Communication changes in Parkinson's disease

Abstract

This review looks at the nature and impact of communication changes in Parkinson's, approaches to assessment, and directions for intervention, especially given that medical and surgical interventions beneficial for limb movement are largely ineffective, or even detrimental, for speech. Most people with Parkinson's notice changes to their communication. Voice alters early oneven in the prodromal stage. Later, articulation may impair intelligibility further. These changes impact on mood and social participation.However, a full characterisation of communication changes in Parkinson's must acknowledge that changes are far more pervasive and varied than a quiet voice.Communication is affected by marked dysprosody, cognitive-linguistic impairment, alterations to social interaction and pragmatics. Changes entail not just expressive elements but also receptive. A comprehensive evaluation of potential communication challenges faced by people with Parkinson's must cover all these aspects. Similarly, intervention that ignores the breadth and depth of changes will always remain incomplete.

Misconceptions about speech impairment in Parkinson's disease

“…However, these articulatory/acoustic characteristics are far from being isolated in a specific motor sphere; they are part of a more general communication deficit that involves several dimensions. 9 Which domains of speech, language, and behavior are involved in the spectrum of speech deficits in PD? We would like to report that beyond speech production deficits, other hidden deficits are critical to understand communication and behavioral troubles in our patients.…”

“…Voice/speech evaluation in PD often focuses on these well‐defined abnormalities, by measuring, for example, voice quality, maximal phonation time, speech rate, diadochokinesia performance, etc. However, these articulatory/acoustic characteristics are far from being isolated in a specific motor sphere; they are part of a more general communication deficit that involves several dimensions . Which domains of speech, language, and behavior are involved in the spectrum of speech deficits in PD?…”

“…7 Until recently, dysarthria in PD was presented as part of "other motor abnormalities" (p. 73), 8 disconnected from communication. 9 "The initial defect in the untreated patient is a failure to control respiration for the purpose of speech and there follows a forward progression of articulatory symptoms involving larynx, pharynx, tongue and finally lips" (p. 751). 10 This understanding of a caudorostral progression of the symptom proposed by Selby (1968), 11 from the respiratory system to the larynx and the supralaryngeal articulation, represents contributions of different pathological processes that underlie different aspects of dysarthrophonia, which might have contributed to both restrict dysarthria as a sole motor expression and underestimate respiratory and phonatory signs (e.g., respiratory control deficit, hypophonia, and dysphonia) for the benefit of articulation deficits, major contributors to speech intelligibility decline.…”

“…“ As the disorder progresses, symptoms due to imbalance and dysarthria may gradually appear ” (p. 243); this conceptualization of progressive worsening of the symptom probably contributed to define dysarthria as a late symptom . Until recently, dysarthria in PD was presented as part of “ other motor abnormalities ” (p. 73), disconnected from communication . “ The initial defect in the untreated patient is a failure to control respiration for the purpose of speech and there follows a forward progression of articulatory symptoms involving larynx, pharynx, tongue and finally lips ” (p. 751) .…”

The diagnosis, clinical findings and treatment options for Parkinson's disease patients attending a tertiary referral voice clinic

“…, 4 This reduced ability to communicate is considered by many of the patients and their families as the most handicapping aspect of the disease. It can have a negative impact on individuals with Parkinson's disease and their family life, long before frank intelligibility impairment is evident 5 …”