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Speech disorders reflect differing pathophysiology in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy

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Abstract

Although speech disorder is frequently an early and prominent clinical feature of Parkinson’s disease (PD) as well as atypical parkinsonian syndromes (APS) such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), there is a lack of objective and quantitative evidence to verify whether any specific speech characteristics allow differentiation between PD, PSP and MSA. Speech samples were acquired from 77 subjects including 15 PD, 12 PSP, 13 MSA and 37 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analysis of 16 speech dimensions. Dysarthria was uniformly present in all parkinsonian patients but was more severe in PSP and MSA than in PD. Whilst PD speakers manifested pure hypokinetic dysarthria, ataxic components were more affected in MSA whilst PSP subjects demonstrated severe deficits in hypokinetic and spastic elements of dysarthria. Dysarthria in PSP was dominated by increased dysfluency, decreased slow rate, inappropriate silences, deficits in vowel articulation and harsh voice quality whereas MSA by pitch fluctuations, excess intensity variations, prolonged phonemes, vocal tremor and strained-strangled voice quality. Objective speech measurements were able to discriminate between APS and PD with 95 % accuracy and between PSP and MSA with 75 % accuracy. Dysarthria severity in APS was related to overall disease severity (r = 0.54, p = 0.006). Dysarthria with various combinations of hypokinetic, spastic and ataxic components reflects differing pathophysiology in PD, PSP and MSA. Thus, motor speech examination may provide useful information in the evaluation of these diseases with similar manifestations.

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Acknowledgments

This study was supported by the Czech Ministry of Health (NT 12288-5).

Conflicts of interest

The authors report no conflicts of interest.

Ethical standard

Each participant provided written, informed consent. The study was approved by the Ethics Committee of the General University Hospital in Prague, Czech Republic, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 160 00, Prague 6, Czech Republic

    Jan Rusz, Tereza Tykalová & Michal Novotný

  2. Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Kateřinská 30, 120 00, Prague 2, Czech Republic

    Jan Rusz, Cecilia Bonnet, Jiří Klempíř, Eva Baborová & Evžen Růžička

  3. AP HP, Neurology Department, Pitié Salpêtrière Hospital, Paris, France

    Cecilia Bonnet

  4. Institute of Anatomy, 1st Faculty of Medicine, Charles University, U nemocnice 3, 128 00, Prague 2, Czech Republic

    Jiří Klempíř

  5. Department of Radiology, Na Homolce Hospital, Prague, Czech Republic

    Aaron Rulseh

  6. Department of Radiology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic

    Aaron Rulseh

Authors
  1. Jan Rusz
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  2. Cecilia Bonnet
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  3. Jiří Klempíř
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  4. Tereza Tykalová
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  5. Eva Baborová
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  6. Michal Novotný
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  7. Aaron Rulseh
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  8. Evžen Růžička
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Correspondence to Jan Rusz.

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Rusz, J., Bonnet, C., Klempíř, J. et al. Speech disorders reflect differing pathophysiology in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy. J Neurol 262, 992–1001 (2015). https://doi.org/10.1007/s00415-015-7671-1

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  • DOI: https://doi.org/10.1007/s00415-015-7671-1

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