Journal of Neural Transmission

, Volume 117, Issue 2, pp 197–205 | Cite as

Short- and long-term dopaminergic effects on dysarthria in early Parkinson’s disease

Movement Disorders - Original Article

Abstract

While the beneficial effect of levodopa on motor impairment in Parkinson’s disease (PD) has been well documented, its effect on speech has rarely been examined and the respective literature is inconclusive. The aim of our study was to analyze the effect of short-term levodopa admission and long-term dopaminergic treatment on speech in PD patients in early stages of the disease. Motor examination according to UPDRS III and speech testing were performed in 23 PD patients (9 males; median age 68, 42–78 years) in the early morning after having abstained from dopaminergic medication overnight (“off” state, t0) after administration of 200 mg of soluble levodopa (t1), and at follow-up after 12–14 weeks under stable dopaminergic medication (t2). Speech examination comprised the perceptual rating of global speech performance and an acoustical analysis based upon a standardized reading task. While UPDRS III showed a significant amelioration after l-dopa application, none of the parameters of phonation, intonation, articulation and speech velocity improved significantly in the “on” state, neither under short-term levodopa administration (t1) nor on stable dopaminergic treatment (t2). However, there was a positive effect of dopaminergic stimulation on vowel articulation in individual patients. Results indicated significant beneficial effect of short-term levodopa administration or long-term dopaminergic medication on different dimensions of speech in PD patients. As some improvement of vowel articulation was seen in individual patients, the pre-existing pattern of speech impairment might be responsible for the different response to pharmacological treatment.

Keywords

Parkinson’s disease Dysarthria Speech disorders Levodopa effects on speech 

Notes

Acknowledgments

This work was supported by financial support of the Deutsche Parkinson Vereinigung/DPV.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Glossary

Fundamental frequency (F0)

Frequency of the oscillation of the vocal cords, perceived as “pitch”

Mean F0

Average fundamental frequency in the course of speaking

Intonation

Variation of pitch while speaking which is not used to distinguish words; intonation and stress are two main elements of linguistic prosody

Prosody

The rhythm, stress, and intonation of speech

Intonation variability

Temporal course of pitch

F0SD

Measure of intonation variability, defined as standard deviation of fundamental frequency

Articulator

Tongue, lips, jaw, and other speech organs involved in making a sound

Stop consonant

Group of consonants produced by a sudden occlusion of the articulators

Speech rate

Measure of articulatory velocity, defined as number of syllables per time

Net speech rate

Number of syllables related to net speech time (total speech time less speech pauses)

Pause ratio (PR%)

Percentage of silent periods related to total speech time

Formant

Sound waves superimposed to the fundamental frequency, which are produced by resonance phenomena in the voice apparatus and important for the distinction of vowels; the formant with the lowest frequency is called F 1, the second F 2, and the third F 3. Most often the two-first formants, F 1 and F 2, are enough to disambiguate the vowel

References

  1. Ackermann H, Konczak J, Hertrich I (1997) The temporal control of repetitive articulatory movements in Parkinson’s disease. Brain Lang 57:312–319CrossRefGoogle Scholar
  2. Azevedo LL, Cardoso F, Reis C (2003) Acoustic analysis of prosody in females with Parkinson’s disease: effect of l-dopa. Arq Neuropsiquiatr 61:995–998PubMedGoogle Scholar
  3. Baker KK, Ramig LO, Johnson AB, Freed CR (1997) Preliminary voice and speech analysis following fetal dopamine transplants in 5 individuals with Parkinson disease. J Speech Lang Hear Res 40:615–626PubMedGoogle Scholar
  4. Baker KK, Ramig LO, Luschei ES, Smith ME (1998) Thyroarytenoid muscle activity associated with hypophonia in Parkinson’s disease and aging. Neurology 51:1592–1598PubMedGoogle Scholar
  5. Benke T, Hohenstein C, Poewe W, Butterworth B (2000) Repetitive speech phenomena in Parkinson’s disease. J Neurol Neurosurg Psychiatry 69:319–324CrossRefPubMedGoogle Scholar
  6. Boersma P, Weenik D (1996) PRAAT: a system for doing phonetics by computer. Report of the Institute of Phonetic Sciences of the University of Amsterdam. http://www.fon.humuva.nl/praat
  7. Braak H, Del Tredici K, Rüb U, de Vos RA, Jansen Steur EN, Braak E (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–211CrossRefPubMedGoogle Scholar
  8. Bradlow A, Torretta G, Pisoni D (1996) Intelligibility of normal speech I: global and fine-grained acoustic phonetic talker characteristics. Speech Commun 20:255–272CrossRefGoogle Scholar
  9. Caekebeke J, Jennekens-Schinkel A, van der Linden A, Buruma I, Roos R (1991) The interpretation of dysprosody in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 54:145–148CrossRefPubMedGoogle Scholar
  10. Caligiuri MP (1989) The influence of speaking rate on articulatory hypokinesia in parkinsonian dysarthria. Brain Lang 36:493–502CrossRefPubMedGoogle Scholar
  11. Daniels N, Oates J, Phyland DJ, Feiglin A, Hughes A (1996) Vocal characteristics and response to levodopa in Parkinson’s disease. Mov Disord 11(suppl 1):117Google Scholar
  12. Darley FL, Aronson AE, Brown JR (1969a) Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 12:462–496PubMedGoogle Scholar
  13. Darley FL, Aronson AE, Brown JR (1969b) Differential diagnostic patterns of dysarthria. J Speech Hear Res 12:246–269PubMedGoogle Scholar
  14. De Letter M, Santens P, Van Borsel J (2003) The effect of levodopa tongue strength and endurance in patients with Parkinson’s disease. Acta Neurol Belg 103:35–38PubMedGoogle Scholar
  15. De Letter M, Santens P, Van Borsel J (2005) The effects of levodopa on word intelligibility in Parkinson’s disease. J Commun Disord 38:187–196CrossRefPubMedGoogle Scholar
  16. De Letter M, Santens P, De Bodt M, Boon P, Van Borsel J (2006) Levodopa-induced alterations in speech rate in advanced Parkinson’s disease. Acta Neurol Belg 106:19–22PubMedGoogle Scholar
  17. De Letter M, Santens P, De Bodt M, Van Maele G, Van Borsel J, Boon P (2007a) The effects of levodopa on respiration and word intelligibility in people with advanced Parkinson’s disease. Clin Neurol Neurosurg 109:495–500CrossRefPubMedGoogle Scholar
  18. De Letter M, Santens P, Estercam I, Van Maele G, De Bodt M, Boon P, Van Borsel J (2007b) Levodopa-induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clin Linguist Phon 21:783–791CrossRefPubMedGoogle Scholar
  19. Doyle P, Raade A, St Pierre A, Desai S (1995) Fundamental frequency and acoustic variability associated with production of sustained vowels by speakers with hypokinetic dysarthria. J Med Speech Lang Pathol 3:41–50Google Scholar
  20. Flint A, Black S, Campbell-Taylor I, Gailey G, Levinton C (1992) Acoustic analysis in the differentiation between Parkinson’s disease and major depression. J Psycholinguist Res 21:383–399CrossRefPubMedGoogle Scholar
  21. Forrest K, Weismer G (1995) Dynamic aspects of lower lip movement in parkinsonian and neurologically normal geriatric speakers’ production of stress. J Speech Hear Res 38:260–272PubMedGoogle Scholar
  22. Gamboa J, Jimenez-Jimenez FJ, Nieto A (1997) Acoustic voice analysis in patients with Parkinson’s disease treated with dopaminergic drugs. J Voice 11:314–320CrossRefPubMedGoogle Scholar
  23. Goberman AM, Blomgren M (2003) Parkinsonian speech disfluencies: effects of l-dopa related fluctuations. J Fluency Disord 28:55–70CrossRefPubMedGoogle Scholar
  24. Goberman AM, Coelho C (2002) Acoustic analysis of parkinsonian speech I: speech characteristics and l-dopa therapy. NeuroRehabilitation 17:237–246PubMedGoogle Scholar
  25. Goberman AM, Coelho C, Robb M (2002) Phonatory characteristics of parkinsonian speech before and after morning medication: the ON and OFF states. J Commun Disord 35:217–239CrossRefPubMedGoogle Scholar
  26. Gobermann AK (2005) Correlation between acoustic speech characteristics and non-speech motor performance in Parkinson disease. Med Sci Monit 11:109–116Google Scholar
  27. Hartelius L, Svensson P (1994) Speech and swallowing symptoms associated with Parkinson’s disease and multiple sclerosis: a survey. Folia Phoniatr Logop 46:9–17CrossRefPubMedGoogle Scholar
  28. Hertrich I, Ackermann H (1995) Gender-specific vocal dysfunction in Parkinson’s disease: electroglottographic and acoustical analyses. Ann Otol Rhinol Laryngol 104:197–202PubMedGoogle Scholar
  29. Hirose H, Kiritani S, Sawashima M (1982) Velocity of articulatory movements in normal and dysarthric subjects. Folia Phoniatr Logop 34:210–215CrossRefGoogle Scholar
  30. Ho AK, Bradshaw JL, Iansek R (2008) For better or worse: the effect of levodopa on speech in Parkinson’s disease. Mov Disord 23:575–580CrossRefGoogle Scholar
  31. Holmes RJ, Oates J, Phyland D, Hughes A (2000) Voice characteristics in the progression of Parkinson’s disease. Int J Lang Commun Disord 35:417–418Google Scholar
  32. Hornykiewicz O (1998) Biochemical aspects of Parkinson’s disease. Neurology 51(suppl 2):S2–S9PubMedGoogle Scholar
  33. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184CrossRefPubMedGoogle Scholar
  34. Hunker C, Abbs J, Barlow S (1982) The relationship between parkinsonain rigidity and hypokinesia in the orofacial system: a quantitative analysis. Neurology 32:749–754PubMedGoogle Scholar
  35. Jiang J, Lin E, Wang J, Hanson D (1999) Glottographic measures before and after levodopa treatment in Parkinson’s disease. Laryngoscope 109:1287–1294CrossRefPubMedGoogle Scholar
  36. Jimenez-Jimenez F, Gamboa J, Nieto A, Guerrero M, Orti-Pareja M, Molina J, Garcia-Albea E, Cobeta I (1997) Acoustic voice analysis in untreated patients with Parkinson’s disease. Park Rel Disord 3:111–116CrossRefGoogle Scholar
  37. Kent RD, Weismer G, Kent J, Rosenbek J (1998) The dysarthrias: speech-voice profiles, related dysfunctions, and neuropathology. J Med Speech Lang Pathol 6:165–187Google Scholar
  38. Kompoliti K, Wang QE, Goetz CG, Leurgans S, Raman R (2000) Effects of central dopaminergic stimulation by apomorphine on speech in Parkinson’s disease. Neurology 54:458–462PubMedGoogle Scholar
  39. Larson K, Ramig L, Scherer R (1994) Acoustic and glottographic voice analysis during drug-related fluctuations in Parkinson’s disease. J Med Speech Lang Pathol 2:227–239Google Scholar
  40. Leanderson R, Meyerson B, Persson A (1971) Effect of l-dopa on speech in parkinsonism: an EMG study of labial articulatory function. J Neurol Neurosurg Psychiatry 34:679–681CrossRefPubMedGoogle Scholar
  41. Luschei ES, Ramig LO, Baker KL, Smith ME (1999) Discharge characteristics of laryngeal single motor units during phonation in young and older adults and in persons with Parkinson’s disease. Neurophysiol 81:2131–2139Google Scholar
  42. Marsden CD (1994) Parkinson’s disease. J Neurol Neurosurg Psychiatry 57:672–681CrossRefPubMedGoogle Scholar
  43. Metter J, Hanson W (1986) Clinical and acoustical variability in hypokinetic dysarthria. J Commun Disord 19:347–366CrossRefPubMedGoogle Scholar
  44. Möbes J, Joppich G, Stiebritz F, Dengler R, Schröder C (2008) Emotional speech in Parkinson’s disease. Mov Disord 23:824–829CrossRefPubMedGoogle Scholar
  45. Nakano K, Zubick H, Tyler H (1973) Speech defects of parkinsonian patients: effects of levodopa therapy on speech intelligibility. Neurology 23:865–870PubMedGoogle Scholar
  46. Neel AT (2008) Vowel space characteristics and vowel identification accuracy. J Speech Lang Hear Res 51:574–585CrossRefPubMedGoogle Scholar
  47. Netsell R, Daniel B, Celesia GG (1975) Acceleration and weakness in parkinsonian dysarthria. J Speech Hear Dis 40:170–178Google Scholar
  48. Perez KS, Ramig LO, Smith ME, Dromey C (1996) The parkinson larynx: tremor and videoscopic findings. J Voice 10:354–361CrossRefPubMedGoogle Scholar
  49. Picheny M, Durlach N, Braida L (1986) Speaking clearly for the hard of hearing II: acoustic characteristics of clear and conversional speech. J Speech Hear Res 29:434–446PubMedGoogle Scholar
  50. Poluha PC, Teulings HL, Brookshire RH (1998) Handwriting and speech changes across the levodopa cycle in Parkinson’s disease. Acta Psychol (Amst) 35:217–239Google Scholar
  51. Roy N, Nissen SL, Dromey C, Sapir S (2009) Articulatory changes in muscle tension dysphonia: evidence for vowel space expansion following manual circumlaryngeal therapy. J Commun Disord 42:124–135CrossRefPubMedGoogle Scholar
  52. Samra K, Riklan M, Levita E (1969) Language and speech correlates of anatomically verified lesions in thalamic surgery for parkinsonism. J Speech Hear 12:510–514Google Scholar
  53. Sanabria J, Ruiz PG, Gutierrez R, Marquez F, Escobar P, Gentil M, Cenjor C (2001) The effect of levodopa on vocal function in Parkinson’s disease. Clin Neuropharmacol 24:99–102CrossRefPubMedGoogle Scholar
  54. Schulz GM, Peterson T, Sapienza CM, Greer M, Friedmann G (1999) Voice and speech characteristics of persons with Parkinson’s disease pre- and post-pallidotomy surgery: preliminary findings. J Speech Lang Hear Res 42:1176–1194PubMedGoogle Scholar
  55. Skodda S, Schlegel U (2008) Speech rate and rhythm in Parkinson’s disease. Mov Disord 23:985–992CrossRefPubMedGoogle Scholar
  56. Skodda S, Rinsche A, Schlegel U (2009) Progression of dysprosody in Parkinson’s disease: a longitudinal study. Mov Disord 24:716–722CrossRefPubMedGoogle Scholar
  57. Stevensson P, Henningson C, Karlsson S (1993) Speech motor control in Parkinson’s disease: a comparison between a clinical assessment protocol and a quantitative analysis of mandibular movements. Folia Phoniatr (Basel) 45:157–164CrossRefGoogle Scholar
  58. Wolfe VI, Garvin JS, Bacon M, Waldrop W (1975) Speech changes in Parkinson’s disease during treatment with l-dopa. J Commun Disord 8:271–279CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Neurology, KnappschaftskrankenhausRuhr-University of BochumBochumGermany

Personalised recommendations