Journal of Neurology

, Volume 262, Issue 4, pp 992–1001 | Cite as

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

  • Jan Rusz
  • Cecilia Bonnet
  • Jiří Klempíř
  • Tereza Tykalová
  • Eva Baborová
  • Michal Novotný
  • Aaron Rulseh
  • Evžen Růžička
Original Communication


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.


Parkinson’s disease Atypical parkinsonism Dysarthria Speech disorder Acoustic analyses 

Supplementary material

415_2015_7671_MOESM1_ESM.pdf (56 kb)
Supplementary material 1 (PDF 55 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jan Rusz
    • 1
    • 2
  • Cecilia Bonnet
    • 2
    • 3
  • Jiří Klempíř
    • 2
    • 4
  • Tereza Tykalová
    • 1
  • Eva Baborová
    • 2
  • Michal Novotný
    • 1
  • Aaron Rulseh
    • 5
    • 6
  • Evžen Růžička
    • 2
  1. 1.Department of Circuit Theory, Faculty of Electrical EngineeringCzech Technical University in PraguePrague 6Czech Republic
  2. 2.Department of Neurology and Centre of Clinical Neuroscience, First Faculty of MedicineCharles University in PraguePrague 2Czech Republic
  3. 3.AP HP, Neurology DepartmentPitié Salpêtrière HospitalParisFrance
  4. 4.Institute of Anatomy, 1st Faculty of MedicineCharles UniversityPrague 2Czech Republic
  5. 5.Department of RadiologyNa Homolce HospitalPragueCzech Republic
  6. 6.Department of Radiology, 1st Faculty of Medicine and General University HospitalCharles UniversityPragueCzech Republic

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