Assessment of voice and speech symptoms in early Parkinson’s disease by the Robertson dysarthria profile

Abstract

Changes in voice and speech are thought to involve 75-90% of people with PD, but the impact of PD progression on voice/speech parameters is not well defined. In this study, we assessed voice/speech symptoms in 48 parkinsonian patients staging <3 on the modified Hoehn and Yahr scale and 37 healthy subjects using the Robertson dysarthria profile (a clinical-perceptual method exploring all components potentially involved in speech difficulties), the Voice handicap index (a validated measure of the impact of voice symptoms on quality of life) and the speech evaluation parameter contained in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III). Accuracy and metric properties of the Robertson dysarthria profile were also measured. On Robertson dysarthria profile, all parkinsonian patients yielded lower scores than healthy control subjects. Differently, the Voice Handicap Index and the speech evaluation parameter contained in the UPDRS-III could detect speech/voice disturbances in 10 and 75% of PD patients, respectively. Validation procedure in Parkinson's disease patients showed that the Robertson dysarthria profile has acceptable reliability, satisfactory internal consistency and scaling assumptions, lack of floor and ceiling effects, and partial correlations with UPDRS-III and Voice Handicap Index. We concluded that speech/voice disturbances are widely identified by the Robertson dysarthria profile in early parkinsonian patients, even when the disturbances do not carry a significant level of disability. Robertson dysarthria profile may be a valuable tool to detect speech/voice disturbances in Parkinson's disease.

Towards the identification of Idiopathic Parkinson’s Disease from the speech. New articulatory kinetic biomarkers

“…As commented in the introduction, statistics show that approximately 75–90% of patients with PD develop dysarthria during the course of the disease [ 4 ][ 9 ][ 7 ][ 8 ]. It means that this is probably the ceiling expected for the sensitivity of a potential system of these characteristics.…”

“…Thus, its use as a ground truth to evaluate the speech is limited, and conclusions have to be extracted having in mind these concerns. Other perceptual scales, specifically developed to evaluate the speech, such as GRBAS, or specifically developed to evaluate dysarthria, such as Roberston Dysarthria Profile (RDP) [ 7 ], or Frenchay Dysarthria Assessment [ 80 ], should be taken into account. A validation procedure in PD patients showed that the RDP has a reasonable reliability, absence of ceiling and floor effects, sufficient internal consistency and scaling assumptions, and considerable correlations with UPDRS-III.…”

“…In more advanced stages the disease also manifests other non-motor symptoms such as neurobehavioral and cognitive abnormality, sensory disruptions and sleep alterations. Statistics show that approximately 75–90% of PD patients develop dysarthria during the course of the disease, but the most evident signs of dysarthria are present in 60% or more people with PD, with increased prevalence as the disease progress [ 4 ][ 7 ][ 8 ][ 9 ].…”

“…Complexity measures have also been used to characterize the speech of PD patients: Largest Lyapunov Exponent (LLE), Correlation Dimension (CD), Detrended Fluctuation analysis (DFE), Hurst Exponent (HE) and Approximate Entropy (AE) among others [ 12 ][ 19 ]. Moreover, PD patients show a decreased voice range profile or phonetogram [ 7 ][ 20 ].…”

Advances in clinical neurology through the journal “Neurological Sciences” (2015–2016)

“…Robertson dysarthria profile may be a valuable tool to detect speech/voice disturbances in Parkinson's disease [121]. Indoor and outdoor falls among people with PD often result in activity limitations, participation restrictions, social isolation or premature mortality [122].…”