Advanced Parkinson disease patients have impairment in prosody processing

Changes in speech prosody perception during Parkinson's disease: A comprehensive analysis

INTRODUCTION

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects approximately 1%-2% of individuals aged 60 and above. Communication disorders in PD can significantly impact the overall quality of life. As prosody plays a vital role in verbal communication, the present study examines Persian prosody perception in PD, focusing on linguistic and emotional aspects of prosody.

METHODS

This cross-sectional study aimed to compare the perception of linguistic and emotional prosody in three groups: middle-aged adults (n = 22; mean age = 50.40 years), healthy older adults (n = 22; mean age = 68.31 years), and individuals with Parkinson's disease (n = 22; mean age = 65years). All individuals with PD were classified in stages 1; 1.5; 2; 2.5, and 3 of the disease using the Hoehn and Yahr scale. All participants had an MMSE score of 24 or above. The Florida Affect Battery (FAB) was used to evaluate prosody perception. This Battery was validated in the Persian language and its reliability and validity were reported as 94 % and 100 % respectively.

RESULTS

Participants with PD presented significantly lower scores than the older adults in all subtests of the FAB (p < 0.05), while healthy older adults were significantly different only in linguistic discrimination (β = -2.14; -3.68 to -0.61), and linguistic naming of prosody (β = 1.25; 0.17 to 2.33) compared to middle-aged adults.

CONCLUSIONS

The present study sheds light on the influence of PD on Persian prosody perception. Given the crucial role of prosody in verbal communication, these findings enhance our understanding of communication disorders in PD and could bring attention to consider prosody perception, among other aspects, when assessing individuals affected by PD.

Automatic and controlled attentional orienting toward emotional faces in patients with Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative motor disorder that can associate with deficits in cognitive and emotional processing. In particular, PD has been reported to be mainly associated with defects in executive control and orienting attentional systems. The deficit in emotional processing mainly emerged in facial expression recognition. It is possible that the defects in emotional processing in PD may be secondary to other cognitive impairments, such as attentional deficits. This study was designed to systematically investigate the different weight of automatic and controlled attentional orienting mechanisms implied in emotional selective attention in PD. To address our purpose, we assessed drug-naïve PD patients and age-matched healthy controls with two dot-probe tasks that differed for stimuli duration. Automatic and controlled attentions were evaluated with stimuli lasting 100 ms and 500 ms, respectively. Furthermore, we introduced an emotion recognition task to investigate the performance in explicit emotion classification. The stimuli used in both the tasks dot-probe and emotion recognition were expressive faces displaying neutral, disgusted, fearful, and happy expressions.Our results showed that in PD patients, compared with healthy controls, there was 1) an alteration of automatic and controlled attentional orienting toward emotional faces in both the dot-probe tasks (with short and long durations), and 2) no difference in the emotion recognition task. These findings suggest that, from the early stages of the disease, PD can yield specific deficits in implicit emotion processing task (i.e., dot-probe task) despite a normal performance in explicit tasks that demand overt emotion recognition.

Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease

Objective

To investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT^®) in improving prosody in patients with Parkinson’s disease over medium-term follow-up.

Methods

15 patients with Parkinson’s disease were assessed before LSVT^®, within one week, and 3 and 6 months after treatment. Subjective and objective evaluation included: Voice Handicap Index - 10 (VHI-10), perceptual assessment by GRBAS scale and item 18 of the Unified Parkinson’s Disease Rating Scale III (UPDRS III), maximum phonation time (MPT /s/) and acoustic analysis by means the Voice Range Profile (VRP) and the “Intonation Stimulability Protocol” of the Motor Speech Profile (MSP).

Results

A significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p < 0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvF₀) (p = 0-01) improved significantly after 3 months, but returned to pre-therapy levels after 6 months. The score of item 18 of the UPDRS III increased significantly early post-therapy (p = 0.03), but did not maintain the improvement at 3 and 6 months. Median values of Grade (G), Asthenia (A) and mean values VHI-10 score significantly decreased at each post-therapy control (p < 0.05).

Conclusions

In addition to the subjective and perceptual beneficial effect of LSVT^®, we found a long-lasting increase of loudness and fundamental frequency. There was also improvement of acoustic parameters related to prosody, although it was temporary.

Deficits in emotion perception and cognition in patients with parkinson's disease: A systematic review

Non-motor symptoms (NMS) are common among Parkinson's disease (PD) patients and have a significant impact on quality of life. NMS such as deficits in emotion perception are gaining due focus in the recent times. As emotion perception and cognitive functions share certain common neural substrates, it becomes pertinent to evaluate existing emotion perception deficits in view of underlying cognitive deficits. The current systematic review aimed at examining studies on emotion perception PD in the last decade. We carried out a systematic review of 44 studies from the PubMed database. We reviewed studies examining emotion perception and associated cognitive deficits, especially executive function and visuospatial function in PD. This review also examines how early and advanced PD differ in emotion perception deficits and how the presence of common neuropsychiatric conditions such as anxiety, apathy, and depression as well as neurosurgical procedure such as deep brain stimulation affect emotion perception. The need for future research employing a comprehensive evaluation of neurocognitive functions and emotion perception is underscored as it has a significant bearing on planning holistic intervention strategies.

(Dys)Prosody in Parkinson's Disease: Effects of Medication and Disease Duration on Intonation and Prosodic Phrasing

The phonology of prosody has received little attention in studies of motor speech disorders. The present study investigates the phonology of intonation (nuclear contours) and speech chunking (prosodic phrasing) in Parkinson’s disease (PD) as a function of medication intake and duration of the disease. Following methods of the prosodic and intonational phonology frameworks, we examined the ability of 30 PD patients to use intonation categories and prosodic phrasing structures in ways similar to 20 healthy controls to convey similar meanings. Speech data from PD patients were collected before and after a dopaminomimetic drug intake and were phonologically analyzed in relation to nuclear contours and intonational phrasing. Besides medication, disease duration and the presence of motor fluctuations were also factors included in the analyses. Overall, PD patients showed a decreased ability to use nuclear contours and prosodic phrasing. Medication improved intonation regardless of disease duration but did not help with dysprosodic phrasing. In turn, disease duration and motor fluctuations affected phrasing patterns but had no impact on intonation. Our study demonstrated that the phonology of prosody is impaired in PD, and prosodic categories and structures may be differently affected, with implications for the understanding of PD neurophysiology and therapy.

Social Symptoms of Parkinson's Disease

Parkinson's disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD also involves a host of emotional and communicative changes which can cause major disruptions to social functioning. These incude problems producing emotional facial expressions (i.e., facial masking) and emotional speech (i.e., dysarthria), as well as difficulties recognizing the verbal and nonverbal emotional cues of others. These social symptoms of PD can result in severe negative social consequences, including stigma, dehumanization, and loneliness, which might affect quality of life to an even greater extent than more well-recognized motor or cognitive symptoms. It is, therefore, imperative that researchers and clinicans become aware of these potential social symptoms and their negative effects, in order to properly investigate and manage the socioemotional aspects of PD. This narrative review provides an examination of the current research surrounding some of the most common social symptoms of PD and their related social consequences and argues that proactively and adequately addressing these issues might improve disease outcomes.

Central auditory processing in parkinsonian disorders: A systematic review

Altered auditory processing has been increasingly recognized as a non-motor feature in parkinsonian disorders. This systematic review provides an overview of behavioral and electrophysiological literature on central auditory processing in patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A systematic database search was conducted and yielded 88 studies that met the intelligibility criteria. The collected data revealed distinct impairments in a range of central auditory processes in PD, including altered deviance detection of basic auditory features, auditory brainstem processing, auditory gating and selective auditory attention. In contrast to PD, literature on central auditory processing in atypical parkinsonian disorders was relatively scarce, but provided some evidence for impaired central auditory processing in MSA and PSP. The interpretation of these findings is discussed and suggestions for further research are offered.

Social perceptual function in parkinson's disease: A meta-analysis

Social perceptual impairment is a common presenting feature of Parkinson's disease (PD) that has the potential to contribute considerably to disease burden. The current study reports a meta-analytic integration of 79 studies which shows that, relative to controls, PD is associated with a moderate emotion recognition deficit (g = -0.57, K = 73), and that this deficit is robust and almost identical across facial and prosodic modalities. However, the magnitude of this impairment does appear to vary as a function of task and emotion type, with deficits generally greatest for identification tasks (g = -0.65, K = 54), and for negative relative to other basic emotions. With respect to clinical variables, dopaminergic medication, deep brain stimulation, and a predominant left side onset of motor symptoms are each associated with greater social perceptual difficulties. However, the magnitude of social perceptual impairment seen for the four atypical parkinsonian conditions is broadly comparable to that associated with PD. The theoretical and practical implications of these findings are discussed.

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.

Facial emotion recognition in Parkinson's disease: A review and new hypotheses

Parkinson's disease is a neurodegenerative disorder classically characterized by motor symptoms. Among them, hypomimia affects facial expressiveness and social communication and has a highly negative impact on patients' and relatives' quality of life. Patients also frequently experience nonmotor symptoms, including emotional-processing impairments, leading to difficulty in recognizing emotions from faces. Aside from its theoretical importance, understanding the disruption of facial emotion recognition in PD is crucial for improving quality of life for both patients and caregivers, as this impairment is associated with heightened interpersonal difficulties. However, studies assessing abilities in recognizing facial emotions in PD still report contradictory outcomes. The origins of this inconsistency are unclear, and several questions (regarding the role of dopamine replacement therapy or the possible consequences of hypomimia) remain unanswered. We therefore undertook a fresh review of relevant articles focusing on facial emotion recognition in PD to deepen current understanding of this nonmotor feature, exploring multiple significant potential confounding factors, both clinical and methodological, and discussing probable pathophysiological mechanisms. This led us to examine recent proposals about the role of basal ganglia-based circuits in emotion and to consider the involvement of facial mimicry in this deficit from the perspective of embodied simulation theory. We believe our findings will inform clinical practice and increase fundamental knowledge, particularly in relation to potential embodied emotion impairment in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Identification and intensity of disgust: Distinguishing visual, linguistic and facial expressions processing in Parkinson disease

OBJECTIVES & METHODS

Most of the studies since now show an impairment for facial displays of disgust recognition in Parkinson disease. A general impairment in disgust processing in patients with Parkinson disease might adversely affect their social interactions, given the relevance of this emotion for human relations. However, despite the importance of faces, disgust is also expressed through other format of visual stimuli such as sentences and visual images. The aim of our study was to explore disgust processing in a sample of patients affected by Parkinson disease, by means of various tests tackling not only facial recognition but also other format of visual stimuli through which disgust can be recognized.

RESULTS

Our results confirm that patients are impaired in recognizing facial displays of disgust. Further analyses show that patients are also impaired and slower for other facial expressions, with the only exception of happiness. Notably however, patients with Parkinson disease processed visual images and sentences as controls.

CONCLUSIONS

Our findings show a dissociation within different formats of visual stimuli of disgust, suggesting that Parkinson disease is not characterized by a general compromising of disgust processing, as often suggested. The involvement of the basal ganglia-frontal cortex system might spare some cognitive components of emotional processing, related to memory and culture, at least for disgust.

Utility and accuracy of perceptual voice and speech distinctions in the diagnosis of Parkinson’s disease, PSP and MSA-P

Aim: To determine if perceptual speech measures distinguish people with Parkinson’s disease (PD), multiple system atrophy with predominant parkinsonism (MSA-P) and progressive supranuclear palsy (PSP). Methods: Speech–language therapists blind to patient characteristics employed clinical rating scales to evaluate speech/voice in 24 people with clinically diagnosed PD, 17 with PSP and 9 with MSA-P, matched for disease duration (mean 4.9 years, standard deviation 2.2). Results: No consistent intergroup differences appeared on specific speech/voice variables. People with PD were significantly less impaired on overall speech/voice severity. Analyses by severity suggested further investigation around laryngeal, resonance and fluency changes may characterize individual groups. Conclusion: MSA-P and PSP compared with PD were distinguished by severity of speech/voice deterioration, but individual speech/voice parameters failed to consistently differentiate groups.

Altered emotional recognition and expression in patients with Parkinson's disease

BACKGROUND

Parkinson's disease (PD) patients exhibit deficits in emotional recognition and expression abilities, including emotional faces and voices. The aim of this study was to explore emotional processing in pre-deep brain stimulation (pre-DBS) PD patients using two sensory modalities (visual and auditory).

METHODS

Fifteen PD patients who needed DBS surgery and 15 healthy, age- and gender-matched controls were recruited as participants. All participants were assessed by the Karolinska Directed Emotional Faces database 50 Faces Recognition test. Vocal recognition was evaluated by the Montreal Affective Voices database 50 Voices Recognition test. For emotional facial expression, the participants were asked to imitate five basic emotions (neutral, happiness, anger, fear, and sadness). The subjects were required to express nonverbal vocalizations of the five basic emotions. Fifteen Chinese native speakers were recruited as decoders. We recorded the accuracy of the responses, reaction time, and confidence level.

RESULTS

For emotional recognition and expression, the PD group scored lower on both facial and vocal emotional processing than did the healthy control group. There were significant differences between the two groups in both reaction time and confidence level. A significant relationship was also found between emotional recognition and emotional expression when considering all participants between the two groups together.

CONCLUSION

The PD group exhibited poorer performance on both the recognition and expression tasks. Facial emotion deficits and vocal emotion abnormalities were associated with each other. In addition, our data allow us to speculate that emotional recognition and expression may share a common system.