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Acoustic Speech Analytics Are Predictive of Cerebellar Dysfunction in Multiple Sclerosis


Speech production relies on motor control and cognitive processing and is linked to cerebellar function. In diseases where the cerebellum is impaired, such as multiple sclerosis (MS), speech abnormalities are common and can be detected by instrumental assessments. However, the potential of speech assessments to be used to monitor cerebellar impairment in MS remains unexplored. The aim of this study is to build an objectively measured speech score that reflects cerebellar function, pathology and quality of life in MS. Eighty-five people with MS and 21 controls participated in the study. Speech was independently assessed through objective acoustic analysis and blind expert listener ratings. Cerebellar function and overall disease disability were measured through validated clinical scores; cerebellar pathology was assessed via magnetic resonance imaging, and validated questionnaires informed quality of life. Selected speech variables were entered in a regression model to predict cerebellar function. The resulting model was condensed into one composite speech score and tested for prediction of abnormal 9-hole peg test (9HPT), and for correlations with the remaining cerebellar scores, imaging measurements and self-assessed quality of life. Slow rate of syllable repetition and increased free speech pause percentage were the strongest predictors of cerebellar impairment, complemented by phonatory instability. Those variables formed the acoustic composite score that accounted for 54% of variation in cerebellar function, correlated with cerebellar white matter volume (r = 0.3, p = 0.017), quality of life (r = 0.5, p < 0.001) and predicted an abnormal 9HPT with 85% accuracy. An objective multi-feature speech metric was highly representative of motor cerebellar impairment in MS.

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The authors acknowledge the immeasurable contribution of participants who voluntarily donated their time and patience for science.


This study was funded by NHMRC fellowship grants number 1085461 and 1082910.

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Authors and Affiliations



Adam Vogel was responsible for conception, organization and execution of the research project; critique and writing of the manuscript.

Andrew Evans was responsible for conception of the research project; review and critique of the manuscript.

Anneke van der Walt was responsible for conception, organization and execution of the research project; review and critique of the statistical analysis; review, critique and writing of manuscript.

Frederique Boonstra was responsible for conception, organization and execution of the research project; review, critique and writing of the manuscript.

Gustavo Noffs was responsible for conception, organization and execution of the research project; design and execution of the statistical analysis; writing of the first and subsequent drafts.

Helmut Butzkueven was responsible for conception of the research project; review and critique of the statistical analysis; review, critique and writing of the manuscript.

Jim Stankovich was responsible for design, critique and review of the statistical analysis.

Scott Kolbe was responsible for conception and organization of the research project; review and critique of the statistical analysis; review, critique and writing of the manuscript.

Thushara Perera was responsible for conception of the research project; design, review and critique of the statistical analysis; review, critique and writing of the manuscript.

Corresponding author

Correspondence to Gustavo Noffs.

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Conflict of Interest

Adam Vogel is Chief Science Officer of Redenlab Inc. He receives grant and fellowship funding from the National Health and Medical Research Council of Australia. Andrew Evans received honoraria from Novartis for giving presentations and providing consultancy services. He has participated in scientific advisory board meetings for Novartis, UCB Pharma, Allergan, and Boehringer Ingelheim. He has received conference travel support from Boehringer Ingelheim. Anneke van der Walt has received travel support and served on advisory boards for Novartis, Biogen, Merck Serono, Roche and Teva. She receives grant support from the National Health and Medical Research Council of Australia. Frederique M.C. Boonstra has nothing to disclose. Gustavo Noffs has nothing to disclose. Helmut Butzkueven served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and received conference travel support from Novartis, Biogen and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen and Novartis received research support from Merck, Novartis and Biogen. Scott Kolbe receives grant income from the National Health and Medical Research Council of Australia and has received honoraria from Novartis, Biogen and Merck. Thushara Perera has nothing to disclose.

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Noffs, G., Boonstra, F.M.C., Perera, T. et al. Acoustic Speech Analytics Are Predictive of Cerebellar Dysfunction in Multiple Sclerosis. Cerebellum 19, 691–700 (2020).

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  • Multiple Sclerosis
  • disability evaluation
  • speech acoustics
  • magnetic resonance imaging
  • quality of life
  • biomarkers