Speech intelligibility and clinical parameters in patients with Parkinson‘s disease

Česká verzia

Authors: Ľ. Mičianová ¹; A. Kušnírová ²; I. Straka ²; P. Valkovič ^2,3; Z. Cséfalvay ¹
Authors place of work: Katedra logopédie, PdF UK Bratislava ¹; I. Neurologická klinika LF UK a UN Bratislava, Nemocnica akad. L. Dérera, Bratislava ²; Ústav normálnej a patologickej fyziológie, CEM SAV, Bratislava ³
Published in the journal: Cesk Slov Neurol N 2018; 81(5): 586-592
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018586

Summary

Introduction:
Parkinson‘s disease (PD) is very often accompanied by motor speech disorder – hypokinetic dysathria. This specific speech impairment is characterized by a variety of symptoms in phonation, articulation and resonance, but most strikingly is manifested by gradual worsening of intelligibility which greatly worsens the quality of life in these patients.

Aim:
In our research, we compared speech intelligibility of patients with PD with our newly developed test with matched healthy controls to reveal a relationship between the speech characteristics of PD patients and some neurological aspects of their disease.

Patients and methods:
51 patients with PD and 51 age-matched healthy subjects were included. To assess speech intelligibility, we used our experimental test battery designed for the Slovak language – Speech Intelligibility Test, Intelligibility Rating Scale for Motor Speech Disorders and procedures used in stimulation of narrative production. Clinical parameters included onset of illness, duration of disease, Hoehn and Yahr (H&Y) staging, and motor part of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III.

Results:
There were statistically significant differences in word and phrase intelligibility level between PD patients and control group; however, both groups achieved mostly ceiling results. Healthy individuals produced significantly greater percentage of intelligible words also in spontaneous speech production than PD patients. There were no differences in the amount and type of dysfluencies between the groups studied. The results of speech tests were significantly correlated with more neurological parameters, from motoric symptoms with bradykinesia and axial subscore. Brief assessment of speech made by the neurologist was consistent with the results of a comprehensive speech evaluation.

Key words:
Parkinson‘s disease – speech – intelligibility – MDS-UPDRS III

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

帕金森病患者的语言清晰度和临床参数

介绍：

帕金森病（PD）常伴有运动性言语障碍 - 运动功能减退性呼吸困难。这种特定的言语障碍以发声，发音和共鸣中的各种症状为特征，但最显著的是理解能力逐渐变差，这极大地降低了这些患者的生活质量。

目标：

在我们的研究中，我们用我们新开发的测试将PD患者的语音清晰度与匹配的健康对照进行比较，以揭示PD患者的言语特征与其疾病的一些神经学方面之间的关系。

患者和方法：

包括51名PD患者和51名年龄匹配的健康受试者。为了评估语音清晰度，我们使用了为斯洛伐克语设计的实验测试电池 - 语音清晰度测试，运动语音障碍的可理解程度评定量表和用于刺激叙事制作的程序。临床参数包括疾病发作，疾病持续时间，Hoehn和Yahr（H＆Y）分期，以及运动障碍学会 - 运动障碍协会修订统一帕金森病评定量表（MDS-UPDRS）第三部分的运动部分。

结果：

PD患者与对照组的单词和短语理解水平存在统计学差异; 然而，这两个群体都取得了大部分上限。与PD患者相比，健康个体在自发言语产生中产生显著更高百分比的可理解单词。研究组之间言语障碍的数量和类型没有差异。言语测试的结果与更多的神经学参数显著相关，从运动性症状与运动迟缓和轴向子分数。对神经病学家的言论进行简要评估与综合言语评估的结果一致。

关键词：

帕金森病 - 言语 - 可理解性 - MDS-UPDRS III

Zdroje

1. Kurčová S, Menšíková K, Kaiserová M et al. Pre-motorické a non-motorické príznaky Parkinsonovej choroby – taxonómia, klinická manifestácia a neuropatologické koreláty. Cesk Slov Neurol N 2016; 79/ 112(3): 255– 270. doi: 10.14735/ amcsnn2016255.

2. Zemanová N, Bezdíček O, Michalec J et al. Validační studie české verze Bostonského testu pojmenování. Cesk Slov Neurol N 2016; 79/ 112(3): 307– 316. doi: 10.14735/ amcsnn2016307.

3. Brustmannová S, Anderková L, Rektorová I et al. Token test – validační studie české verze u osob vyššího věku a pacientů s neurodegenerativním onemocněním mozku. Cesk Slov Neurol N 2017; 80/ 113(3): 300– 306. doi: 10.14735/ amcsnn2017300.

4. Ho AK, Iansek R, Marigliani C et al. Speech Impairment in a large sample of patients with Parkinson‘s disease. Behav Neurol 1999; 11(3): 131– 137.

5. Brabo NC, Minnet TSC, Ortiz KZ. Fluency in Parkinson’s disease: disease duration, cognitive status and age. Arq Neuropsiquiatr 2014; 72(5): 349– 355.

6. Neubauer K. Narušení článkovaní řeči. In: Škodová E, Jedlička I. Klinická logopedie. Praha: Portál 2007: 303– 325.

7. Hartelius L, Svensson P. Speech and swallowing symptoms associated with Parkinson‘s disease and multiple sclerosis: a survey. Folia Phoniatr Logop 1994; 46(1): 9– 17. doi: 10.1159/ 000266286.

8. Juste FS, de Andrade CR. Speech fluency profile on different tasks for individuals with Parkinson’s disease. Codas 2017; 29(4): e20160130. doi: 10.1590/ 2317-1782/ 20172016130.

9. Duffy JR. Motor speech disorders: substrates, differential diagnosis, and management. 3rd ed. St. Louis: Elsevier Mosby 2013.

10. Kent RD. Intelligibility in speech disorders. Amsterdam: John Benjamins Publishing Company 1992.

11. Barreto SS, Ortiz KZ. Intelligibility measurements in speech disorders: a critical review of the literature. Pró-Fono Revista de Atualizacao Científica 2008; 20(3): 201– 206.

12. Hustad KC. The relationship between listener comprehension and intelligibility scores for speakers with dysarthria. J Speech Lang Hear Res 2008; 51(3): 562– 573. doi: 10.1044/ 1092-4388(2008/ 040).

13. Ziegler W, Zierdt A. Telediagnostic assessment of intelligibility in dysarthria: A pilot investigation of MVP-online. J Commun Disord 2008; 41(6): 553– 577. doi: 10.1016/ j.jcomdis.2008.05.001.

14. Stipanic KL, Tjaden K, Wilding G. Comparison of intelligibility measures for adults with Parkinson’s disease, adults with multiple sclerosis, and healthy controls. J Speech Lang Hear Res 2016; 59(2): 230– 238. doi: 10.1044/ 2015_JSLHR-S-15-0271.

15. Nasreddine ZS, Phillips NA, Bédirian V. The Montreal Cognitive Assessment (MoCA): A brief screening tool for mild cognitive impairment. J American Geriatr Soc 2005; 53(4): 695– 699. doi: 10.1111/ j.1532-5415.2005.53221.x.

16. Cséfalvay Z, Marková J. Montreálsky test kognitívnych funkcií. Slovenská adaptácia testu Montreal Cognitive Assessment. [online]. Dostupné z URL: https:/ / www.mocatest.org/ .

17. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17(5): 427– 442.

18. Goetz CG, Poewe W, Rascol O et al. Movement Disorder Society Task Force on Rating Scales for Parkinson‘s Disease. Movement disorder society task force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 2004; 19(9): 1020– 1208. doi: 10.1002/ mds.20213.

19. Goetz CG, Tilley BC, Shaftman SR et al. Movement DisorderSociety UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008; 23(15): 2129– 2170. doi: 10.1002/ mds.22340.

20. Škorvánek M, Košutzká Z, Valkovič P et al. Validizácia slovenskej verzie Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Cesk Slov Neurol N 2013; 76/ 109(4): 463– 468.

21. Mičianová Ľ, Egryová M, Tomášová L et al. Analýza zrozumiteľnosti reči pacientov s Parkinsonovou chorobou a intaktnej dospelej populácie. Logopaedica 2017; 19(1): 37–42.

22. Kevická V, Marková J. Hodnotenie konexie a koherencie v spontánnych prejavoch. Logopaedica 2018; 20(1): 47–55.

23. Bunton K, Keintz CK. The use of dual-task paradigm for assessing speech intelligibility in clients with Parkinson disease. J Med Speech Lang Pathol 2008; 16(3): 141– 155.

24. Yorkston KM, Beukelman DR. A comparison of techniques for measuring intelligibility of dysarthric speech. J Commun Disord 1978; 11(6): 499– 512.

25. Miller N. Communication changes in Parkinson disease. Pract Neurol 2007; 17(4): 266– 274. doi: 10.1136/ practneurol-2017-001635.

26. Kent RD, Kim YJ. The Assessment of intelligibility in motor speech disorders. In: Lowit A, Kent R (eds). Assessment of Motor Speech Disorders. San Diego: Plural Publishing Group 2010: 21– 37.

27. Sidtis D, Cameron K, Sidtis JJ. Dramatic effects of speech task on motor and linguistic planning in severely dysfluent parkinsonian speech. Clin Linguist Phon 2012; 26(8): 695– 711. doi: 10.3109/ 02699206.2012.696307.

28. Van Nuffelen G, De Bodt M, Wuyts F et al. The effect of rate control on speech rate and intelligibility of dysarthric speech. Folia Phoniatr Logop 2009; 61(2): 69– 75. doi: 10.1159/ 000208805.

29. Georgeton L, Meunier C. Spontaneous speech production by dysarthric and healthy speakers: temporal organisation and speaking rate. Proceedings of the 18th International Congress of Phonetic Sciences (ICPhS) 2015, Glasgow, UK. Glasgow: The University of Glasgow 2015.

30. Goberman AM, Blomgren M, Metzger E. Characteristics of speech disfluency in Parkinson disease. J Neurolinguist 2010; 23(5): 470– 478.

31. Ortiz KZ, Brabo NC, Minett TS. Sensorimotor speech disorders in Parkinson‘s disease: programming and execution deficits. Dement Neuropsychol 2016; 10(3): 210– 216. doi: 10.1590/ S1980-5764-2016DN1003007.

32. Miller N, Allcock L, Jones D et al. Prevalence and pattern of perceived intelligibility changes in Parkinson‘s disease. J Neurol Neurosurg Psychiatry 2007; 78(11): 1188– 1190. doi: 10.1136/ jnnp.2006.110171.

33. Dias AE, Barbosa MT, Limong JC et al. Speech disorders did not correlate with age at onset of Parkinson’s disease. Arq Neuropsiquiatr 2016; 74(2): 117– 121. doi: 10.1590/ 0004-282X20160008.

34. Kempster PA, Sullivan SS, Holton JL et al. Relationships between age and late progression of Parkinson‘s disease: a clinico-pathological study. Brain 2010; 133(Pt 6): 1755– 1762. doi: 10.1093/ brain/ awq059.

35. Hlavnička J, Čmejla R, Tykalová T et al. Automated analysis of connected speech reveals early biomarkers of Parkinson‘s disease in patients with rapid eye movement sleep behaviour disorder. Sci Rep 2017; 7(1): 12. doi: 10.1038/ s41598-017-00047-5.

36. Swigert NB. The Source for Dysarthria. 2nd ed. Austin: Pro-Ed 2010.

37. Kuschmann A, Miller N, Lowit A. Motor speech disorders: issues in assessment and managment. In: Miller N, Lowit A (eds). Motor speech disorder. a cross-language perspective. Bristol: Multilingual Matters 2014: 41– 57.

38. Middag C, Martens JP, Van Nuffelen G et al. Automated intelligibility assessment of pathological speech using phonological features. EURASIP J Adv Signal Process 2009; 2009(1): 629030.