Speech changes in Parkinson's disease during treatment with L-DOPA

doi:10.1016/0021-9924(75)90019-2

Journal of Communication Disorders

Volume 8, Issue 3, September 1975, Pages 271-279

https://doi.org/10.1016/0021-9924(75)90019-2 Get rights and content

Abstract

The speech of 17 Parkinsonian patients was evaluated before and after the administration of L-DOPA therapy. A significant difference was demonstrated after treatment for voice quality, articulation, and pitch variation, but not for rate of speech. Amount of speech improvement correlated significantly with amount of physical improvement. Although age and duration of disease may exert some influence on speech change, the results suggest that these factors do not reliably predict the response. After 4 years of L-DOPA therapy, three out of four patients demonstrated additional improvement or the same degree of speech improvement.

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Vocal deficits and anxiety are common, co-occurring, and interacting signs of Parkinson Disease (PD) that have a devastating impact on quality of life. Both manifest early in the disease process. Unlike hallmark motor signs of PD, neither respond adequately to dopamine replacement therapies, suggesting that their disease-specific mechanisms are at least partially extra-dopaminergic. Because noradrenergic dysfunction is also a defining feature of PD, especially early in the disease progression, drug therapies targeting norepinephrine are being trialed for treatment of motor and non-motor impairments in PD. Research assessing the effects of noradrenergic manipulation on anxiety and vocal impairment in PD, however, is sparse. In this pre-clinical study, we quantified the influence of pharmacologic manipulation of norepinephrine on vocal impairment and anxiety in Pink1-/- rats, a translational model of PD that demonstrates both vocal deficits and anxiety. Ultrasonic vocalization acoustics, anxiety behavior, and limb motor activity were tested twice for each rat: after injection of saline and after one of three drugs. We hypothesized that norepinephrine reuptake inhibitors (atomoxetine and reboxetine) and a β receptor antagonist (propranolol) would decrease vocal impairment and anxiety compared to saline, without affecting spontaneous motor activity. Our results demonstrated that atomoxetine and reboxetine decreased anxiety behavior. Atomoxetine also modulated ultrasonic vocalization acoustics, including an increase in vocal intensity, which is almost always reduced in animal models and patients with PD. Propranolol did not affect anxiety or vocalization. Drug condition did not influence spontaneous motor activity. These studies demonstrate relationships among vocal impairment, anxiety, and noradrenergic systems in the Pink1-/- rat model of PD.
Quantification of brainstem norepinephrine relative to vocal impairment and anxiety in the Pink1-/- rat model of Parkinson disease
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Citation Excerpt :
While the physiologic mechanisms of vocal deficits in PD remain uncertain, it is becoming clear that they are at least partially independent of classical dopaminergic degeneration [43–45]. The likelihood of an extra-dopaminergic pathological process is further-supported by the fact that the most commonly prescribed medication, levodopa, improves motor impairments in the limbs [46], while non-hallmark signs, including vocal impairment and anxiety, have a minimal response to dopamine replacement therapies [14–16,19,21]. Aside from dopamine-mediated deficits, other neural substrates, including those governed by NE, are disrupted in PD [47–53].
Vocal communication impairment and anxiety are co-occurring and interacting signs of Parkinson Disease (PD) that are common, poorly understood, and under-treated. Both vocal communication and anxiety are influenced by the noradrenergic system. In light of this shared neural substrate and considering that noradrenergic dysfunction is a defining characteristic of PD, tandem investigation of vocal impairment and anxiety in PD relative to noradrenergic mechanisms is likely to yield insights into the underlying disease-specific causes of these impairments. In order to address this gap in knowledge, we assessed vocal impairment and anxiety behavior relative to brainstem noradrenergic markers in a genetic rat model of early-onset PD (Pink1-/-) and wild type controls (WT). We hypothesized that 1) brainstem noradrenergic markers would be disrupted in Pink1-/-, and 2) brainstem noradrenergic markers would be associated with vocal acoustic changes and anxiety level. Rats underwent testing of ultrasonic vocalization and anxiety (elevated plus maze) at 4, 8, and 12 months of age. At 12 months, brainstem norepinephrine markers were quantified with immunohistochemistry. Results demonstrated that vocal impairment and anxiety were increased in Pink1-/- rats, and increased anxiety was associated with greater vocal deficit in this model of PD. Further, brainstem noradrenergic markers including TH and α1 adrenoreceptor immunoreactivity in the locus coeruleus, and β1 adrenoreceptor immunoreactivity in vagal nuclei differed by genotype, and were associated with vocalization and anxiety behavior. These findings demonstrate statistically significant relationships among vocal impairment, anxiety, and brainstem norepinephrine in the Pink1-/- rat model of PD.
Differences in early speech patterns between Parkinson variant of multiple system atrophy and Parkinson's disease
2015, Brain and Language
Citation Excerpt :
Furthermore, speech deficits in our patients with early PD were generally consistent with results of previous studies that adopted acoustic measurements to evaluate untreated PD patients during the early stages (Jimenez-Jimenez et al., 1997; Rusz et al., 2011). These abnormalities have been reported to be relatively responsive to treatment with levodopa (Pinto et al., 2004; Rusz et al., 2013; Wolfe, Garvin, Bacon, & Waldrop, 1975), despite contradictory findings. Moreover, several reports have found that deficits in these parameters correlate with non-speech motor performance in PD (Goberman, 2005; Rusz et al., 2013).
In Parkinson variant of multiple system atrophy (MSA-P), patterns of early speech impairment and their distinguishing features from Parkinson’s disease (PD) require further exploration. Here, we compared speech data among patients with early-stage MSA-P, PD, and healthy subjects using quantitative acoustic and perceptual analyses. Variables were analyzed for men and women in view of gender-specific features of speech. Acoustic analysis revealed that male patients with MSA-P exhibited more profound speech abnormalities than those with PD, regarding increased voice pitch, prolonged pause time, and reduced speech rate. This might be due to widespread pathology of MSA-P in nigrostriatal or extra-striatal structures related to speech production. Although several perceptual measures were mildly impaired in MSA-P and PD patients, none of these parameters showed a significant difference between patient groups. Detailed speech analysis using acoustic measures may help distinguish between MSA-P and PD early in the disease process.
Articulation disorders and duration, severity and L-dopa dosage in idiopathic parkinson’s disease
2015, Neurologia i Neurochirurgia Polska
Parkinson's disease (PD) is one of the most common diseases of the central nervous system (CNS). It is frequently heralded by speech disturbances, which are one of its first symptoms.
The aim of this paper is to share our own experience concerning the correlation between the severity of speech disorders and the PD duration, its severity and the intake of l-dopa.
The research included 93 patients with idiopathic PD, aged 26–86 years (mean age 65.1 years). Participants were examined neurologically according to the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale. They were also assessed by Frenchay Dysarthria Assessment.
Considerable and severe disorders were concurrent with impairments in the mobility of the tongue, lips, the jaw as well as the pitch and loudness of the voice. The strongest correlation but at a moderate level was found to exist between the severity of labial impairment, voice loudness and the length of the disease. There was also a positive correlation between lip movement while the motions were being diversified, lip arrangement while speaking and the intake of l-dopa.
As PD progresses a significant decline in vocal articulation can be observed, which is due to reduced mobility within the lips and the jaw. Exacerbation of articulation disorders resulting from progression of the disease does not materially influence the UPDRSS scores. l-dopa has been found to positively affect the mobility of the lips while the patient is speaking and their arrangement at rest.
Functional neuroanatomy of vocalization in patients with Parkinson's disease
2012, Journal of the Neurological Sciences
Citation Excerpt :
In addition, abnormalities in the auditory system and abnormal auditory-motor integration in PD [17,18] may contribute both to disturbances of self-perception of voice and speech production in this patient population [14]. Although pharmacological and surgical treatments are effective in treating motor symptoms of PD, the gains are not as significant for speech as they are for limb symptoms and the results of studies are variable depending mostly on study parameters and subpopulations of PD patients involved [e.g. 6,11,19–28]. On the other hand, LSVT (Lee Silverman Voice Treatment), have been effective for the treatment of hypokinetic dysarthria [e.g. 10,14].
In Parkinson's disease (PD) both speech production and self-monitoring of voiced speech are altered.
In our previous study we used functional magnetic resonance imaging (fMRI) to examine which brain areas are involved in overt reading in nine female PD patients (mean age 66.0 ± 11.6 years) compared with eight age-matched healthy female controls (mean age 62.2 years ± 12.3). Here we performed the post-hoc seed-based functional connectivity analysis of our data to assess the functional connectivity between the periaqueductal gray matter (PAG; i.e. the core subcortical structure involved in human vocalization) and other brain regions in the same groups of PD patients and controls.
In PD patients as compared with controls we observed increased connectivity between PAG and basal ganglia, posterior superior temporal gyrus, supramarginal and fusiform gyri and inferior parietal lobule on the right side. In the PD group, the connectivity strength in the right putamen and the right sypramarginal gyrus was correlated with variability of pitch while the connectivity strength in the right posterior superior temporal gyrus and in the right inferior parietal lobule was correlated with speech loudness.
We observed functional reorganization in PD patients as compared with controls in both the motor basal ganglia-thalamo-cortical circuitry and cortical areas known to be engaged in-auditory and somatosensory feedback control of voiced speech. These changes were hemisphere-specific and might either reflect effects of dopaminergic treatment or at least partially successful compensatory mechanisms involved in early-stage PD.
Characterizing Dysarthria Diversity for Automatic Speech Recognition: A Tutorial From the Clinical Perspective
2022, Frontiers in Computer Science

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^∗: J.S. Garvin is with the Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center.

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Speech changes in Parkinson's disease during treatment with L-DOPA

Abstract

Speech problems in Parkinsonian patients undergoing anterior choriodal artery occlusion or chemopallidectomy

J. Am. Geriat. Soc.

A method for evaluating disability in patients with Parkinson's disease

J. Nervous and Mental Disease

Clusters of deviant speech dimensions in the dysarthrias

J. Speech Hearing Dis.

Dysarthria in post-encephalitic Parkinsonism

Acta Psychiat. Neurol. Scand.

Treatment of Parkinsonism with L-DOPA

Dis. Nerv. Syst.

Role of the Department of Rehabilitation in preoperative evaluation of Parkinsonian patients

J. Am. Geriat. Soc.

Effect of L-DOPA on speech in Parkinsonism

J. Neurology, Neurosurgery, and Psychiatry