietro Di Leo
- Department of Electronic Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Federica Amato
- Department of Control and Computer Engineering, Polytechnic University of Turin, 10129 Turin, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Francesco Asci
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Alessandra Calculli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
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6
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Johari K, Kelley RM, Tjaden K, Patterson CG, Rohl AH, Berger JI, Corcos DM, Greenlee JDW. Human subthalamic nucleus neurons differentially encode speech and limb movement. Front Hum Neurosci 2023; 17:962909. [PMID: 36875233 PMCID: PMC9983637 DOI: 10.3389/fnhum.2023.962909] [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: 06/06/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN), which consistently improves limb motor functions, shows mixed effects on speech functions in Parkinson's disease (PD). One possible explanation for this discrepancy is that STN neurons may differentially encode speech and limb movement. However, this hypothesis has not yet been tested. We examined how STN is modulated by limb movement and speech by recording 69 single- and multi-unit neuronal clusters in 12 intraoperative PD patients. Our findings indicated: (1) diverse patterns of modulation in neuronal firing rates in STN for speech and limb movement; (2) a higher number of STN neurons were modulated by speech vs. limb movement; (3) an overall increase in neuronal firing rates for speech vs. limb movement; and (4) participants with longer disease duration had higher firing rates. These data provide new insights into the role of STN neurons in speech and limb movement.
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Affiliation(s)
- Karim Johari
- Human Neurophysiology and Neuromodulation Lab, Department of Communication Science and Disorders, Louisiana State University, Baton Rouge, LA, United States.,Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Ryan M Kelley
- Medical Scientist Training Program, The University of Iowa, Iowa City, IA, United States.,Program in Neuroscience, The University of Iowa, Iowa City, IA, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Charity G Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea H Rohl
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Joel I Berger
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Jeremy D W Greenlee
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States.,Program in Neuroscience, The University of Iowa, Iowa City, IA, United States.,Iowa Neuroscience Institute, Iowa City, IA, United States
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7
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Campbell P, Rooney S, Nicoll A, Brady MC, Smith CH, Deane KHO, Herd CP, Tomlinson CL, Clarke CE, Sackley CM. Speech and language therapy interventions for speech problems in Parkinson's disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Scott Rooney
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Avril Nicoll
- Health Services Research Unit; University of Aberdeen; Aberdeen UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Christina H Smith
- Division of Psychology and Language Sciences; University College London; London UK
| | | | - Clare P Herd
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Claire L Tomlinson
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - Carl E Clarke
- Department of Neurology; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust; Birmingham UK
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8
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Suppa A, Costantini G, Asci F, Di Leo P, Al-Wardat MS, Di Lazzaro G, Scalise S, Pisani A, Saggio G. Voice in Parkinson's Disease: A Machine Learning Study. Front Neurol 2022; 13:831428. [PMID: 35242101 PMCID: PMC8886162 DOI: 10.3389/fneur.2022.831428] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Parkinson's disease (PD) is characterized by specific voice disorders collectively termed hypokinetic dysarthria. We here investigated voice changes by using machine learning algorithms, in a large cohort of patients with PD in different stages of the disease, OFF and ON therapy. Methods We investigated 115 patients affected by PD (mean age: 68.2 ± 9.2 years) and 108 age-matched healthy subjects (mean age: 60.2 ± 11.0 years). The PD cohort included 57 early-stage patients (Hoehn &Yahr ≤ 2) who never took L-Dopa for their disease at the time of the study, and 58 mid-advanced-stage patients (Hoehn &Yahr >2) who were chronically-treated with L-Dopa. We clinically evaluated voices using specific subitems of the Unified Parkinson's Disease Rating Scale and the Voice Handicap Index. Voice samples recorded through a high-definition audio recorder underwent machine learning analysis based on the support vector machine classifier. We also calculated the receiver operating characteristic curves to examine the diagnostic accuracy of the analysis and assessed possible clinical-instrumental correlations. Results Voice is abnormal in early-stage PD and as the disease progresses, voice increasingly degradres as demonstrated by high accuracy in the discrimination between healthy subjects and PD patients in the early-stage and mid-advanced-stage. Also, L-dopa therapy improves but not restore voice in PD as shown by high accuracy in the comparison between patients OFF and ON therapy. Finally, for the first time we achieved significant clinical-instrumental correlations by using a new score (LR value) calculated by machine learning. Conclusion Voice is abnormal in early-stage PD, progressively degrades in mid-advanced-stage and can be improved but not restored by L-Dopa. Lastly, machine learning allows tracking disease severity and quantifying the symptomatic effect of L-Dopa on voice parameters with previously unreported high accuracy, thus representing a potential new biomarker of PD.
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Affiliation(s)
- Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Costantini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | | | - Pietro Di Leo
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | | | - Giulia Di Lazzaro
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simona Scalise
- Department of System Medicine UOSD Parkinson, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
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9
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Hoffmeister JD, Kelm-Nelson CA, Ciucci MR. Manipulation of vocal communication and anxiety through pharmacologic modulation of norepinephrine in the Pink1-/- rat model of Parkinson disease. Behav Brain Res 2022; 418:113642. [PMID: 34755639 PMCID: PMC8671235 DOI: 10.1016/j.bbr.2021.113642] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/23/2022]
Abstract
Vocal deficits and anxiety are common, co-occurring, and interacting signs of Parkinson Disease (PD) that have a devastating impact on quality of life. Both manifest early in the disease process. Unlike hallmark motor signs of PD, neither respond adequately to dopamine replacement therapies, suggesting that their disease-specific mechanisms are at least partially extra-dopaminergic. Because noradrenergic dysfunction is also a defining feature of PD, especially early in the disease progression, drug therapies targeting norepinephrine are being trialed for treatment of motor and non-motor impairments in PD. Research assessing the effects of noradrenergic manipulation on anxiety and vocal impairment in PD, however, is sparse. In this pre-clinical study, we quantified the influence of pharmacologic manipulation of norepinephrine on vocal impairment and anxiety in Pink1-/- rats, a translational model of PD that demonstrates both vocal deficits and anxiety. Ultrasonic vocalization acoustics, anxiety behavior, and limb motor activity were tested twice for each rat: after injection of saline and after one of three drugs. We hypothesized that norepinephrine reuptake inhibitors (atomoxetine and reboxetine) and a β receptor antagonist (propranolol) would decrease vocal impairment and anxiety compared to saline, without affecting spontaneous motor activity. Our results demonstrated that atomoxetine and reboxetine decreased anxiety behavior. Atomoxetine also modulated ultrasonic vocalization acoustics, including an increase in vocal intensity, which is almost always reduced in animal models and patients with PD. Propranolol did not affect anxiety or vocalization. Drug condition did not influence spontaneous motor activity. These studies demonstrate relationships among vocal impairment, anxiety, and noradrenergic systems in the Pink1-/- rat model of PD.
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Affiliation(s)
- Jesse D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-7375, USA.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-7375, USA.
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-7375, USA; Neuroscience Training Program, University of Wisconsin-Madison, 9531 WIMR II, 1111 Highland Avenue, Madison, WI 53705, USA.
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10
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Rohl A, Gutierrez S, Johari K, Greenlee J, Tjaden K, Roberts A. Speech dysfunction, cognition, and Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:153-173. [PMID: 35248193 DOI: 10.1016/bs.pbr.2022.01.017] [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] [Indexed: 10/19/2022]
Abstract
Communication difficulties are a ubiquitous symptom of Parkinson's disease and include changes to both motor speech and language systems. Communication challenges are a significant driver of lower quality of life. They are associated with decreased communication participation, social withdrawal, and increased risks for social isolation and stigmatization in persons with Parkinson's disease. Recent theoretical advances and experimental evidence underscore the intersection of cognition and motor processes in speech production and their impact on spoken language. This chapter overviews a growing evidence base demonstrating that cognitive impairments interact with motor changes in Parkinson's disease to negatively affect communication abilities in myriad ways, at all stages of the disease, both in the absence and presence of dementia. The chapter highlights common PD interventions (pharmacological, surgical, and non-pharmacological) and how cognitive influences on speech production outcomes are considered in each.
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Affiliation(s)
- Andrea Rohl
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Stephanie Gutierrez
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Karim Johari
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Jeremy Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States; Department of Computer Science, Western University, London, ON, Canada.
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11
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Vandana VP, Darshini JK, Vikram VH, Nitish K, Kumar PP, Ravi Y. Speech Characteristics of Patients with Parkinson's Disease-Does Dopaminergic Medications Have a Role? J Neurosci Rural Pract 2021; 12:673-679. [PMID: 34737501 PMCID: PMC8559083 DOI: 10.1055/s-0041-1735249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective
The present study aimed to investigate the effects of dopaminergic medication on voice, speech motor functions, and motor impairment in patients with Parkinson's disease (PD).
Materials and Methods
Twenty-five individuals (16 males and 9 females) with PD underwent comprehensive assessment of voice, speech, and motor functions in levodopa medication ON and medication OFF conditions. Age- and gender-matched healthy controls were recruited to compare speech and acoustic parameters. Multi-Dimensional Voice Program (MDVP) from Computerized Speech Laboratory (Model: 4500) was utilized for acoustic analysis of voice and the Voice Handicap Index (VHI) for the self-assessment of vocal function. Frenchay Dysarthria Assessment (FDA-2) and Unified Parkinson's Disease Rating Scale-III (UPDRS III) were used to evaluate speech motor and motor functions, respectively.
Statistical Analysis
The mean and standard deviation were used as descriptive statistics measures. Raw scores were obtained for FDA-2, DRS, VHI, MDVP parameters, and UPDRS-III in either medication condition. The Wilcoxon signed-rank test was performed to determine the statistical significance of the above measures in both genders across the medication conditions. Spearman's rank correlation coefficient was used to determine the relationship between motor speech function and motor impairment and between VHI and MDVP parameters across both medication conditions. The interrater reliability rating was established using Cohen's kappa.
Results
An improvement in lip and laryngeal functioning was found in the medication ON over medication OFF state in both males and females with PD. A few frequency and amplitude-related measures improved in the medication-ON state over the medication-OFF state. UPDRS-III scores reduced from the OFF state to the ON state, and no change in dysarthria severity or VHI was found in either gender or medication condition. No correlation was found between speech motor function and motor function or between VHI and acoustic parameters of voice in either medication condition.
Conclusions
Improvement in motor symptoms with levodopa was predominantly observed when compared with the minor improvements in a few aspects of speech motor function and vocal parameters. The results of this study suggest the need for speech therapy as a nonpharmacological treatment method for speech impairments in PD.
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Affiliation(s)
| | - Jeevendra Kumar Darshini
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Venkappayah Holla Vikram
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kamble Nitish
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pal Pramod Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Yadav Ravi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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12
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Hoffmeister JD, Kelm-Nelson CA, Ciucci MR. Quantification of brainstem norepinephrine relative to vocal impairment and anxiety in the Pink1-/- rat model of Parkinson disease. Behav Brain Res 2021; 414:113514. [PMID: 34358571 PMCID: PMC8393386 DOI: 10.1016/j.bbr.2021.113514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/31/2022]
Abstract
Vocal communication impairment and anxiety are co-occurring and interacting signs of Parkinson Disease (PD) that are common, poorly understood, and under-treated. Both vocal communication and anxiety are influenced by the noradrenergic system. In light of this shared neural substrate and considering that noradrenergic dysfunction is a defining characteristic of PD, tandem investigation of vocal impairment and anxiety in PD relative to noradrenergic mechanisms is likely to yield insights into the underlying disease-specific causes of these impairments. In order to address this gap in knowledge, we assessed vocal impairment and anxiety behavior relative to brainstem noradrenergic markers in a genetic rat model of early-onset PD (Pink1-/-) and wild type controls (WT). We hypothesized that 1) brainstem noradrenergic markers would be disrupted in Pink1-/-, and 2) brainstem noradrenergic markers would be associated with vocal acoustic changes and anxiety level. Rats underwent testing of ultrasonic vocalization and anxiety (elevated plus maze) at 4, 8, and 12 months of age. At 12 months, brainstem norepinephrine markers were quantified with immunohistochemistry. Results demonstrated that vocal impairment and anxiety were increased in Pink1-/- rats, and increased anxiety was associated with greater vocal deficit in this model of PD. Further, brainstem noradrenergic markers including TH and α1 adrenoreceptor immunoreactivity in the locus coeruleus, and β1 adrenoreceptor immunoreactivity in vagal nuclei differed by genotype, and were associated with vocalization and anxiety behavior. These findings demonstrate statistically significant relationships among vocal impairment, anxiety, and brainstem norepinephrine in the Pink1-/- rat model of PD.
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Affiliation(s)
- Jesse D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA; Neuroscience Training Program, University of Wisconsin-Madison, 9531 WIMR II, 1111 Highland Avenue, Madison, WI, 53705, USA.
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13
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(Dys)Prosody in Parkinson's Disease: Effects of Medication and Disease Duration on Intonation and Prosodic Phrasing. Brain Sci 2021; 11:brainsci11081100. [PMID: 34439719 PMCID: PMC8392525 DOI: 10.3390/brainsci11081100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
The phonology of prosody has received little attention in studies of motor speech disorders. The present study investigates the phonology of intonation (nuclear contours) and speech chunking (prosodic phrasing) in Parkinson’s disease (PD) as a function of medication intake and duration of the disease. Following methods of the prosodic and intonational phonology frameworks, we examined the ability of 30 PD patients to use intonation categories and prosodic phrasing structures in ways similar to 20 healthy controls to convey similar meanings. Speech data from PD patients were collected before and after a dopaminomimetic drug intake and were phonologically analyzed in relation to nuclear contours and intonational phrasing. Besides medication, disease duration and the presence of motor fluctuations were also factors included in the analyses. Overall, PD patients showed a decreased ability to use nuclear contours and prosodic phrasing. Medication improved intonation regardless of disease duration but did not help with dysprosodic phrasing. In turn, disease duration and motor fluctuations affected phrasing patterns but had no impact on intonation. Our study demonstrated that the phonology of prosody is impaired in PD, and prosodic categories and structures may be differently affected, with implications for the understanding of PD neurophysiology and therapy.
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Xu H, Bao Z, Liang D, Li M, Wei M, Ge X, Liu J, Li J. Speech and Language Therapy for Voice Problems in Parkinson's Disease: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 32:344-351. [PMID: 32374650 DOI: 10.1176/appi.neuropsych.19020044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with Parkinson's disease (PD) commonly have speech and voice problems that affect their functional communication and that are not sensitive to pharmacological or neurosurgical treatments. The authors aimed to evaluate the effects of speech and language therapies (SLTs) on dysphonia in patients with PD by analyzing data from published randomized controlled trials (RCTs). Studies in English and Chinese that were related to speech and language treatment for patients with PD were retrieved from PubMed, Embase, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database, and Wanfang Database. On the basis of exclusion criteria, 391 records identified through the search were reduced to 10 studies that included 230 patients in the treatment groups and 205 patients in the control groups. A meta-analysis of data from the 10 studies was performed to examine the effects of SLTs on dysphonia in patients with PD. SLTs increased sound pressure level during sustained phonation, reading of the Rainbow Passage, and monologue 6 months after treatment, enhanced semitone standard deviation during reading of the Rainbow Passage more than 12 months after treatment, and reduced Voice Handicap Index scores among patients with PD with dysphonia problems at least 3 months after treatment. These findings demonstrate the efficacy of SLTs, especially Lee Silverman Voice Treatment, in increasing vocal loudness and functional communication among patients with PD. Further RCTs with large samples and multicenter participation are needed to validate the long-term effects and the efficacy of SLTs among patients with severe PD.
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Affiliation(s)
- Hongyan Xu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Zhuohua Bao
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Daye Liang
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Mengxia Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Minguang Wei
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Xueqing Ge
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jingli Liu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jinpin Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
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15
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Cavallieri F, Budriesi C, Gessani A, Contardi S, Fioravanti V, Menozzi E, Pinto S, Moro E, Valzania F, Antonelli F. Dopaminergic Treatment Effects on Dysarthric Speech: Acoustic Analysis in a Cohort of Patients With Advanced Parkinson's Disease. Front Neurol 2021; 11:616062. [PMID: 33613419 PMCID: PMC7892955 DOI: 10.3389/fneur.2020.616062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/29/2020] [Indexed: 01/10/2023] Open
Abstract
Importance: The effects of dopaminergic treatment on speech in patients with Parkinson's disease (PD) are often mixed and unclear. The aim of this study was to better elucidate those discrepancies. Methods: Full retrospective data from advanced PD patients before and after an acute levodopa challenge were collected. Acoustic analysis of spontaneous monologue and sustained phonation including several quantitative parameters [i.e., maximum phonation time (MPT); shimmer local dB] as well as the Unified Parkinson's Disease Rating Scale (UPDRS) (total scores, subscores, and items) and the Clinical Dyskinesia Rating Scale (CDRS) were performed in both the defined-OFF and -ON conditions. The primary outcome was the changes of speech parameters after levodopa intake. Secondary outcomes included the analysis of possible correlations of motor features and levodopa-induced dyskinesia (LID) with acoustic speech parameters. Statistical analysis included paired t-test between the ON and OFF data (calculated separately for male and female subgroups) and Pearson correlation between speech and motor data. Results: In 50 PD patients (male: 32; female: 18), levodopa significantly increased the MPT of sustained phonation in female patients (p < 0.01). In the OFF-state, the UPDRS part-III speech item negatively correlated with MPT (p = 0.02), whereas in the ON-state, it correlated positively with the shimmer local dB (p = 0.01), an expression of poorer voice quality. The total CDRS score and axial subscores strongly correlated with the ON-state shimmer local dB (p = 0.01 and p < 0.01, respectively). Conclusions: Our findings emphasize that levodopa has a poor effect on speech acoustic parameters. The intensity and location of LID negatively influenced speech quality.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Carla Budriesi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Annalisa Gessani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Sara Contardi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Menozzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Serge Pinto
- Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Antonelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
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16
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Gómez-Rodellar A, Palacios-Alonso D, Ferrández Vicente JM, Mekyska J, Álvarez-Marquina A, Gómez-Vilda P. A Methodology to Differentiate Parkinson's Disease and Aging Speech Based on Glottal Flow Acoustic Analysis. Int J Neural Syst 2020; 30:2050058. [PMID: 32880202 DOI: 10.1142/s0129065720500586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Speech is controlled by axial neuromotor systems, therefore, it is highly sensitive to the effects of neurodegenerative illnesses such as Parkinson's Disease (PD). Patients suffering from PD present important alterations in speech, which are manifested in phonation, articulation, prosody, and fluency. These alterations may be evaluated using statistical methods on features obtained from glottal, spectral, cepstral, or fractal descriptions of speech. This work introduces an evaluation paradigm based on Information Theory (IT) to differentiate the effects of PD and aging on glottal amplitude distributions. The study is conducted on a database including 48 PD patients (24 males, 24 females), 48 age-matched healthy controls (HC, 24 males, 24 females), and 48 mid-age normative subjects (NS, 24 males, 24 females). It may be concluded from the study that Hierarchical Clustering (HiCl) methods produce a clear separation between the phonation of PD patients from NS subjects (accuracy of 89.6% for both male and female subsets), but the separation between PD patients and HC subjects is less efficient (accuracy of 75.0% for the male subset and 70.8% for the female subset). Conversely, using feature selection and Support Vector Machine (SVM) classification, the differentiation between PD and HC is substantially improved (accuracy of 94.8% for the male subset and 92.8% for the female subset). This improvement was mainly boosted by feature selection, at a cost of information and generalization losses. The results point to the possibility that speech deterioration may affect HC phonation with aging, reducing its difference to PD phonation.
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Affiliation(s)
- Andrés Gómez-Rodellar
- Usher Institute, Medical School, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Daniel Palacios-Alonso
- Escuela Técnica Superior de Ingeniería Informática, Universidad Rey Juan Carlos, Calle Tulipán, s/n, 28933 Móstoles, Madrid, Spain
| | - José M Ferrández Vicente
- Universidad Politécnica de Cartagena, Campus Universitario Muralla del Mar, Pza. Hospital 1, 30202 Cartagena, Spain
| | - Jiri Mekyska
- Department of Telecommunications, Brno University of Technology, Technicka 10, 61600 Brno, Czech Republic
| | - Agustín Álvarez-Marquina
- Neuromorphic Speech Processing Lab, Center for Biomedical Technology, Universidad, Politécnica de Madrid, Campus de Montegancedo, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Pedro Gómez-Vilda
- Neuromorphic Speech Processing Lab, Center for Biomedical Technology, Universidad, Politécnica de Madrid, Campus de Montegancedo, 28223 Pozuelo de Alarcón, Madrid, Spain
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17
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Norel R, Agurto C, Heisig S, Rice JJ, Zhang H, Ostrand R, Wacnik PW, Ho BK, Ramos VL, Cecchi GA. Speech-based characterization of dopamine replacement therapy in people with Parkinson's disease. NPJ PARKINSONS DISEASE 2020; 6:12. [PMID: 32566741 PMCID: PMC7293295 DOI: 10.1038/s41531-020-0113-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
People with Parkinson's (PWP) disease are under constant tension with respect to their dopamine replacement therapy (DRT) regimen. Waiting too long between doses results in more prominent symptoms, loss of motor function, and greater risk of falling per step. Shortened pill cycles can lead to accelerated habituation and faster development of disabling dyskinesias. The Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is the gold standard for monitoring Parkinson's disease progression but requires a neurologist to administer and therefore is not an ideal instrument to continuously evaluate short-term disease fluctuations. We investigated the feasibility of using speech to detect changes in medication states, based on expectations of subtle changes in voice and content related to dopaminergic levels. We calculated acoustic and prosodic features for three speech tasks (picture description, reverse counting, and diadochokinetic rate) for 25 PWP, each evaluated "ON" and "OFF" DRT. Additionally, we generated semantic features for the picture description task. Classification of ON/OFF medication states using features generated from picture description, reverse counting and diadochokinetic rate tasks resulted in cross-validated accuracy rates of 0.89, 0.84, and 0.60, respectively. The most discriminating task was picture description which provided evidence that participants are more likely to use action words in ON than in OFF state. We also found that speech tempo was modified by DRT. Our results suggest that automatic speech assessment can capture changes associated with the DRT cycle. Given the ease of acquiring speech data, this method shows promise to remotely monitor DRT effects.
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Affiliation(s)
- R Norel
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
| | - C Agurto
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
| | - S Heisig
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
| | - J J Rice
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
| | - H Zhang
- Pfizer Digital Medicine & Translational Imaging: Early Clinical Development, Cambridge, MA 02139 USA
| | - R Ostrand
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
| | - P W Wacnik
- Pfizer Digital Medicine & Translational Imaging: Early Clinical Development, Cambridge, MA 02139 USA
| | - B K Ho
- Department of Neurology, Tufts University School of Medicine and Tufts Medical Center, 800 Washington St, Boston, MA 02111 USA
| | - V L Ramos
- Pfizer Digital Medicine & Translational Imaging: Early Clinical Development, Cambridge, MA 02139 USA
| | - G A Cecchi
- IBM T.J. Watson Research Center, Yorktown Heights, NY 10598 USA
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18
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Ma A, Lau KK, Thyagarajan D. Voice changes in Parkinson's disease: What are they telling us? J Clin Neurosci 2020; 72:1-7. [PMID: 31952969 DOI: 10.1016/j.jocn.2019.12.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Emerging evidence suggests voice dysfunction is the earliest sign of motor impairment in Parkinson's disease (PD). The complexity and fine motor control involved in vocalization may result in dysfunction here before the limbs. The voice in PD demonstrates characteristic changes on perceptual and acoustic analyses. The physiological and anatomical correlates of these have been investigated through laryngoscopy, stroboscopy, photoglottography, laryngeal electromyography, computed-tomography, pulmonary function testing and aerodynamic assessments. These have revealed numerous abnormalities including incomplete glottic closure and vocal fold hypoadduction/bowing to account for these voice changes. Many of these phenomena are likely related to rigidity or bradykinesia of the laryngeal muscles. The early onset of voice changes is resonant with the pathophysiological insights offered by Braak's hypothesis and murine models of the disease. These physiological abnormalities and pathological models largely stand to support dopaminergic and non-dopaminergic mechanisms being implicated in the pathogenesis of voice dysfunction. This review focuses on characterizing the voice changes in PD. These stand as a promising area of enquiry to further our understanding of the pathophysiology of the disease and offer potential to be utilized as an early diagnostic biomarker or marker of disease progression.
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Affiliation(s)
- Andrew Ma
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Kenneth K Lau
- Monash Imaging, Monash Health, Melbourne, Victoria 3168, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dominic Thyagarajan
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia.
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19
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De Luca R, Latella D, Maggio MG, Leonardi S, Sorbera C, Di Lorenzo G, Balletta T, Cannavò A, Naro A, Impellizzeri F, Calabrò RS. Do patients with PD benefit from music assisted therapy plus treadmill-based gait training? An exploratory study focused on behavioral outcomes. Int J Neurosci 2020; 130:933-940. [DOI: 10.1080/00207454.2019.1710147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | | | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
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20
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Magee M, Copland D, Vogel AP. Motor speech and non-motor language endophenotypes of Parkinson’s disease. Expert Rev Neurother 2019; 19:1191-1200. [DOI: 10.1080/14737175.2019.1649142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Michelle Magee
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia
| | - David Copland
- School of Health & Rehabilitation Sciences, Centre for Clinical Research, University of Queensland, Queensland, Australia
| | - Adam P. Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
- Redenlab, Australia
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