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Abstract
Background and Objectives Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy.
Methods We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis.
Results Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002).
Discussion Distinct speech phenotypes in de novo PD reflect divergent underlying mechanisms and allow prediction of response of speech impairment to levodopa therapy.
Classification of Evidence This study provides Class II evidence that, in patients with newly diagnosed PD with speech impairment, speech phenotype is associated with levodopa responsiveness.
Glossary
- CI=
- confidence interval;
- CPP=
- cepstral peak prominence;
- CSII=
- composite speech impairment index;
- DAT-SPECT=
- dopamine transporter SPECT;
- F0SD=
- fundamental frequency variability;
- HNR=
- harmonics-to-noise ratio;
- MDS-UPDRS=
- Movement Disorder Society–Unified Parkinson Disease Rating Scale;
- MoCA=
- Montreal Cognitive Assessment;
- PD=
- Parkinson disease;
- PIGD=
- postural instability/gait difficulty;
- PSIS=
- perceptual speech impairment score;
- SCOPA-AUT=
- Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction;
- VOT=
- voice onset time
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
Podcast: NPub.org/Podcast9721
- Received April 26, 2021.
- Accepted in final form September 20, 2021.
- © 2021 American Academy of Neurology
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