Relationship Between Respiratory Sensory Perception, Speech, and Swallow in Parkinson's Disease

Wheeler-Hegland, Karen; Troche, Michelle S.; Brandimore, Alexandra E.

doi:10.1002/mdc3.12732

Cited by 20 publications

(11 citation statements)

References 27 publications

(36 reference statements)

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“…Results from this study are not in agreement with previous reports, which have indicated that PWPD demonstrated an impaired ability to consistently perceive and identify communication and swallow impairment. Rationale for that impairment was associated with changes to both central and peripheral sensorimotor feedback loops [ 23 , 24 ]. However, we found that a set of questionnaires with questions specific to communication (speech and voice) and swallowing function increased the likelihood that participants would be able to identify impairments…”

Section: Discussionmentioning

confidence: 99%

Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

Dumican

2020

Clinical Parkinsonism & Related Disorders

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Introduction The ability of people with Parkinson's Disease (PWPD) to perceive and identify impairments related to communication and swallowing is often impaired. This impairment prolongs the time to diagnosis of dysphonia and dysphagia, and can delay implementation of speech or swallowing therapy. We have limited knowledge of how different motor phenotypes of PD impact speech, voice and swallowing, nor how PWPD perceive these impacts. The purpose of this study was to identify how perceptions of speech and voice impairments predict dysphagia in PD, and how those perceptions differ between motor phenotypes. Methods 38 PWPD completed clinical surveys including V-RQOL, DHI, and a speech, voice, and swallow symptom questionnaire. Participants were categorized as either tremor dominant (TD) or non-tremor dominant (NTD) phenotypes. Multiple regression and MANOVA were utilized to identify predictors of dysphagia perceptions, and for differentiating between motor phenotype based on perceptual severity. Results Perceptions of speech and voice impairment predicted perceptions of swallow impairment regardless of phenotype ( p < .05, CI = 0.08–0.77). NTD participants reported significantly more communication and swallowing impairments than TD ( p < .05) and perceived communication impairment severity was the strongest predictor of group classification (OR = 0.50). The survey battery displayed a robust discriminatory ability between phenotype (AUC = 0.87, CI = 0.76–0.98). Conclusion The use of a noninvasive and cost-efficient survey battery may be useful in predicting patient perceived swallow impairment in PWPD. Speech, voice, and swallow impairments based on survey responses were found to differ between motor phenotypes.

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Section: Discussionmentioning

confidence: 99%

Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

Dumican

2020

Clinical Parkinsonism & Related Disorders

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“…For example, the term “sensory dyspnea” has been used in PD to refer to the feeling of inability to take a breath in the absence of observable abnormal breathing. These observations lead to further questions regarding the contribution to the genesis of dyspnea of subjective sensory and perceptual changes, such as the threshold for dyspnea and the perception of respiratory load, which have so far received limited attention and warrant further investigation …”

Section: Future Studiesmentioning

confidence: 99%

“…These observations lead to further questions regarding the contribution to the genesis of dyspnea of subjective sensory and perceptual changes, such as the threshold for dyspnea and the perception of respiratory load, which have so far received limited attention and warrant further investigation. 38,97…”

Section: Future Studiesmentioning

confidence: 99%

Brainstem Ventilatory Dysfunction: A Plausible Mechanism for Dyspnea in Parkinson's Disease?

et al. 2020

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Dyspnea is an under‐recognized and debilitating symptom that is reported in up to 40% of patients with Parkinson's disease and may have multiple origins. Despite its frequency, it is poorly researched, and there is a general lack of understanding of the pathophysiology of dyspnea and respiratory dysfunction in PD. Consequently, a number of PD patients are labelled as having “unexplained dyspnea.” Studies to date have focused mainly on evaluating ventilatory capacity and lung volumes, and little is known about the effects of the disease on the medullary and pontine ventilatory control centers within the brainstem. This is of particular relevance in view of neuropathological studies demonstrating early involvement of the dorsal medulla and other brainstem structures by the disease process. The possibility that impaired brainstem ventilatory control is a contributory mechanism for dyspnea and could be a premotor manifestation in some PD patients therefore warrants further attention. This review focuses on clinical, pathological, and experimental evidence for the involvement of brainstem respiratory centers in PD. We highlight the need for further research, particularly in PD patients with unexplained dyspnea. © 2020 International Parkinson and Movement Disorder Society

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“…The presence of behaviorally altered tongue function in the absence of extensive or overt biological tongue muscle differences is compatible with the possibility that sensory dysfunction and central mechanisms play predominant roles in alteration of these oromotor functions in Pink1-/- at early disease timepoints. It has been suggested that in humans with PD, sensory impairments contribute to clinical deficits in speech and swallowing [ 44 ], and it is possible that mechanosensory impairments may emerge prior to chemosensory impairments [ 45 ]. Prior work in humans with PD has reported alterations in sensorimotor aspects of oral functions including deficits in jaw proprioception, deficits of tactile localization of sensation on the tongue, and deficits in head movement in response to oral sensation [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Functional characterization of extrinsic tongue muscles in the Pink1-/- rat model of Parkinson disease

et al. 2020

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Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem studies of PD, pathology has been reported in pharyngeal and laryngeal nerves and muscles. However, it is unknown whether PD is associated with neuromuscular changes in the tongue. Prior work in a rat model of PD (Pink1-/-) showed oromotor and swallowing deficits in the premanifest stage which suggested sensorimotor impairments of these functions. The present study tested the hypothesis that Pink1-/-rats show altered tongue function coinciding with neuromuscular differences within tongue muscles compared to wildtype (WT). Male Pink1-/-and WT rats underwent behavioral tongue function assays at 4 and 6 months of age (n = 7-8 rats per group), which are time points early in the disease. At 6 months, genioglossus (GG) and styloglossus (SG) muscles were analyzed for myosin heavy chain isoforms (MyHC), αsynuclein levels, myofiber size, centrally nucleated myofibers, and neuromuscular junction (NMJ) innervation. Pink1-/-showed greater tongue press force variability, and greater tongue press forces and rates as compared to WT. Additionally, Pink1-/-showed relative increases of MyHC 2a in SG, but typical MyHC profiles in GG. Western blots revealed Pink1-/-had more α-synuclein protein than WT in GG, but not in SG. There were no differences between Pink1-/-and WT in myofiber size, centrally-nucleated myofibers, or NMJ innervation. α-synuclein protein was observed in nerves, NMJ, and vessels in both genotypes. Findings at these early disease stages suggest small changes or no changes in several peripheral biological measures, and intact motor innervation of tongue muscles. Future work should evaluate these measures at later disease stages to determine when robust pathological peripheral change contributes to functional change, and what CNS deficits cause behavioral changes. Understanding how PD affects central and peripheral mechanisms will help determine therapy targets for speech and swallowing disorders.

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Relationship Between Respiratory Sensory Perception, Speech, and Swallow in Parkinson's Disease

Cited by 20 publications

References 27 publications

Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

Brainstem Ventilatory Dysfunction: A Plausible Mechanism for Dyspnea in Parkinson's Disease?

Functional characterization of extrinsic tongue muscles in the Pink1-/- rat model of Parkinson disease

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