Speech and Voice Response to a Levodopa Challenge in Late-Stage Parkinson’s Disease

Abstract

BackgroundParkinson’s disease (PD) patients are affected by hypokinetic dysarthria, characterized by hypophonia and dysprosody, which worsens with disease progression. Levodopa’s (l-dopa) effect on quality of speech is inconclusive; no data are currently available for late-stage PD (LSPD).ObjectiveTo assess the modifications of speech and voice in LSPD following an acute l-dopa challenge.MethodLSPD patients [Schwab and England score <50/Hoehn and Yahr stage >3 (MED ON)] performed several vocal tasks before and after an acute l-dopa challenge. The following was assessed: respiratory support for speech, voice quality, stability and variability, speech rate, and motor performance (MDS-UPDRS-III). All voice samples were recorded and analyzed by a speech and language therapist blinded to patients’ therapeutic condition using Praat 5.1 software.Results24/27 (14 men) LSPD patients succeeded in performing voice tasks. Median age and disease duration of patients were 79 [IQR: 71.5–81.7] and 14.5 [IQR: 11–15.7] years, respectively. In MED OFF, respiratory breath support and pitch break time of LSPD patients were worse than the normative values of non-parkinsonian. A correlation was found between disease duration and voice quality (R = 0.51; p = 0.013) and speech rate (R = −0.55; p = 0.008). l-Dopa significantly improved MDS-UPDRS-III score (20%), with no effect on speech as assessed by clinical rating scales and automated analysis.ConclusionSpeech is severely affected in LSPD. Although l-dopa had some effect on motor performance, including axial signs, speech and voice did not improve. The applicability and efficacy of non-pharmacological treatment for speech impairment should be considered for speech disorder management in PD.

Vocalization development in common marmosets for neurodegenerative translational modeling

“…For example, PD affects voice and speech in up to 90% of patients [16], compromising health, employment, social engagement, and quality of life [17, 18, 19]. These voice and speech deficits are mostly refractory to standard of care medical treatment (levodopa) [20] or surgical treatment (deep brain stimulation) [21, 22]. Although voice and speech changes are not commonly reported by patients with PD until the later stages of the disease [23], there is recent evidence of preclinical communication changes, both in humans [3] and in animal models [24, 25].…”

Speech-based identification of L-DOPA ON/OFF state in Parkinson’s Disease subjects

“…Among those articles, we found that Okada et al [25], analyzed isolated vowel articulation in PD subjects reporting that vowel space area was significantly expanded after L-DOPA treatment contrary to previous findings by [26], where no changes in speech over L-DOPA cycle were found. A recent article [27] analyzes a small cohort of late stage PD subjects using data from a L-DOPA challenge described in [28]. This work, which was limited to the analysis of sustained vowel /a/ and the repetition of a 8-word simple sentence, did not find significant changes in speech.…”

<p>Parkinson’s disease-associated dysarthria: prevalence, impact and management strategies</p>

“…10,11 Although voice disorders may be the primary concern regarding speech production in the early stages of the disease, disfluency and articulation impairments also emerge as the neurodegeneration progresses, with motor control deficits affecting articulation exerting the greatest negative impact on communication in the final stage of the disease. 10 Physiologically, hypokinetic dysarthria is associated with poor breath support and reduced range of motion of the speech articulators, 12,13 contributing to perceived undershoot of target sounds. 14 These acoustic-perceptual and physiological characteristics, therefore, have a detrimental effect on the individuals' intelligibility and, hence, their ability to communicate effectively.…”

“…26 A recent study of levodopa effects on speech and voice in 24 individuals in the late stage of the disease (ie, with a Schwab and England score of <50 or a Hoehn and Yahr stage >3 while on medication) found no improvements in speech in response to this medication. 12 Thus, current evidence suggests limited and variable success in response to pharmacological treatment of dysarthria, leading to clinical reliance primarily on behavioral management strategies.…”