Pragmatic comprehension deficit in Parkinson's disease

Computerized analysis of speech and voice for Parkinson's disease: A systematic review

BACKGROUND AND OBJECTIVE

Speech impairment is an early symptom of Parkinson's disease (PD). This study has summarized the literature related to speech and voice in detecting PD and assessing its severity.

METHODS

A systematic review of the literature from 2010 to 2021 to investigate analysis methods and signal features. The keywords "Automatic analysis" in conjunction with "PD speech" or "PD voice" were used, and the PubMed and ScienceDirect databases were searched. A total of 838 papers were found on the first run, of which 189 were selected. One hundred and forty-seven were found to be suitable for the review. The different datasets, recording protocols, signal analysis methods and features that were reported are listed. Values of the features that separate PD patients from healthy controls were tabulated. Finally, the barriers that limit the wide use of computerized speech analysis are discussed.

RESULTS

Speech and voice may be valuable markers for PD. However, large differences between the datasets make it difficult to compare different studies. In addition, speech analytic methods that are not informed by physiological understanding may alienate clinicians.

CONCLUSIONS

The potential usefulness of speech and voice for the detection and assessment of PD is confirmed by evidence from the classification and correlation results.

Subcortical Involvement in Formulaic Language: Studies on Bilingual Individuals With Parkinson's Disease

Purpose An impoverished production of routinized expressions, namely, formulaic language, has been reported for monolingual speakers with Parkinson's disease (PD). Little is known regarding how formulaic expressions might be manifested in individuals with neurological damage who speak more than one language. This study investigated the processing of formulaic language across first language (L1) and second language (L2) in bilingual individuals with PD. Method Eleven Korean-English bilingual speakers with PD, who acquired Korean as L1 and English as L2, were recruited for this study. Two matched control groups composed of 11 healthy Korean-English bilingual individuals and 11 healthy native English speakers were included for comparison. Their performance on three structured tasks (comprehension, completion, and judgment-correction) and conversational speech was measured and compared across groups for analyses. Results The bilingual speakers with PD had significantly impaired comprehension of formulaic language in L1 and had lower proportions of formulaic expressions in their L1 conversational speech compared with the bilingual controls. Regarding L2, both bilingual groups with and without PD were comparable in their English performance across all tasks. Both groups performed significantly poorer in L2 structured tasks than the native English speakers. Spontaneous production of formulaic language in English (L2 for bilingual individuals) was similar across all three groups. Conclusions The results of this study contribute to the growing body of literature on impoverishment of formulaic language production following subcortical dysfunction. Additionally, findings here demonstrate a selective impairment of formulaic language performance in L1 but not L2 for bilinguals with PD, further supporting the role of the basal ganglia in native language.

Pragmatic Language Disorder in Parkinson's Disease and the Potential Effect of Cognitive Reserve

It is known that patients with Parkinson's Disease (PD) may show deficits in several areas of cognition, including speech and language abilities. One domain of particular interest is pragmatics, which refers to the capacity of using language in context for a successful communication. Several studies showed that some specific aspects of pragmatics - both in production and in comprehension - might be impaired in patients with PD. However, a clear picture of pragmatic abilities in PD is still missing, as most of the existing studies focused on specific aspects of the pragmatic competence rather than on sketching a complete pragmatic profile. Moreover, little is known on the potential role of protective factors in compensating the decline of communicative skills as the disease progresses. The present study has two aims: (1) to provide a complete picture of pragmatic abilities in patients with PD, by using a comprehensive battery (Assessment of Pragmatic Abilities and Cognitive Substrates, APACS) and by investigating the relationship with other aspects of cognitive functioning (e.g., working memory and Theory of Mind) and (2) to investigate whether Cognitive Reserve, i.e., the resilience to cognitive impairment provided by life experiences and activities, may compensate for the progressive pragmatic deficits in PD. We found that patients with PD, compared to healthy matched controls, had worse performance in discourse production and in the description of scenes, and that these impairments were tightly correlated with the severity of motor impairment, suggesting reduced intentionality of engaging in a communicative exchange. Patients with PD showed also an impairment in comprehending texts and humor, suggesting a problem in inferring from stories, which was related to general cognitive impairment. Notably, we did not find any significant difference between patients and controls in figurative language comprehension, a domain that is commonly impaired in other neurodegenerative diseases. This might be indicative of a specific profile of pragmatic impairment in patients with PD, worth of further investigation. Finally, Cognitive Reserve measures showed a high degree of association with pragmatic comprehension abilities, suggesting that the modification of life-styles could be a good candidate for compensating the possible problems in understanding the pragmatic aspects of language experienced by patients with PD.

Multifaceted Communication Problems in Everyday Conversations Involving People with Parkinson's Disease

It is known that Parkinson's disease is often accompanied by a motor speech disorder, which results in impaired communication. However, people with Parkinson's disease may also have impaired word retrieval (anomia) and other communicative problems, which have a negative impact on their ability to participate in conversations with family as well as healthcare staff. The aim of the present study was to explore effects of impaired speech and language on communication and how this is managed by people with Parkinson's disease and their spouses. Using a qualitative method based on Conversation Analysis, in-depth analyses were performed on natural conversational interaction in five dyads including elderly men who were at different stages of Parkinson's disease. The findings showed that the motor speech disorder in combination with word retrieval difficulties and adaptations, such as using communication strategies, may result in atypical utterances that are difficult for communication partners to understand. The coexistence of several communication problems compounds the difficulties faced in conversations and individuals with Parkinson's disease are often dependent on cooperation with their communication partner to make themselves understood.

How language flows when movements don't: An automated analysis of spontaneous discourse in Parkinson's disease

To assess the impact of Parkinson's disease (PD) on spontaneous discourse, we conducted computerized analyses of brief monologues produced by 51 patients and 50 controls. We explored differences in semantic fields (via latent semantic analysis), grammatical choices (using part-of-speech tagging), and word-level repetitions (with graph embedding tools). Although overall output was quantitatively similar between groups, patients relied less heavily on action-related concepts and used more subordinate structures. Also, a classification tool operating on grammatical patterns identified monologues as pertaining to patients or controls with 75% accuracy. Finally, while the incidence of dysfluent word repetitions was similar between groups, it allowed inferring the patients' level of motor impairment with 77% accuracy. Our results highlight the relevance of studying naturalistic discourse features to tap the integrity of neural (and, particularly, motor) networks, beyond the possibilities of standard token-level instruments.

Reading comprehension in Parkinson's disease

PURPOSE

Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results.

METHOD

Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning.

RESULT

The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group.

CONCLUSION

Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.

Speech, voice and language in Parkinson’s disease: changes and interventions

SUMMARY This article covers recent developments in the understanding of communication changes in idiopathic Parkinson’s disease and selected issues in intervention. By contrast to earlier narrow considerations of voice and speech, the effects on communication of cognitive–linguistic and prosody perception and production are also highlighted. Decline can occur from the earliest stages, even when listeners perceive no frank changes. Communication may be relatively trouble-free in one-to-one quiet clinical situations but declines in multi-talker, dual/competing task situations. Assessment should reflect this to gain more accurate insights into daily living performance. Currently, therapies focusing on attention-to-effort in voice production and on monitoring the sense of effort and loudness production appear to be most successful. Medical and surgical treatments have little effect on intelligibility and communication and may even exacerbate the situation.

The role of the right hemisphere in speech act comprehension

In this research the role of the RH in the comprehension of speech acts (or illocutionary force) was examined. Two split-screen experiments were conducted in which participants made lexical decisions for lateralized targets after reading a brief conversation remark. On one-half of the trials the target word named the speech act performed with the preceding conversation remark; on the remaining trials the target did not name the speech act that the remark performed. In both experiments, lexical decisions were facilitated for targets representing the speech act performed with the prior utterance, but only when the target was presented to the left visual field (and hence initially processed by the RH) and not when presented to the right visual field. This effect occurred at both short (Experiment 1: 250 ms) and long (Experiment 2: 1000 ms) delays. The results demonstrate the critical role played by the RH in conversation processing.

Are verbal fluency and nonliteral language comprehension deficits related to depressive symptoms in Parkinson's disease?

Depression in Parkinson's disease (PD) is frequently associated with executive deficits, which can influence nonliteral comprehension and lexical access. This study explores whether depressive symptoms in PD modulate verbal fluency and nonliteral language comprehension. Twelve individuals with PD without depressive symptoms, 13 with PD and depressive symptoms (PDDSs), and 13 healthy controls completed a semantic and phonemic verbal fluency task and an indirect speech acts comprehension task. All groups had the same performance in the phonemic fluency task while the PDDS group was impaired in the semantic task. For the indirect speech act comprehension task, no difference was observed between the groups. However, the PDDS group had difficulty answering direct speech act questions. As some language impairments in PD become apparent when depressive symptoms are associated with the disease, it would appear to be important to take the presence of depressive symptoms into account when evaluating language abilities in PD.