Cognitive profile of patients with and without speech impairment in Parkinson's disease

Cognitive functions have been the subject of studies evaluating the pathophysiological mechanism of speech control.

Objective

To compare the groups of patients with and without speech disorders with cognitive assessment, demographic, and clinical data (disease duration, functionality, and motor symptoms).

Methods

Retrospective, cross-sectional study. Patients were evaluated using the Addenbrooke's Cognitive Examination III and neuropsychological tests. The following speech subsystems were analyzed: articulation, phonation, resonance, and prosody, through auditory-perceptual evaluation (based on the Protocol for the Evaluation of Acquired Speech Disorders in Individuals with Parkinson's Disease - PADAF Protocol tests), observing aspects of speech programming and execution. The patients were distributed into three subgroups (normal cognition, mild cognitive impairment, and dementia). After speech evaluation, they were divided into two subgroups (with and without speech disorders).

Results

A total of 150 patients participated in this study, 104 men and 46 women, 63.58 (8.81) years of age, 11.03 (4.00) years of schooling, 6.61 (4.69) years of disease progression, and with the highest proportion of individuals in stage I-II of the Hoehn & Yarh (H&Y) scale (86, or 57.33%). Statistically significant differences were observed between subgroups with and without speech alteration. Worse performance was verified in the Trail Making Test (TMT) TMT-Δ and a tendency of difference in the TMT-B of the subgroup with speech disorders, in addition to worse severity of motor symptoms (H&Y) and cognitive complaints.

Conclusion

Individuals with speech disorders brought more frequent cognitive complaints and impairment below expected in tests assessing executive functions. Future studies, with stratification by type of speech disorder, are necessary to contribute to and validate these results.

Assessment of non-progressive dysarthria: practice and attitude of speech and language therapists in Lebanon

BACKGROUND

Non-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists' clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF).

METHODS

A cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria.

RESULTS

A total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools.

CONCLUSION

It can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.

The physical significance of acoustic parameters and its clinical significance of dysarthria in Parkinson's disease

Dysarthria is universal in Parkinson's disease (PD) during disease progression; however, the quality of vocalization changes is often ignored. Furthermore, the role of changes in the acoustic parameters of phonation in PD patients remains unclear. We recruited 35 PD patients and 26 healthy controls to perform single, double, and multiple syllable tests. A logistic regression was performed to differentiate between protective and risk factors among the acoustic parameters. The results indicated that the mean f0, max f0, min f0, jitter, duration of speech and median intensity of speaking for the PD patients were significantly different from those of the healthy controls. These results reveal some promising indicators of dysarthric symptoms consisting of acoustic parameters, and they strengthen our understanding about the significance of changes in phonation by PD patients, which may accelerate the discovery of novel PD biomarkers.

[Speech disorders in neurodegenerative diseases as dysphasia manifestation]

OBJECTIVE

To develop the classification and methodology for assessment of speech disorders in neurodegenerative diseases, and to identify the characteristics of speech disorders for various forms.

MATERIALS AND METHODS

The study included 1016 patients with neurodegenerative diseases. Screening assessment identified 42.1% patients with speech disorders exceeding isolated dysarthria. Patients were assessed using the speech disorder test battery developed by the authors. Cluster, multifactor and contingency analyses were performed.

RESULTS

Nine subtypes of speech disorders were identified in neurodegenerative diseases that we denominated as dysphasia. Based on contingency analysis, the principal and the additional dysphasia variants were identified for each form of neurodegenerative pathology, which may contribute to better understanding of various phenotypes. Based on the general scheme of speech origination, the level of disorders typical for a given dysphasia subtype was identified.

CONCLUSION

The proposed classification enables identification of the subtypes of speech disorders for individual forms of neurodegenerative diseases. Introducing dysphasia concept to clinical practice will improve differential diagnosis and understanding of phenotypical heterogeneity of each nosological form as well as will facilitate therapy optimization.