Longitudinal decline in speech production in Parkinson's disease spectrum disorders

Detecting neuropsychiatric fluctuations in Parkinson's Disease using patients' own words: the potential of large language models

Over the past decade, neuropsychiatric fluctuations in Parkinson's disease (PD) have been increasingly recognized for their impact on patients' quality of life. Speech, a complex function carrying motor, emotional, and cognitive information, offers potential insights into these fluctuations. While previous studies have focused on acoustic analysis to assess motor speech disorders reliably, the potential of linguistic patterns associated with neuropsychiatric fluctuations in PD remains unexplored. This study analyzed the content of spontaneous speech from 33 PD patients in ON and OFF medication states, using machine learning and large language models (LLMs) to predict medication states and a neuropsychiatric state score. The top-performing model, the LLM Gemma-2 (9B), achieved 98% accuracy in differentiating ON and OFF states and its predicted scores were highly correlated with actual scores (Spearman's ρ = 0.81). These methods could provide a more comprehensive assessment of PD treatment effects, allowing remote neuropsychiatric symptom monitoring via mobile devices.

Speech and language biomarkers for Parkinson's disease prediction, early diagnosis and progression

Parkinson's disease (PD), a multifaceted neurodegenerative disorder, can manifest as an array of motor and non-motor symptoms. Among these, speech and language impairments are particularly prevalent, often preceding motor dysfunctions. Emerging research indicates that these impairments may serve as early disease indicators. In this narrative review, we synthesised current findings on the potential of speech and language symptoms in PD identification and progression monitoring. Our review highlights convergent, albeit preliminary, lines of evidence supporting the value of speech-related features in detecting early or prodromal PD, even across language groups, especially with sophisticated analytical techniques. Distinct speech patterns in PD subtypes and other neurological disorders may assist in differential diagnosis and inform targeted management efforts. These features also evolve over the disease course and could effectively be utilised for disease tracking and guide management plan modifications. Advances in digital voice processing allow cost-effective, remote and scalable monitoring for larger populations.

Digital Phenotyping of Parkinson's Disease via Natural Language Processing

Frontostriatal degeneration in Parkinson's disease (PD) is associated with language deficits, which can be identified using natural language processing, a remarkable tool for digital phenotyping. Current evidence is limited in linguistic coverage and mostly blind to the disorder's cognitive phenotypes. We validated an AI-driven approach to capture digital language markers of PD with and without mild cognitive impairment (PD-MCI, PD-nMCI) relative to healthy controls (HCs). Analyzing the connected speech samples of participants, we extracted linguistic features with CLAN software. Classification was performed using Support Vector Machine and Recursive Feature Elimination. Discrimination between PD and HCs reached an AUC of 77%, with even better results for subgroup analyses (AUC 85% PD-nMCI vs. HCs; 83% PD-MCI vs. HCs; 75% PD-nMCI vs. PD-MCI). Key linguistic features included retracing ratio, action verb ratio, utterance error ratio, and verbless-utterance ratio, highlighting the foundational capabilities of linguistic digital markers for early diagnosis and phenotyping of PD.

Systematic Review and Meta-Analyses of Word Production Abilities in Dysfunction of the Basal Ganglia: Stroke, Small Vessel Disease, Parkinson's Disease, and Huntington's Disease

Clinical populations with basal ganglia pathologies may present with language production impairments, which are often described in combination with comprehension measures or attributed to motor, memory, or processing-speed problems. In this systematic review and meta-analysis, we studied word production in four (vascular and non-vascular) pathologies of the basal ganglia: stroke affecting the basal ganglia, small vessel disease, Parkinson's disease, and Huntington's disease. We compared scores of these clinical populations with those of matched cognitively unimpaired adults on four well-established production tasks, namely picture naming, category fluency, letter fluency, and past-tense verb inflection. We conducted a systematic search in PubMed and PsycINFO with terms for basal ganglia structures, basal ganglia disorders and language production tasks. A total of 114 studies were included, containing results for one or more of the tasks of interest. For each pathology and task combination, effect sizes (Hedges' g) were extracted comparing patient versus control groups. For all four populations, performance was consistently worse than that of cognitively unimpaired adults across the four language production tasks (p-values < 0.010). Given that performance in picture naming and verb inflection across all pathologies was quantified in terms of accuracy, our results suggest that production impairments cannot be fully explained by motor or processing-speed deficits. Our review shows that while language production difficulties in these clinical populations are not negligible, more evidence is necessary to determine the exact mechanism that leads to these deficits and whether this mechanism is the same across different pathologies.

Unveiling the Diagnostic Potential of Linguistic Markers in Identifying Individuals with Parkinson's Disease through Artificial Intelligence: A Systematic Review

While extensive research has documented the cognitive changes associated with Parkinson's disease (PD), a relatively small portion of the empirical literature investigated the language abilities of individuals with PD. Recently, artificial intelligence applied to linguistic data has shown promising results in predicting the clinical diagnosis of neurodegenerative disorders, but a deeper investigation of the current literature available on PD is lacking. This systematic review investigates the nature of language disorders in PD by assessing the contribution of machine learning (ML) to the classification of patients with PD. A total of 10 studies published between 2016 and 2023 were included in this review. Tasks used to elicit language were mainly structured or unstructured narrative discourse. Transcriptions were mostly analyzed using Natural Language Processing (NLP) techniques. The classification accuracy (%) ranged from 43 to 94, sensitivity (%) ranged from 8 to 95, specificity (%) ranged from 3 to 100, AUC (%) ranged from 32 to 97. The most frequent optimal linguistic measures were lexico-semantic (40%), followed by NLP-extracted features (26%) and morphological consistency features (20%). Artificial intelligence applied to linguistic markers provides valuable insights into PD. However, analyzing measures derived from narrative discourse can be time-consuming, and utilizing ML requires specialized expertise. Moving forward, it is important to focus on facilitating the integration of both narrative discourse analysis and artificial intelligence into clinical practice.

Global Acoustic Speech Temporal Characteristics for Mandarin Speakers With Parkinson's Disease During Syllable Repetition and Passage Reading

PURPOSE

Previous research has revealed considerable variation in speech rates among English speakers with Parkinson's disease (PD) with slower, faster, or similar rates than controls. The purpose of this study was to characterize speech rates of Mandarin speakers with PD and the corresponding articulation and pause characteristics explaining the speech rates to enhance rate control therapies.

METHOD

Eighteen Mandarin speakers with PD and 18 controls produced syllable repetitions and passage reading using their typical speech style. Speech rates, articulation rates, mean pause durations (≥ 10 ms), and the number of pauses with duration between 10 ms and 300 ms and greater than 300 ms were measured and compared between groups and tasks as well as across the initial, middle, and final periods of the passage. Two-way, mixed-model analyses of variance were employed for data analysis.

RESULTS

Compared to controls, individuals with PD spoke with similar speech rates and faster articulation rates during passage reading, whereas during syllable repetitions, they produced slower speech rates and comparable articulation rates. The slower syllable repetitions produced by speakers with PD may be explained by longer pauses and more perceptual pauses, whereas faster articulation rates may explain the trend of faster speech rates during reading. Speech and articulation rates accelerated for both groups during passage reading.

CONCLUSIONS

Speech rates of Mandarin speakers with PD were characterized by faster articulation, longer pauses, and more perceptual pauses for passage reading. A descriptive model of speech rate suggested that speakers with PD and dysarthria in this study would benefit from rate reduction therapy decreasing articulation rate.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23982282.

Narrative discourse production in Parkinson's disease: Decoupling the role of cognitive-linguistic and motor speech changes

Introduction

the interplay between neuropsychological and communicative abilities in Parkinson's disease (PD) has been relatively overlooked, and it is not entirely understood which difficulties are consequent to impaired motor control, and which have a linguistic/cognitive basis. Here, we examined narrative discourse in PD using a multi-level analysis procedure considering sentence-level (productivity, lexical-grammatical processing) and discourse-level processes (narrative organization, informativeness), and partialling out patients' motor speech impairments. The interaction between cognitive (i.e. linguistic and executive) and communication abilities was also investigated.

Methods

Twenty-nine PD subjects in the mild stage of the disease were compared to 29 matched healthy comparators (HC) on quantitative measures of narrative discourse derived from two picture description tasks. Multivariate (considering articulation rate and educational attainment as covariates) and univariate (with group membership as independent variable) analyses of variance were conducted on separate linguistic domains. The contribution of executive/linguistic abilities to PD's narrative performance was explored by multiple regression analyses on narrative measures significantly differentiating patients from HC.

Results

significant reductions in patients were observed on measures of productivity (less well-formed words, shorter sentences) and informativeness (fewer conceptual units, less informative elements, lower number of details) and these alterations were explained by variations in linguistic abilities (action and object naming) rather than executive abilities. Articulation rate and educational attainment did not impact the observed reduced productivity and under-informativeness.

Conclusion

referential narrative discourse is altered in PD, regardless of motor impairments in speech production. The observed reductions in productivity/informativeness aspects of narratives were related to naming abilities and in particular to verbs processing, consistently with the neurocognitive model of motor language coupling. Since narratives are amenable to recurrent and automated analysis for the identification of linguistic patterns potentially anticipating the development of PD and the onset of cognitive deterioration, discourse abilities should be quantitatively and repeatedly profiled in the disorder.

Voice Acoustic Instability During Spontaneous Speech in Parkinson's Disease

BACKGROUND

In people with Parkinson's disease (PwPD), both motor and cognitive deficits influence voice and other aspects of communication. PwPD demonstrate vocal instability, but acoustic declines over the course of speaking are not well characterized and the role of cognition on these declines is unknown. We examined voice acoustics related to speech motor instability by comparing the first and the last utterances within a speech task. Our objective was to determine if mild cognitive impairment (MCI) status was associated with different patterns of acoustic change during these tasks.

METHODS

Participants with PD (n = 44) were enrolled at University of Massachusetts Chan Medical School and classified by gold-standard criteria as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI). The speech was recorded during the Rainbow Passage and a picture description task (Cookie Theft). We calculated the difference between first and last utterances in fo mean and standardized semitones (STSD), cepstral peak prominence-smoothed (CPPS), and low to high ratio (LH). We used t-tests to compare the declines in acoustic parameters between the task types and between participants with PD-NC versus PD-MCI.

RESULTS

Mean fo, fo variability (STSD) and CPPS declined from the first to the last utterance in both tasks, but there was no significant difference in these declines between the PD-NC and PD-MCI groups. Those with PD-MCI demonstrated lower fo variability on the whole in both tasks and lower CPPS in the picture description task, compared to those with PD-NC.

CONCLUSIONS

Mean and STSD fo as well as CPPS may be sensitive to PD-MCI status in reading and spontaneous speech tasks. Speech motor instability can be observed in these voice acoustic parameters over brief speech tasks, but the degree of decline does not depend on cognitive status. These findings will inform the ongoing development of algorithms to monitor speech and cognitive function in PD.

Apraxia of Speech in the Spontaneous Speech of Nonfluent/Agrammatic Primary Progressive Aphasia

Background

Apraxia of speech (AOS) is a core feature of nonfluent/agrammatic primary progressive aphasia (naPPA), but its precise characteristics and the prevalence of AOS features in spontaneous speech are debated.

Objective

To assess the frequency of features of AOS in the spontaneous, connected speech of individuals with naPPA and to evaluate whether these features are associated with an underlying motor disorder such as corticobasal syndrome or progressive supranuclear palsy.

Methods

We examined features of AOS in 30 patients with naPPA using a picture description task. We compared these patients to 22 individuals with behavioral variant frontotemporal dementia and 30 healthy controls. Each speech sample was evaluated perceptually for lengthened speech segments and quantitatively for speech sound distortions, pauses between and within words, and articulatory groping. We compared subgroups of naPPA with and without at least two features of AOS to assess the possible contribution of a motor impairment to speech production deficits.

Results

naPPA patients produced both speech sound distortions and other speech sound errors. Speech segmentation was found in 27/30 (90%) of individuals. Distortions were identified in 8/30 (27%) of individuals, and other speech sound errors occurred in 18/30 (60%) of individuals. Frequent articulatory groping was observed in 6/30 (20%) of individuals. Lengthened segments were observed rarely. There were no differences in the frequencies of AOS features among naPPA subgroups as a function of extrapyramidal disease.

Conclusion

Features of AOS occur with varying frequency in the spontaneous speech of individuals with naPPA, independently of an underlying motor disorder.

Pausing before verb production is associated with mild cognitive impairment in Parkinson's disease

Background

Cognitive dysfunction and communication impairment are common and disabling symptoms in Parkinson's Disease (PD). Action verb deficits occur in PD, but it remains unclear if these impairments are related to motor system dysfunction and/or cognitive decline. The objective of our study was to evaluate relative contributions of cognitive and motor dysfunction to action verb production in naturalistic speech of patients with PD. We proposed that pausing before action-related language is associated with cognitive dysfunction and may serve as a marker of mild cognitive impairment in PD.

Method

Participants with PD (n = 92) were asked to describe the Cookie Theft picture. Speech files were transcribed, segmented into utterances, and verbs classified as action or non-action (auxiliary). We measured silent pauses before verbs and before utterances containing verbs of different classes. Cognitive assessment included Montreal Cognitive Assessment (MoCA) and neuropsychological tests to categorize PD participants as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) based on Movement Disorders Society (MDS) Task Force Tier II criteria. Motor symptoms were assessed using MDS-UPDRS. We performed Wilcoxon rank sum tests to identify differences in pausing between PD-NC and PD-MCI. Logistic regression models using PD-MCI as dependent variables were used to evaluate the association between pause variables and cognitive status.

Results

Participants with PD-MCI demonstrated more pausing before and within utterances compared to PD-NC, and the duration of these pauses were correlated with MoCA but not motor severity (MDS-UPDRS). Logistic regression models demonstrated that pauses before action utterances were associated with PD-MCI status, whereas pauses before non-action utterances were not significantly associated with cognitive diagnosis.

Conclusion

We characterized pausing patterns in spontaneous speech in PD-MCI, including analysis of pause location with respect to verb class. We identified associations between cognitive status and pausing before utterances containing action verbs. Evaluation of verb-related pauses may be developed into a potentially powerful speech marker tool to detect early cognitive decline in PD and better understand linguistic dysfunction in PD.

Laterality in Parkinson's disease: A neuropsychological review

Laterality of motor symptom onset in Parkinson's disease is both well-known and under-appreciated. Treatment of disorders that have asymmetric pathological features, such as stroke and epilepsy, demonstrate the importance of incorporating hemispheric lateralization and specialization into therapy and care planning. These practices could theoretically extend to Parkinson's disease, providing increased diagnostic accuracy and improved treatment outcomes. Additionally, while motor symptoms have generally received the majority of attention, non-motor features (e.g., autonomic dysfunction) also decrease quality of life and are influenced by asymmetrical neurodegeneration. Due to the laterality of cognitive and behavioral processes in the two brain hemispheres, analysis of hemibody side of onset can potentially give insight into expected symptom profile of the patient and allow for increased predictive accuracy of disease progression and outcome, thus opening the door to personalized and improved therapy in treating Parkinson's disease patients. This review discusses motor and non-motor symptoms (namely autonomic, sensory, emotional, and cognitive dysfunction) of Parkinson's disease in respect to hemispheric lateralization from a theoretical perspective in hopes of providing a framework for future research and personalized treatment.

Vocal changes in a zebra finch model of Parkinson's disease characterized by alpha-synuclein overexpression in the song-dedicated anterior forebrain pathway

Deterioration in the quality of a person's voice and speech is an early marker of Parkinson's disease (PD). In humans, the neural circuit that supports vocal motor control consists of a cortico-basal ganglia-thalamo-cortico loop. The basal ganglia regions, striatum and globus pallidus, in this loop play a role in modulating the acoustic features of vocal behavior such as loudness, pitch, and articulatory rate. In PD, this area is implicated in pathogenesis. In animal models of PD, the accumulation of toxic aggregates containing the neuronal protein alpha-synuclein (αsyn) in the midbrain and striatum result in limb and vocal motor impairments. It has been challenging to study vocal impairments given the lack of well-defined cortico-basal ganglia circuitry for vocalization in rodent models. Furthermore, whether deterioration of voice quality early in PD is a direct result of αsyn-induced neuropathology is not yet known. Here, we take advantage of the well-characterized vocal circuits of the adult male zebra finch songbird to experimentally target a song-dedicated pathway, the anterior forebrain pathway, using an adeno-associated virus expressing the human wild-type αsyn gene, SNCA. We found that overexpression of αsyn in this pathway coincides with higher levels of insoluble, monomeric αsyn compared to control finches. Impairments in song production were also detected along with shorter and poorer quality syllables, which are the most basic unit of song. These vocal changes are similar to the vocal abnormalities observed in individuals with PD.

Longitudinal Effects of Parkinson's Disease on Speech Breathing During an Extemporaneous Connected Speech Task

PURPOSE

A critical component to the development of any type of intervention to improve speech production in individuals with Parkinson's disease (PD) is a complete understanding of the speech impairments present at each stage of the disease and how these impairments change with disease progression. The purpose of this longitudinal study was to examine the impact of disease on speech production and speech breathing during an extemporaneous speech task in individuals with PD over the course of approximately 3.5 years.

METHOD

Eight individuals with PD and eight age- and sex-matched control participants produced an extemporaneous connected speech task on two occasions (Time 1 and Time 2) an average of 3 years 7 months apart. Dependent variables included sound pressure level; utterance length; speech rate; lung volume initiation, termination, and excursion; and percent vital capacity per syllable.

RESULTS

From Time 1 to Time 2, individuals with PD demonstrated decreased utterance length and lung volume initiation, termination, and excursion and increased speech rate. Control participants demonstrated decreased utterance length and lung volume termination and increased lung volume excursion and percent vital capacity per syllable from Time 1 to Time 2.

CONCLUSIONS

Changes in speech production and speech breathing variables experienced by individuals with PD over the course of several years are related to their disease process and not typical aging. Changes to speech breathing highlight the need to provide intervention focused on increasing efficient respiratory patterning for speech production.

Speech dysfunction, cognition, and Parkinson's disease

Communication difficulties are a ubiquitous symptom of Parkinson's disease and include changes to both motor speech and language systems. Communication challenges are a significant driver of lower quality of life. They are associated with decreased communication participation, social withdrawal, and increased risks for social isolation and stigmatization in persons with Parkinson's disease. Recent theoretical advances and experimental evidence underscore the intersection of cognition and motor processes in speech production and their impact on spoken language. This chapter overviews a growing evidence base demonstrating that cognitive impairments interact with motor changes in Parkinson's disease to negatively affect communication abilities in myriad ways, at all stages of the disease, both in the absence and presence of dementia. The chapter highlights common PD interventions (pharmacological, surgical, and non-pharmacological) and how cognitive influences on speech production outcomes are considered in each.

When it is not primary progressive aphasia: A scoping review of spoken language impairment in other neurodegenerative dementias

BACKGROUND

Progressive difficulties with spoken language occur across the spectrum of degenerative dementia. When not a primary presenting and dominant symptom, language difficulties may be overlooked in favor of more prominent cognitive, behavior, or motor deficits. The aim of this scoping review is to examine the extent and nature of the research evidence describing (1) the spoken language impairments found in non-language led dementias, (2) their impact on everyday living, and (3) the reported language interventions.

METHODS

We searched PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and SpeechBITE using terms related to spoken language for the following dementia types: Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), cortico-basal syndrome (CBS), behavior variant frontotemporal dementia (bvFTD), early-onset Alzheimer's disease (EOAD), posterior cortical atrophy (PCA), and motor neuron disease associated with FTD (MND+FTD). Risk of bias was assessed with the QualSyst tool.

RESULTS

Seventy-three eligible studies were included. A wide range of spoken language impairments were reported, involving both linguistic (e.g., syntactic processing) and other cognitive (e.g., sustained attention) underlying mechanisms. Although the severity of these deficits was scarcely reported, in some cases they manifested as non-fluent, dynamic, and global aphasias. No papers in the review described either the impact of these language impairments on everyday living or language therapies to treat them.

DISCUSSION

There is a need to understand better the level of disability produced by language impairment in people living with non-language-led dementias. Our findings suggest three calls for action: (1) research studies should assess the clinical relevance of any spoken language deficits examined, (2) both linguistic and cognitive underlying mechanisms should be fully described (to inform the design of effective language and behavioral interventions), and (3) trials of language therapy should be conducted in those groups of individuals where significant language impairment is proved.

Investigation of sensorimotor dysfunction in Parkinson disease by resting-state fMRI

PURPOSE

Functional MRI has played a fundamental role in Parkinson's disease(PD) study. In this paper, we performed an independent component analysis (ICA) based on functional networks to reveal the intricate variations on the morphology and functional properties of brain. Our analysis aims at discovering the differences between PD patients with sensorimotor function impairment and normal controls(NC), thus helping to understand the coordination neurological function degeneration in PD objectively.

METHOD

We investigated the blood oxygen level dependent(BOLD) functional MRI obtained at a 3.0 T MRI scanner. 30 PD patients and 28 NC subjects underwent the scan in resting state. The signals of sensory and motor coordinative control areas in the sensorimotor, insula and cerebellum networks acquired by ICA(Independent Component Analysis)were applied to analyze the functional alterations. Specifically, intra-network analysis was performed with signals in local networks, and inter-network analysis was conducted by functional network connectivity (FNC) with signals across different networks. Two sample T test was carried out to detect the significant (p < 0.05, FDR p < 0.05) functional abnormality in PD patients.

CONCLUSION

We identified an obvious increase in bilateral posterior insula, but decrease in bilateral cerebellum hemisphere, supplementary motor area(SMA) and precentral gyrus paracentral lobule of left postcentral gyrus. Besides, we found a significantly increased connection between independent component (IC) 13 which was located in right postcentral gyrus and cerebellum. Decreased connections were detected between sensory and motor cortex in sensorimotor network and between cerebellum and insula network by FNC analysis in PD patients as well.

DISCUSSION

Parkinson's disease derives from the degeneration of the dopaminergic neurons in substantia nigra, and results in decreased secretion of inhibitory neurotransmitter. The significant differences between PD and NC groups in our research maybe explain the clinical manifestations of prominent bradykinesia and multiple extrapyramidal symptoms.

The Impact of Parkinson's Disease on Breath Pauses and Their Relationship to Speech Impairment: A Longitudinal Study

Purpose The purposes of this longitudinal study were to (a) examine the impact of Parkinson's disease (PD) progression on breath pause patterns and speech and linguistic errors and (b) determine the extent to which breath pauses and speech and linguistic errors contribute to speech impairment. Method Eight individuals with PD and eight age- and sex-matched control participants produced a reading passage on two occasions (Time 1 and Time 2) 3 years and 7 months apart on average. Two speech-language pathologists rated the severity of speech impairment for all participants at each time. Dependent variables included the location of each breath pause relative to syntax and punctuation as well as the number of disfluencies and mazes. Results At Time 1, there were no significant differences between the groups regarding breath pause patterns. At Time 2, individuals with PD produced significantly fewer breath pauses at major syntactic boundaries and periods as well as significantly more breath pauses at locations with no punctuation than control participants. Individuals with PD produced a significantly greater number of disfluencies than control participants at both time points. There were no significant differences between the groups in the number of mazes produced at either time point. Together, the number of mazes and the percentage of breath pauses at locations with no punctuation explained 50% of the variance associated with the ratings of severity of speech impairment. Conclusion These results highlight the importance of targeting both respiratory physiological and cognitive-linguistic systems in order to improve speech production in individuals with PD.

A Comparison of Speech Amplification and Personal Communication Devices for Hypophonia

Purpose This study compared the performance of three amplification devices hypothesized to improve speech communication in individuals with hypophonia (HP), as well as to identify individuals' device preferences. Method Twenty-two individuals with HP and their primary communication partners participated in a cross-over design study comparing three different speech amplification devices: a wired portable amplifier (Device A), a wireless stationary amplifier (Device B), and a one-way personal communication system (Device C). Participants attended one laboratory visit followed by 1-week trial periods with each device. At the first visit, HP participants completed speech tasks with and without the devices, in quiet and in noise. Following the in-laboratory test period, participants trialed each device at home for approximately 1 week per device. Following completion of the study, participants indicated whether or not they would like to continue using a device. Results Overall, in the presence of noise, all three devices demonstrated significant improvements in speech-to-noise levels and speech intelligibility compared to no device. A clear device hierarchy emerged such that the personal communication device (Device C) was associated with significantly better speech outcomes compared to the other two devices. The majority of participants elected to continue using a device at the completion of the study. Device preferences, however, did not clearly reflect the objective device hierarchy that was found for the objective speech measures. Each of the three devices was selected as a preferred device by at least three participants at the completion of the study. Conclusion Results from this study demonstrated clear differences in device performance in three distinct forms of amplification devices for individuals with HP. Findings suggest that amplification device use may be beneficial for this clinical population and underscore the potential to improve device availability and device selection criteria in future research. Supplemental Material https://doi.org/10.23641/asha.12735875.

Automated analysis of natural speech in amyotrophic lateral sclerosis spectrum disorders

OBJECTIVE

We implemented automated methods to analyze speech and evaluate the hypothesis that cognitive and motor factors impair prosody in partially distinct ways in patients with amyotrophic lateral sclerosis (ALS).

METHODS

We recruited 213 participants, including 67 with ALS (44 with motor ALS, 23 with ALS and frontotemporal degeneration [FTD]), 33 healthy controls, and neurodegenerative reference groups with behavioral variant FTD (n = 90) and nonfluent/agrammatic primary progressive aphasia (n = 23). Digitized, semistructured speech samples obtained from picture descriptions were automatically segmented with a Speech Activity Detector; continuous speech segments were pitch-tracked; and duration measures for speech and silent pause segments were extracted. Acoustic measures were calculated, including fundamental frequency (f0) range, mean speech and pause segment durations, total speech duration, and pause rate (pause count per minute of speech). Group comparisons related performance on acoustic measures to clinical scales of cognitive and motor impairments and explored MRI cortical thinning in ALS and ALS-FTD.

RESULTS

The f0 range was significantly impaired in ALS spectrum disorders and was related to bulbar motor disease, and regression analyses related this to cortical thickness in primary motor cortex and perisylvian regions. Impaired speech and pause duration measures were related to the degree of cognitive impairment in ALS spectrum disorders, and regressions related duration measures to bilateral frontal opercula and left anterior insula.

CONCLUSION

Automated analyses of acoustic speech properties dissociate motor and cognitive components of speech deficits in ALS spectrum disorders.

Progression of Cognitive Decline in Parkinson's Disease

Background:

Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson’s disease (PD), often experienced as more debilitating for patients and caregivers than motor problems. Therefore, a deeper understanding of the course of cognitive decline and the identification of valid progression markers for Parkinson’s disease dementia (PDD) is essential.

Objective:

This systematic review summarizes the current state of knowledge on cognitive decline over time by reporting effect sizes of cognitive changes in neuropsychological tests.

METHODS:

1368 studies were identified by a PubMed database search and 25 studies by additionally scanning previous literature. After screening all records, including 69 full-text article reviews, 12 longitudinal studies on the progression of cognitive decline in PD met our criteria (e.g., sample size ≥50 patients).

Results:

Only a few studies monitored cognitive decline over a longer period (>4 years). Most studies focused on the evaluation of change in global cognitive state by use of the Mini-Mental State Examination, whereas the use of neuropsychological tests was highly heterogenic among studies. Only one study evaluated patients’ cognitive performance in all specified domains (executive function, attention & working memory, memory, language, and visual-spatial function) allowing for diagnosis of cognitive impairment according to consensus guidelines. Medium to strong effect sizes could only be observed in studies with follow-up intervals of four years or longer.

Conclusions:

The results emphasize the need for the assessment of larger PD cohorts over longer periods of follow-up with a comprehensive neuropsychological battery.

Communication impairment in Parkinson's disease: Impact of motor and cognitive symptoms on speech and language

Communication impairment is common in Parkinson's disease (PD) and may have both motor speech control and cognitive-linguistic underpinnings. The neurobiology of communication impairment in PD is poorly understood, and work is needed to disentangle the relative contributions of motor and cognitive dysfunction. In clinical practice, cognitive-linguistic impairments are often overlooked despite the large body of research on this topic in neurocognitive and linguistics literature. In this review, we will discuss the roles of motor speech changes, cognitive and linguistic impairment, and other related functions in the communication disabilities of individuals with PD. We will describe the various types of communication difficulties in PD and tools for measuring these symptoms. We will discuss specific deficits that may further understanding of the neurobiology of communication impairment in PD, including voice and speech acoustic changes, linguistic processing and production difficulties, and pausing. We will emphasize the importance of an interdisciplinary approach and the patient perspective on daily communication in guiding future research.

Information Content and Efficiency in the Spoken Discourse of Individuals With Parkinson's Disease

PURPOSE

This study compared the information content and information efficiency of spoken language in individuals with Parkinson's disease (PD) to a healthy comparator group.

METHOD

Nineteen participants with PD and 19 healthy older adults completed the prospective, cross-sectional study. In the primary analysis, 2 language samples elicited by standardized protocols were analyzed for group differences using standard discourse informativeness measures including main events (MEs; Wright, Capilouto, Wagovich, Cranfill, & Davis, 2005) analyzed as %MEs and correct information units (CIUs; Nicholas & Brookshire, 1993) analyzed as %CIUs and CIUs/min. In exploratory analyses, the following were examined: (a) associations among conceptual (%MEs) and lexical (%CIUs and CIUs/min) measures and (b) associations among informativeness measures and age, education, disease severity/duration, global cognition, speech intelligibility, and a verb confrontation naming measure.

RESULTS

In the primary analysis, the PD group differed significantly from the control group on conceptual (%MEs) and lexical measures of content (%CIUs) and efficiency (CIUs/min). In exploratory analyses, for the control group %MEs were significantly correlated with CIUs/min. Significant associations among conceptual and lexical measures of informativeness were not found in the PD group. For controls, there were no significant correlations between informativeness measures and any of the demographic or speech/cognitive/language variables. In the PD group, there was a significant and positive association between CIUs/min and Dementia Rating Scale-Second Edition scores (Mattis, 2001). A significant but negative correlation was found between CIUs/min and motor severity scores. However, %MEs and verb naming were significantly and positively correlated.

CONCLUSIONS

Individuals with PD without dementia demonstrated reduced discourse informativeness that reflects disruptions to both conceptual and lexical discourse processes. In exploratory analyses, reduced efficiency of information content was associated with global cognition and motor severity. Clinical and research implications are discussed within a Cognitivist framework of discourse production (Sheratt, 2007).