Abstract
Despite the initial reports showing beneficial effects of dopaminergic treatment on speech in Parkinson’s disease (PD), more recent studies based upon valid measurements have not approved any improvement of speech performance under pharmacotherapy. The aim of this study was to analyze the effect of treatment initiation on the progression of speech impairment in PD, using novel evaluation criteria. Nineteen de novo patients with PD were tested and retested within 2 years after the introduction of antiparkinsonian therapy. As controls, 19 age-matched individuals were recorded. Speech examination included sustained phonation, fast syllable repetition, reading text, and monolog. Quantitative acoustic analyses of the key aspects of speech based on Gaussian kernel distribution, statistical decision-making theory, and healthy speech observation were used to assess the improvement or deterioration of speech. A trend for speech performances to improve was demonstrated after treatment mainly in quality of voice, intensity variability, pitch variability, and articulation. The treatment-related improvement differed in various aspects of speech for individual PD patients. Improvements in vowel articulation and pitch variability correlated with treatment-related changes in bradykinesia and rigidity, whereas voice quality and loudness variability improved independently. Using a novel approach of acoustic analysis and advanced statistics, improvements in speech performance can be demonstrated in PD patients after the introduction of antiparkinsonian therapy. Moreover, changes in speech articulation and pitch variability appear to be related with dopaminergic responsiveness of bradykinesia and rigidity. Therefore, speech may be a valuable marker of disease progression and treatment efficacy in PD.
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References
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 40:615–626
Benke T, Hohenstein C, Poewe W, Butterworth B (2000) Repetitive speech phenomena in Parkinson’s disease. J Neurol Neurosurg Psychiatry 69:319–324
Boersma P, Weenink D (2001) PRAAT, a system for doing phonetics by computer. Glot Int 5:341–345
Boril H, Pollak P (2004) Direct time domain fundamental estimation of speech in noisy conditions. In: EUSIPCO Proceedings, Vienna, Austria
Bowman AW, Azzalini A (1997) Applied smoothing techniques for data analysis. Oxford University Press, Oxford, pp 1–208
Camacho A, Harris JG (2008) A sawtooth waveform inspired pitch estimator for speech and music. J Acoust Soc Am 124:1638–1652
Canter GJ (1963) Speech characteristics of patients with Parkinson’s disease: I. Intensity, pitch, and duration. J Speech Hear Disord 28:221–229
Daniels N, Oates J, Phyland DJ, Feiglin A, Hughes A (1996) Vocal characteristics and response to levodopa in Parkinson’s disease. Mov Disord 11:117
Darley FL, Aronson AE, Brown JR (1969) Differential diagnostic patterns of dysarthria. J Speech Hear Res 12:246–269
De Letter M, Santens P, De Bodt M, Boon P, Van Borsel J (2006) Levodopa-induced alteration in speech rate in advanced Parkinson’s disease. Acta Neurol Belg 106:19–22
De Letter M, Santens P, De Bodt M, Van Maele G, Van Borsel J, Boon P (2007) The effect of levodopa on respiration and word intelligibility in people with advanced Parkinson’s disease. Clin Neurol Neurosurg 109:495–500
Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K et al (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. New Engl J Med 355:896–908
Duffy JR (2005) Motor speech disorders: substrates, differential diagnosis and management, 2nd edn. Mosby, New York
Gamboa J, Jimenez-Jimenez FJ, Nieto A, Montojo J, Orti-Pareja M, Molina JA et al (1997) Acoustic voice analysis in patients with Parkinson’s disease treated with dopaminergic drugs. J Voice 11:314–320
Goberman AM (2005) Correlations between acoustic speech characteristics and non-speech motor performance in Parkinson’s disease. Med Sci Monit 11:109–116
Goberman AM, Blomgren M (2003) Parkinsonia speech disfluencies: effect of l-dopa related fluctuations. J Fluency Disord 28:55–70
Goberman AM, Coelho C (2002) Acoustic analysis of Parkinsonian speech I: speech characteristics and l-Dopa therapy. Neurorehabilitation 17:237–246
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 35:217–239
Goberman AM, Blomgren M, Metzger E (2010) Characteristics of speech disfluency in Parkinson’s disease. J Neurolinguist 23:470–478
Hertrich I, Ackermann H (1995) Gender-specific vocal dysfunction in Parkinson’s disease: electroglottographic and acoustic analyses. Ann Otol Rhinol Laryngol 104:197–202
Hilker R, Schweitzer K, Coburger S, Ghaemi M, Weisenbach S, Jacobs AH et al (2005) Nonlinear progression of Parkinson disease as determined by serial positron emission tomographic imaging of striatal fluorodopa F18 activity. Arch Neurol 62:378–382
Ho AK, Iansek R, Marigliani C, Bradshaw J, Gates S (1998) Speech impairment in large sample of patients with Parkinson’s disease. Behav Neurol 11:131–137
Ho AK, Bradshaw JL, Iansek R (2008) For better or worse: the effect of levodopa on speech in Parkinson’s disease. Mov Disord 23:575–580
Holmes RJ, Oates JM, Phyland DJ, Hughes AJ (2000) Voice characteristics in the progression of Parkinson’s disease. Int J Lang Commun Dis 35:407–418
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 55:181–184
Hunker C, Abbs J, Barlow S (1982) The relationship between parkinsonian rigidity and hypokinesia in the orofacial system: a quantitative analysis. Neurology 32:749–754
Jankovic J, Kapadia AS (2001) Functional decline in Parkinson’s disease. Arch Neurol 58:1611–1615
Jiang J, Lin E, Wang J, Hanson D (1999) Glottographic measures before and after levodopa treatment in Parkinson’s disease. Laryngoscope 109:1287–1294
Jimenez-Jimenez FJ, Gamboa J, Nieto A, Guerrero J, Orti-Pareja M, Molina JA, Garcia-Albea E, Cobeta I (1997) Acoustic voice analysis in untreated patients with Parkinson’s disease. Parkinsonism Relat Disord 3:111–116
Kompoliti K, Wang QE, Goetz CG, Leurgans S, Raman R (2000) Effect of central dopaminergic stimulation by apomorphine on speech in Parkinson’s disease. Neurology 54:458–462
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 2:227–239
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 34:679–681
Liss JM, Weismer G, Rosenbek JC (1990) Selected acoustic characteristics of speech production in very old males. J Gerontol 45:35–45
Little MA, McSharry PE, Roberts SJ, Costello DA, Moroz IM (2007) Exploiting nonlinear recurrence and fractal scaling properties for voice disorder detection. Biomed Eng Online 26:6–23
Little MA, McSharry PE, Hunter EJ, Spielman J, Ramig LO (2009) Suitability of dysphonia measurement for telemonitoring of Parkinson’s disease. IEEE Trans Biomed Eng 56:1015–1022
Logemann JA, Fisher HB, Boshes B, Blonsky ER (1978) Frequency and coocurence of vocal tract dysfunction in the speech of a large sample of Parkinson patients. J Speech Hear Disord 43:47–57
Mawdsley C, Gamsu C (1971) Periodicity of speech in Parkinsonism. Nature 231:315–316
Metter J, Hanson W (1986) Clinical and acoustical variability in hypokinetic dysarthria. J Commun Disord 19:347–366
Mobes J, Joppich G, Stiebritz F, Dengler R, Schroder C (2008) Emotional speech in Parkinson’s disease. Mov Disord 23:824–829
Nakano K, Zubick H, Tyler H (1973) Speech defects of parkinsonian patients: effects of levodopa therapy on speech intelligibility. Neurology 23:865–870
Pinto S, Ozsancak C, Tripoliti E, Thoibos S, Limousin-Dowsey P, Auzou P (2004) Treatments for dysarthria in Parkinson’s disease. Lancet Neurol 3:547–556
Poluha PC, Teulings HL, Brookshire RH (1998) Handwriting and speech changes across the levodopa cycle in Parkinson’s disease. Acta Psychol 35:217–239
Quaglieri CE, Celesia GG (1977) Effect of thalamotomy and levodopa therapy on the speech of Parkinson patients. Eur Neurol 15:34–39
Rigrodsky S, Morrison EB (1970) Speech changes in Parkinsonism during l-dopa therapy: preliminary findings. J Am Geriatr Soc 18:142–151
Rosen K, Kent R, Duffy J (2005) Task-based profile of vocal intensity decline in Parkinson’s speech. Folia Phoniatr Logop 57:28–37
Rusz J, Cmejla R, Ruzickova H, Ruzicka E (2011a) Quantitative acoustic measurements for characterization of voice and speech disorders in early untreated Parkinson’s disease. J Acoust Soc Am 129:350–367
Rusz J, Cmejla R, Ruzickova H, Klempir J, Majerova V, Picmausova J, Roth J, Ruzicka E (2011b) Acoustic assessment of voice and speech disorders in Parkinson’s disease through quick vocal test. Mov Disord 26:1951–1952
Sapir S, Spielman JL, Ramig LO, Stroy BH, Fox C (2007) Effect of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 50:899–912
Sapir S, Ramig LO, Spielman JL, Fox C (2010) Formant centralization ratio: a proposal for a new acoustic measure of dysarthric speech. J Speech Lang Hear Res 53:114–125
Sato K, Hirano M, Nakashima T (2002) Age-related changes of collagenous fibers in the human vocal fold mucosa. Ann Otol Rhinol Laryngol 111:15–20
Schlesinger MI, Hlavac V (2002) Ten lectures on statistical and structural pattern recognition. In: Volume 24 of computational imaging and vision. Kluwer Academic Press, Dordrecht, pp 1–544
Schulz GM, Grant MK (2000) Effect of speech therapy and pharmacologic and surgical treatments on voice and speech in Parkinson’s disease: a review of the literature. J Commun Disord 33:59–88
Skodda S, Rinsche A, Schlegel U (2009) Progression of dysprosody in Parkinson’s disease: a longitudinal study. Mov Disord 24:716–722
Skodda S, Wenke V, Schlegel U (2010) Short- and long-term dopaminergic effect on dysarthria in early Parkinson’s disease. J Neural Transm 117:2197–2205
Skodda S, Flasskamp A, Schlegel U (2011a) Instability of syllable repetition as a marker of disease progression in Parkinson’s disease: a longitudinal study. Mov Disord 26:59–64
Skodda S, Visser W, Schlegel U (2011b) Vowel articulation in Parkinson’s disease. J Voice 25:467–472
Steffen T, Seney M (2008) Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the Unified Parkinson’s Disease Rating Scale in people with parkinsonism. Phys Ther 88:733–746
Stevenson 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 45:157–164
Talkin D (1995) A robust algorithm for pitch tracking (RAPT). In: Kleijn WB, Paliwal KK (eds) Speech coding and synthesis. Elsevier Science, London, pp 497–518
Tsanas A, Little MA, McSharry PE, Ramig LO (2011) Nonlinear speech analysis algorithms mapped to a standard metric achieve clinically useful quantification of average Parkinson’s disease symptom severity. J R Soc Interface 8:842–855
Wolfe VI, Garvin JS, Bacon M, Waldrop W (1975) Speech changes in Parkinson’s disease during treatment with l-dopa. J Commun Disord 8:271–279
Acknowledgments
This study was supported by the Czech Science Foundation (GACR 102/12/2230), Czech Ministry of Health (NT 11331-6/2010), Czech Ministry of Health (NT 12288-5/2011), and Czech Ministry of Education (MSM 0021620849). The authors thank to Cecilia Bonnet for her valuable comments on the manuscript and to Aaron Rulseh for his thoughtful English correction.
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The authors declare that they have no conflicts of interest.
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Rusz, J., Čmejla, R., Růžičková, H. et al. Evaluation of speech impairment in early stages of Parkinson’s disease: a prospective study with the role of pharmacotherapy. J Neural Transm 120, 319–329 (2013). https://doi.org/10.1007/s00702-012-0853-4
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DOI: https://doi.org/10.1007/s00702-012-0853-4