Ing. Tereza Tykalová, Ph.D.

Objective: This study assessed the relationship between speech and language impairment and outcome in a multicenter cohort of isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD).Methods: Patients with iRBD from 7 centers speaking Czech, English, German, French, and Italian languages underwent a detailed speech assessment at baseline. Story-tale narratives were transcribed and linguistically annotated using fully automated methods based on automatic speech recognition and natural language processing algorithms, leading to the 3 distinctive linguistic and 2 acoustic patterns of language deterioration and associated composite indexes of their overall severity. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow-up. The Cox proportional hazard was performed to evaluate the predictive value of language patterns for phenoconversion over a follow-up period of 5 years.Results: Of 180 patients free of parkinsonism or dementia, 156 provided follow-up information. After a mean follow-up of 2.7 years, 42 (26.9%) patients developed neurodegenerative disease. Patients with higher severity of linguistic abnormalities (hazard ratio [HR = 2.35]) and acoustic abnormalities (HR = 1.92) were more likely to develop a defined neurodegenerative disease, with converters having lower content richness (HR = 1.74), slower articulation rate (HR = 1.58), and prolonged pauses (HR = 1.46). Dementia-first (n = 16) and parkinsonism-first with mild cognitive impairment (n = 9) converters had higher severity of linguistic abnormalities than parkinsonism-first with normal cognition converters (n = 17).Interpretation: Automated language analysis might provide a predictor of phenoconversion from iRBD into synucleinopathy subtypes with cognitive impairment, and thus can be used to stratify patients for neuroprotective trials. ANN NEUROL 2023

Imprecise vowels represent a common deficit associated with hypokinetic dysarthria resulting from a reduced articulatory range of motion in Parkinson's disease (PD). It is not yet unknown whether the vowel articulation impairment is already evident in the prodromal stages of synucleinopathy. We aimed to assess whether vowel articulation abnormalities are present in isolated rapid eye movement sleep behaviour disorder (iRBD) and early-stage PD. A total of 180 male participants, including 60 iRBD, 60 de-novo PD and 60 age-matched healthy controls performed reading of a standardized passage. The first and second formant frequencies of the corner vowels /a/, /i/, and /u/ extracted from predefined words, were utilized to construct articulatory-acoustic measures of Vowel Space Area (VSA) and Vowel Articulation Index (VAI). Compared to controls, VSA was smaller in both iRBD (p = 0.01) and PD (p = 0.001) while VAI was lower only in PD (p = 0.002). iRBD subgroup with abnormal olfactory function had smaller VSA compared to iRBD subgroup with preserved olfactory function (p = 0.02). In PD patients, the extent of bradykinesia and rigidity correlated with VSA (r = -0.33, p = 0.01), while no correlation between axial gait symptoms or tremor and vowel articulation was detected. Vowel articulation impairment represents an early prodromal symptom in the disease process of synucleinopathy. Acoustic assessment of vowel articulation may provide a surrogate marker of synucleinopathy in scenarios where a single robust feature to monitor the dysarthria progression is needed.

Background: An early diagnosis together with an accurate disease progression monitoring of multiple sclerosis is an important component of successful disease management. Prior studies have established that multiple sclerosis is correlated with speech discrepancies. Early research using objective acoustic measurements has discovered measurable dysarthria.Method: The objective was to determine the potential clinical utility of machine learning and deep learning/AI approaches for the aiding of diagnosis, biomarker extraction and progression monitoring of multiple sclerosis using speech recordings. A corpus of 65 MS-positive and 66 healthy individuals reading the same text aloud was used for targeted acoustic feature extraction utilizing automatic phoneme segmentation. A series of binary classification models was trained, tuned, and evaluated regarding their Accuracy and area-under-the-curve.Results: The Random Forest model performed best, achieving an Accuracy of 0.82 on the validation dataset and an area-under-the-curve of 0.76 across 5 k-fold cycles on the training dataset. 5 out of 7 acoustic features were statistically significant.Conclusion: Machine learning and artificial intelligence in automatic analyses of voice recordings for aiding multiple sclerosis diagnosis and progression tracking seems promising. Further clinical validation of these methods and their mapping onto multiple sclerosis progression is needed, as well as a validating utility for English-speaking populations.

Background The mechanisms underlying speech abnormalities in Parkinson's disease (PD) remain poorly understood, with most of the available evidence based on male patients. This study aimed to estimate the occurrence and characteristics of speech disorder in early, drug-naive PD patients with relation to gender and dopamine transporter imaging. Methods Speech samples from 60 male and 40 female de novo PD patients as well as 60 male and 40 female age-matched healthy controls were analyzed. Quantitative acoustic vocal assessment of 10 distinct speech dimensions related to phonation, articulation, prosody, and speech timing was performed. All patients were evaluated using [123]I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single-photon emission computed tomography and Montreal Cognitive Assessment. Results The prevalence of speech abnormalities in the de novo PD cohort was 56% for male and 65% for female patients, mainly manifested with monopitch, monoloudness, and articulatory decay. Automated speech analysis enabled discrimination between PD and controls with an area under the curve of 0.86 in men and 0.93 in women. No gender-specific speech dysfunction in de novo PD was found. Regardless of disease status, females generally showed better performance in voice quality, consonant articulation, and pauses production than males, who were better only in loudness variability. The extent of monopitch was correlated to nigro-putaminal dopaminergic loss in men (r = 0.39, p = 0.003) and the severity of imprecise consonants was related to cognitive deficits in women (r = -0.44, p = 0.005). Conclusions Speech abnormalities represent a frequent and early marker of motor abnormalities in PD. Despite some gender differences, our findings demonstrate that speech difficulties are associated with nigro-putaminal dopaminergic deficits.

Even though hypomimia is a hallmark of Parkinson’s disease (PD), objective and easily interpretable tools to capture the disruption of spontaneous and deliberate facial movements are lacking. This study aimed to develop a fully automatic video-based hypomimia assessment tool and estimate the prevalence and characteristics of hypomimia in de-novo PD patients with relation to clinical and dopamine transporter imaging markers. For this cross-sectional study, video samples of spontaneous speech were collected from 91 de-novo, drug-naïve PD participants and 75 age and sex-matched healthy controls. Twelve facial markers covering areas of forehead, nose root, eyebrows, eyes, lateral canthal areas, cheeks, mouth, and jaw were used to quantitatively describe facial dynamics. All patients were evaluated using Movement Disorder Society-Unified PD Rating Scale and Dopamine Transporter SinglePhoton Emission Computed Tomography. Newly developed automated facial analysis tool enabled high-accuracy discrimination between PD and controls with area under the curve of 0.87. The prevalence of hypomimia in de-novo PD cohort was 57%, mainly associated with dysfunction of mouth and jaw movements, and decreased variability in forehead and nose root wrinkles (p < 0.001). Strongest correlation was found between reduction of lower lip movements and nigro-putaminal dopaminergic loss (r = 0.32, p = 0.002) as well as limb bradykinesia/rigidity scores (r = −0.37 p < 0.001). Hypomimia represents a frequent, early marker of motor impairment in PD that can be robustly assessed via automatic video-based analysis. Our results support an association between striatal dopaminergic deficit and hypomimia in PD.

Background Impairments of olfactory and speech function are likely early prodromal symptoms of alpha-synucleinopathy. Objective The aim of this study is to assess whether dysprosody is present in isolated rapid eye movement sleep behavior disorder (iRBD) with hyposmia/anosmia and a normal nigrostriatal system. Methods Pitch variability during speech was investigated in 17 iRBD subjects with normal olfactory function (iRBD-NOF), 30 iRBD subjects with abnormal olfactory function (iRBD-AOF), and 50 healthy controls. iRBD subjects were evaluated using the University of Pennsylvania Smell Identification Test and [123I]-2ss-carbomethoxy-3ss-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane dopamine transporter single-photon emission computed tomography (DAT-SPECT). All iRBD subjects completed the 24-month follow-up with DAT-SPECT, speech, and olfactory testing. Results At baseline, only iRBD-AOF showed monopitch when compared to iRBD-NOF (P = 0.04) and controls (P = 0.03), with no difference between iRBD-NOF and controls (P = 1). At follow-up, dysprosody progressed only in iRBD-AOF with abnormal DAT-SPECT (P = 0.03). Conclusion Prosody is impaired in hyposmic but not in normosmic iRBD subjects before the nigrostriatal dopaminergic transmission is affected (Braak stage 2). (c) 2021 International Parkinson and Movement Disorder Society

Background: Patients with synucleinopathies frequently display language abnormalities. However, whether patients with isolated rapid eye movement sleep behavior disorder (iRBD) have prodromal language impairment remains unknown. Objectives: We examined whether the linguistic abnormalities in iRBD can serve as potential biomarkers for conversion to synucleinopathy, including the possible effect of mild cognitive impairment (MCI), speaking task, and automation of analysis procedure. Methods: We enrolled 139 Czech native participants, including 40 iRBD without MCI and 14 iRBD with MCI compared to 40 PD without MCI, 15 PD with MCI, and 30 healthy controls. Spontaneous discourse and story tale narrative were transcribed and linguistically annotated. A quantitative analysis was performed computing 3 linguistic features. Human annotations were compared to fully-automated annotations. Results: Compared to controls, iRBD patients showed poorer content density, reflecting the reduction of content words and modifiers. Both PD and iRBD subgroups with MCI manifested less occurrence of unique words and a higher number of n-grams repetitions, indicating poorer lexical richness. The spontaneous discourse task demonstrated language impairment in iRBD without MCI with an area under the curve of 0.72, while the story tale narrative task better reflected the presence of MCI, discriminating both PD and iRBD subgroups with MCI from controls with an area under the curve of up to 0.81. A strong correlation between manually and automatically computed results was achieved. Conclusions: Linguistic features might provide a reliable automated method for detecting cognitive decline due to prodromal neurodegeneration in subjects with iRBD, providing critical outcomes for future therapeutic trials.

Purpose: This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson’s disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech. Method: Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age-and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions. Results: All LTAS spectral moments including mean, standard deviation, skew-ness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups. Conclusions: Our findings confirmed that LTAS is a suitable approach to objec-tively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria.

The effect of dopaminergic medication on speech has rarely been examined in early-stage Parkinson's disease (PD) and the respective literature is inconclusive and limited by inappropriate design with lack of PD control group. The study aims to examine the short-term effect of dopaminergic medication on speech in PD using patients with good motor responsiveness to levodopa challenge compared to a control group of PD patients with poor motor responsiveness. A total of 60 early-stage PD patients were investigated before (OFF) and after (ON) acute levodopa challenge and compared to 30 age-matched healthy controls. PD patients were categorised into two clinical subgroups (PD responders vs. PD nonresponders) according to the comparison of their motor performance based on movement disorder society-unified Parkinson's disease rating scale, part Ill. Seven distinctive parameters of hypokinetic dysarthria were examined using quantitative acoustic analysis. We observed increased monopitch (p> 0.01), aggravated monoloudness (p> 0.05) and longer duration of stop consonants (p> 0.05) in PD compared to healthy controls, confirming the presence of hypokinetic dysarthria in early PD. No speech alterations from OFF to ON state were revealed in any of the two PD groups and speech dimensions investigated including monopitch, monoloudness, imprecise consonants, harsh voice, slow sequential motion rates, articulation rate, or inappropriate silences, although a subgroup of PD responders manifested obvious improvement in motor function after levodopa intake (p> 0.001). Since the short-term usage of levodopa does not easily affect voice and speech performance in PD, speech assessment may provide a medication state-independent motor biomarker of PD.

While speech disorder represents an early and prominent clinical feature of atypical parkinsonian syndromes such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), little is known about the sensitivity of speech assessment as a potential diagnostic tool. Speech samples were acquired from 215 subjects, including 25 MSA, 20 PSP, 20 Parkinson’s disease participants, and 150 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analysis of 26 speech dimensions related to phonation, articulation, prosody, and timing. A semi-supervised weighting-based approach was then applied to find the best feature combinations for separation between PSP and MSA. Dysarthria was perceptible in all PSP and MSA patients and consisted of a combination of hypokinetic, spastic, and ataxic components. Speech features related to respiratory dysfunction, imprecise consonants, monopitch, slow speaking rate, and subharmonics contributed to worse performance in PSP than MSA, whereas phonatory instability, timing abnormalities, and articulatory decay were more distinctive for MSA compared to PSP. The combination of distinct speech patterns via objective acoustic evaluation was able to discriminate between PSP and MSA with very high accuracy of up to 89% as well as between PSP/MSA and PD with up to 87%. Dysarthria severity in MSA/PSP was related to overall disease severity. Speech disorders reflect the differing underlying pathophysiology of tauopathy in PSP and α-synucleinopathy in MSA. Vocal assessment may provide a low-cost alternative screening method to existing subjective clinical assessment and imaging diagnostic approaches.

Purpose: This study aimed to evaluate the reliability of different approaches for estimating the articulation rates in connected speech of Parkinsonian patients with different stages of neurodegeneration compared to healthy controls. Method: Monologues and reading passages were obtained from 25 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 25 de novo patients with Parkinson's disease (PD), 20 patients with multiple system atrophy (MSA), and 20 healthy controls. The recordings were subsequently evaluated using eight syllable localization algorithms, and their performances were compared to a manual transcript used as a reference. Results: The Google & Pyphen method, based on automatic speech recognition followed by hyphenation, outperformed the other approaches (automated vs. hand transcription: r > .87 for monologues and r > .91 for reading passages, p < .001) in precise feature estimates and resilience to dysarthric speech. The Praat script algorithm achieved sufficient robustness (automated vs. hand transcription: r > .65 for monologues and r > .78 for reading passages, p < .001). Compared to the control group, we detected a slow rate in patients with MSA and a tendency toward a slower rate in patients with iRBD, whereas the articulation rate was unchanged in patients with early untreated PD. Conclusions: The state-of-the-art speech recognition tool provided the most precise articulation rate estimates. If speech recognizer is not accessible, the freely available Praat script based on simple intensity thresholding might still provide robust properties even in severe dysarthria. Automated articulation rate assessment may serve as a natural, inexpensive biomarker for monitoring disease severity and a differential diagnosis of Parkinsonism

Background and objectives: Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy. Methods: We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis. Results: Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002).

Substantial variability and severity of dysarthric patterns across Parkinson's disease (PD) patients may reflect distinct phenotypic differences. We aimed to compare patterns of speech disorder in early-onset PD (EOPD) and late-onset PD (LOPD) in drug-naive patients at early stages of disease. Speech samples were acquired from a total of 96 participants, including two subgroups of 24 de-novo PD patients and two subgroups of 24 age- and sex-matched young and old healthy controls. The EOPD group included patients with age at onset below 51 (mean 42.6, standard deviation 6.1) years and LOPD group patients with age at onset above 69 (mean 73.9, standard deviation 3.0) years. Quantitative acoustic vocal assessment of 10 unique speech dimensions related to respiration, phonation, articulation, prosody, and speech timing was performed. Despite similar perceptual dysarthria severity in both PD subgroups, EOPD showed weaker inspirations (p = 0.03), while LOPD was characterized by decreased voice quality (p = 0.02) and imprecise consonant articulation (p = 0.03). In addition, age-independent occurrence of monopitch (p < 0.001), monoloudness (p = 0.008), and articulatory decay (p = 0.04) was observed in both PD subgroups. The worsening of consonant articulation was correlated with the severity of axial gait symptoms (r = 0.38, p = 0.008). Speech abnormalities in EOPD and LOPD share common features but also show phenotype-specific characteristics, likely reflecting the influence of aging on the process of neurodegeneration. The distinct pattern of imprecise consonant articulation can be interpreted as an axial motor symptom of PD.

We read with great interest the recent study by Garcia et al., which showed differing patterns of dysarthria in Parkinson's disease (PD) subgroups with and without mild cognitive impairment (PD-MCI and PD-nMCI, respectively) across two speaking tasks with low (reading) and high (retelling) processing demands. To complement the data and overcome some of the noted limitations such as a requirement for replication, missing within-group comparisons to assess direct contrasts between speaking tasks, unavailable measure of intensity, and potential confounding effect of dopaminergic medication, we investigated the effect of cognitive impairment on motor speech performance in de-novo, drug-naive PD with a similar study design.

Background: The relevance of formant-based measures has been noted across a spectrum of medical, technical, and linguistic applications. Therefore, the primary aim of the study was to evaluate the effect of ageing on vowel articulation, as the previous research revealed contradictory findings. The secondary aim was to provide normative acoustic data for all Czech monophthongs. Methods: The database consisted of 100 healthy speakers (50 men and 50 women) aged between 20 and 90. Acoustic characteristics, including vowel duration, vowel space area (VSA), fundamental frequency (fo), and the first to fourth formant frequencies (F1−F4) of 10 Czech vowels were extracted from a reading passage. In addition, the articulation rate was calculated from the entire duration of the reading passage. Results: Age-related changes in pitch were sex-dependent, while age-related alterations in F2/a/, F2/u/, VSA, and vowel duration seemed to be sex-independent. In particular, we observed a clear lowering of fo with age for women, but no change for men. With regard to formants, we found lowering of F2/a/ and F2/u/ with increased age, but no statistically significant changes in F1, F3, or F4 frequencies with advanced age. Although the alterations in F1 and F2 frequencies were rather small, they appeared to be in a direction against vowel centralization, resulting in a significantly greater VSA in the older population. The greater VSA was found to be related partly to longer vowel duration. Conclusions: Alterations in vowel formant frequencies across several decades of adult life appear to be small or in a direction against vowel centralization, thus indicating the good preservation of articulatory precision in older speakers.

Little is known about the minimum sample length required for the stable acoustic assessment of speech in Parkinson's disease (PD). This study aimed to investigate the effect of the duration of the reading passage on the determination of reliable acoustic patterns in individuals with PD treated with subthalamic nucleus deep brain stimulation. A phonetically balanced reading text of 313 words was collected from 32 Czech persons with PD, and 32 age- and sex-matched healthy controls. The reading passage was segmented to produce ten sub-texts of increasing length ranging from a one- to a ten-segment-long sub-text. An error rate analysis was used to estimate the required stabilization value by evaluating the differences between the sub-texts and the entire text across seven hypokinetic dysarthria features. The minimum length of a reading passage equal to 128 words was found to be necessary for acoustic assessment, with similar lengths being required for the controls (120 words) and the two PD subgroups, including Parkinsonian individuals with a mild (126 words) and moderate (128 words) dysarthria severity. The current study provides important guidelines for the necessary sample length for future expert instrumental dysarthria assessments and assists in decreasing the time required for clinical speech evaluations.

Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech subsystems. There is widespread cross-discipline use of speech recordings for diagnostic and research purposes, despite which there are no specific guidelines for a standardized method. This review aims to combine the specific clinical presentations of patients with movement disorders, existing acoustic assessment protocols, and technological advances in capturing speech to provide a basis for future research in this field and to improve the consistency of clinical assessments. We considered 3 areas: the recording environment (room, seating, background noise), the recording process (instrumentation, vocal tasks, elicitation of speech samples), and the acoustic outcome data. Four vocal tasks, namely, sustained vowel, sequential and alternating motion rates, reading passage, and monologues, are integral aspects of motor speech assessment. Fourteen acoustic vocal speech features, including their hypothesized pathomechanisms with regard to typical occurrences in hypokinetic or hyperkinetic dysarthria, are hereby recommended for quantitative exploratory analysis. Using these acoustic features and experimental speech data, we demonstrated that the hyperkinetic dysarthria group had more affected speech dimensions compared with the healthy controls than had the hypokinetic speakers. Several contrasting speech patterns between both dysarthrias were also found. This article is the first attempt to provide initial recommendations for a standardized way of recording the voice and speech of patients with hypokinetic or hyperkinetic dysarthria; thus allowing clinicians and researchers to reliably collect, acoustically analyze, and compare vocal data across different centers and patient cohorts.

We thank Asci et al. for raising the subsequent discussion on the use of machine learning, the type of recording devices and speaking tasks in the field of motor speech disorders. We agree that multidimensional analysis via machine learning could improve sensitivity/specificity in the quantification of specific dysarthria-related aspects. However, the machine learning approach based on high-dimensional data requires a considerable sample size for reliable estimates, whereas studies on motor speech disorder are typically restricted by small sample sizes available (usually less than 100 subjects per group). The disadvantage of many features applied is the high risk for overfitting.

We read with great interest the recent study by Suppa et al., which performed voice analysis in patients with essential tremor (ET) with (ETVT+) and without (ETVT-) clinically overt voice tremor based on power spectral analysis and machine learning. Traditional spectral analysis showing a prominent oscillatory activity peak at 2–6 Hz in ETVT+ seems to be in agreement with a recent study reporting the occurrence of both low (<4 Hz) and medium (4–7 Hz) vocal tremor in ET.

Objective: This multilanguage study used simple speech recording and high-end pattern analysis to provide sensitive and reliable noninvasive biomarkers of prodromal versus manifest alpha-synucleinopathy in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and early-stage Parkinson disease (PD). Methods: We performed a multicenter study across the Czech, English, German, French, and Italian languages at 7 centers in Europe and North America. A total of 448 participants (337 males), including 150 with iRBD (mean duration of iRBD across language groups 0.5-3.4 years), 149 with PD (mean duration of disease across language groups 1.7-2.5 years), and 149 healthy controls were recorded; 350 of the participants completed the 12-month follow-up. We developed a fully automated acoustic quantitative assessment approach for the 7 distinctive patterns of hypokinetic dysarthria. Results: No differences in language that impacted clinical parkinsonian phenotypes were found. Compared with the controls, we found significant abnormalities of an overall acoustic speech severity measure via composite dysarthria index for both iRBD (p = 0.002) and PD (p < 0.001). However, only PD (p < 0.001) was perceptually distinct in a blinded subjective analysis. We found significant group differences between PD and controls for monopitch (p < 0.001), prolonged pauses (p < 0.001), and imprecise consonants (p = 0.03); only monopitch was able to differentiate iRBD patients from controls (p = 0.004). At the 12-month follow-up, a slight progression of overall acoustic speech impairment was noted for the iRBD (p = 0.04) and PD (p = 0.03) groups. Interpretation: Automated speech analysis might provide a useful additional biomarker of parkinsonism for the assessment of disease progression and therapeutic interventions.

Objective: Voice tremor represents a common but frequently overlooked clinical feature of neurological disease. Therefore, we aimed to quantitatively and objectively assess the characteristics of voice tremor in a large sample of patients with various progressive neurological diseases. Methods: Voice samples were acquired from 240 patients with neurological disease and 40 healthy controls. The robust automated method was designed, allowing precise tracking of multiple tremor frequencies and distinguish pathological from the physiological tremor. Results: Abnormal tremor was revealed in Huntington’s disease (65%), essential tremor (50%), multiple system atrophy (40%), cerebellar ataxia (40%), amyotrophic lateral sclerosis (40%), progressive supranuclear palsy (25%), Parkinson’s disease (20%), cervical dystonia (10%), and multiple sclerosis (8%) but not in controls. Low-frequency voice tremor (< 4 Hz) was common in all investigated diseases, whereas medium tremor frequencies (4–7 Hz) were specific for movement disorders of Parkinson’s disease, multiple system atrophy, essential tremor, and cervical dystonia. Conclusions: Careful estimation of vocal tremor may help with accurate diagnosis and tailored treatment. Significance: This study provides (i) more insights into the pathophysiology of vocal tremor in a wide range of neurological diseases and (ii) an accurate method for estimation of vocal tremor suitable for clinical practice.

Purpose: The purpose of this article is to provide a performance comparison of available algorithms for the automated evaluation of oral diadochokinesis using speech samples from patients with amyotrophic lateral sclerosis (ALS). Method: Four different algorithms based on a wide range of signal processing approaches were tested on a sequential motion rate /pa/-/ta/-/ka/ syllable repetition paradigm collected from 18 patients with ALS and 18 age and gender-matched healthy controls. Results: The best temporal detection of syllable position for a 10 ms tolerance value was achieved for ALS patients using a traditional signal processing approach based on a combination of filtering in the spectrogram, Bayesian detection, and polynomial thresholding with an accuracy rate of 74.4%, and for healthy controls using a deep learning approach with an accuracy rate of 87.6%. Compared to healthy controls, a slow diadochokinetic rate (p < 0.001) and diadochokinetic irregularity (p < 0.01) were detected in ALS patients. Conclusions: The approaches using deep learning or multiple-step combinations of advanced signal processing methods provided a more robust solution to the estimation of oral DDK variables than did simpler approaches based on the rough segmentation of the signal envelope. The automated acoustic assessment of oral diadochokinesis shows excellent potential for monitoring bulbar disease progression in individuals with ALS.

Clear speech refers to intentionally modifying conversational speech to maximise intelligibility. This study aimed to compare the speech behaviour of patients with progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and Parkinson’s disease (PD) under conversational and clear speech conditions to gain greater pathophysiological insight. A total of 68 participants including 17 PD, 17 MSA, 17 PSP and 17 healthy controls (HC) performed two readings of the same standardized passage. During the first reading, participants were instructed to read the text in an ordinary way, while during the second reading to read the text as clearly as possible. Acoustic analyses were based upon measurements of mean loudness, loudness variability, pitch variability, vowel articulation, articulation rate and speech severity. During clear speech production, PD patients were able to achieve improvements mainly in loudness (p < 0.05) and pitch variability (p < 0.001), leading to a reduction in overall speech severity (p < 0.001), whereas PSP and MSA patients were able to modulate only articulation rate (p < 0.05). Contrary to HC and PD groups, which slowed or maintained articulation rate, PSP and MSA groups employed a markedly faster articulation rate under the clear speech condition indicating an opposing approach to speech adaptation. Patients with atypical Parkinsonism showed a different strategy to intentionally improve their speech performance following a simple request to produce speech more clearly compared to PD, suggesting important therapeutic implications for speech rehabilitation management.

Hypokinetic dysarthria is a multidimensional impairment affecting all main speech subsystems with variable patterns and severity across individual Parkinson's disease (PD) patients. We can thus assume that inter-individual abnormal speech patterns are related to the various clinical subtypes of PD with different prominent motor symptoms. The aim of this cross-sectional study was to compare speech disorder between patients with the postural instability/gait difficulty (PIGD) and tremor-dominant (TD) motor phenotypes of PD. Speech samples were acquired from a total of 63 participants, including 21 PIGD patients, 21 TD patients, and 21 healthy controls. Quantitative acoustic vocal assessment of 12 unique speech dimensions related to phonation, vocal tremor, oral diadochokinesis, articulation, prosody and speech timing was performed. Speech impairment was more pronounced in the PIGD group than in the TD group, with an area under the curve of 0.76. Patients in the PIGD group manifested abnormalities in pitch breaks, articulatory decay, decreased rate of follow-up speech segments and inappropriate silences, apart from monopitch and irregular AMR that were affected in TD group as well. An abnormal vocal tremor was present in only 10% of PD patients, with no differences between the PD phenotypes. We found a correlation between non-motor symptom severity and speech timing (r = - 0.40,p = 0.009). The present study demonstrates that speech disorder reflects the underlying motor phenotypes. Vocal tremor appeared to be an isolated phenomenon that does not share similar pathophysiology with limb tremor.

Although dysarthria is a common pattern in multiple sclerosis (MS), the contribution of specific brain areas to key factors of dysarthria remains unknown. Speech data were acquired from 123 MS patients with Expanded Disability Status Scale (EDSS) ranging from 1 to 6.5 and 60 matched healthy controls. Results of computerized acoustic analyses of subtests on spastic and ataxic aspects of dysarthria were correlated with MRI-based brain volume measurements. Slow articulation rate during reading was associated with bilateral white and grey matter loss whereas reduced maximum speed during oral diadochokinesis was related to greater cerebellar involvement. Articulation rate showed similar correlation to whole brain atrophy (r=0.46, p<0.001) as the standard clinical scales such as EDSS (r=-0.45, p<0.001). Our results support the critical role of the pyramidal tract and cerebellum in the modification of motor speech timing in MS.

Although motor speech disorders represent an early and prominent clinical feature of multiple system atrophy (MSA), the potential usefulness of speech assessment as a diagnostic tool has not yet been explored. This cross-sectional study aimed to provide a comprehensive, objective description of motor speech function in the parkinsonian (MSA-P) and cerebellar (MSA-C) variants of MSA. Speech samples were acquired from 80 participants including 18 MSA-P, 22 MSA-C, 20 Parkinson's disease (PD), and 20 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on quantitative acoustic analysis of 14 speech dimensions. A mixed type of dysarthria involving hypokinetic, ataxic and spastic components was found in the majority of MSA patients independent of phenotype. MSA-P showed significantly greater speech impairment than PD, and predominantly exhibited harsh voice, imprecise consonants, articulatory decay, monopitch, excess pitch fluctuation and pitch breaks. MSA-C was dominated by prolonged phonemes, audible inspirations and voice stoppages. Inappropriate silences, irregular motion rates and overall slowness of speech were present in both MSA phenotypes. Speech features allowed discrimination between MSA-P and PD as well as between both MSA phenotypes with an area under curve up to 0.86. Hypokinetic, ataxic and spastic dysarthria components in MSA were correlated to the clinical evaluation of rigidity, cerebellar and bulbar/pseudobulbar manifestations, respectively. Distinctive speech alterations reflect underlying pathophysiology in MSA. Objective speech assessment may provide an inexpensive and widely applicable screening instrument for differentiation of MSA and PD from controls and among subtypes of MSA.

Pallidal deep-brain stimulation of the internal globus pallidus (GPi-DBS) is an effective treatment for dystonia. However, GPi-DBS may cause important stimulation-induced side effects such as hypokinetic dysarthria, which is particularly manifested by articulation rate abnormalities. However, little data regarding the effect of the location of the electrode and stimulation parameters for pallidal stimulation on articulation rate in dystonia is available. Speech data were acquired from 18 dystonic patients with GPi-DBS and 18 matched healthy controls. Each of dystonic patients was tested twice within 1 day in both the GPi-DBS ON and GPi-DBS OFF stimulation conditions. Compared to healthy controls, the decreased diadochokinetic rate and slower articulation rate in dystonic patients were observed in both stimulation conditions. No significant differences in speech rate measures between stimulation conditions were detected with no relation to contact localization and stimulation intensity. Our findings do not support the use articulation rate as a surrogate marker of stimulation-induced changes to the speech apparatus in dystonia.

The aim of this study was to evaluate associations of motor and non-motor symptoms with dopamine transporter binding in prodromal stage of synucleinopathies. We examined 74 patients with idiopathic REM sleep behavior disorder (RBD), which is a prodromal synucleinopathy, and 39 controls using Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment, University of Pennsylvania Smell Identification Test (UPSIT), Farnsworth-Munsell 100 hue test, orthostatic test, Scales for Outcomes in PD-Autonomic, Beck depression inventory-II, State-Trait Anxiety Inventory, and video-polysomnography. Electromyographic muscle activity during REM sleep was quantified according to Sleep Innsbruck-Barcelona criteria. In 65 patients, dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging was performed, putaminal binding ratio was calculated and scans were classified as normal, borderline, or abnormal. Compared to controls, RBD patients had significantly more severe scores in all examined tests. Patients with abnormal DAT-SPECT had higher MDS-UPDRS motor score (p = 0.006) and higher prevalence of orthostatic hypotension (p = 0.008). Putamina I binding ratio was positively associated with UPSIT score (p =0.03) and negatively associated with tonic (p = 0.003) and phasic (p = 0.01) muscle activity during REM sleep. These associations likely reflect simultaneous advancement of underlying pathology in substantia nigra and susceptible brainstem and olfactory nuclei in prodromal synucleinopathy.

Background: Impairment of cognition and speech are common in multiple sclerosis (MS) patients, but their relationship is not well understood. Objective: To describe the relationship between articulation rate characteristics and processing speed and to investigate the potential role of objective speech analysis for the detection of cognitive decline in MS. Methods: A total of 122 patients with clinically definite MS were included in this cross-sectional pilot study. Patients underwent three speaking tasks (oral diadochokinesis, reading text and monologue) and assessment of processing speed (Symbol Digit Modalities Test [SDMT], Paced Auditory Serial Addition Test-3 s [PASAT-3]). Association between articulation rate and cognition was analyzed using linear regression analysis. We estimated the area under the receiver operating characteristics curves (AUC) to evaluate the predictive accuracy of articulation rate measures for the detection of abnormal processing speed. Results: We observed an association between articulation rate and cognitive measures (rho = 0.45-0.58; p < 0.001). Faster reading speed by one word per second was associated with an 18.7 point (95% confidence interval ICI] 14.9-22.5) increase of the SDMT score and 14.7 (95% CI 8.9-20.4) point increase of PASAT-3 score (both p < 0.001). AUC values of articulation rate characteristics for the identification of processing speed impairment ranged between 0.67 and 0.79. Using a cutoff of 3.10 in reading speed, we were able to identify impairment in both the SDMT and PASAT-3 with 91% sensitivity and 54% specificity. Conclusion: Slowed articulation rate is strongly associated with processing speed decline. Objective quantitative speech analysis identified patients with abnormal cognitive performance. (C) 2019 Elsevier Ltd. All rights reserved.

Background: Motor speech disorders in multiple sclerosis (MS) are poorly understood and their quantitative, objective acoustic characterization remains limited. Additionally, little data regarding relationships between the severity of speech disorders and neurological involvement in MS, as well as the contribution of pyramidal and cerebellar functional systems on speech phenotypes, is available. Methods: Speech data were acquired from 141 MS patients with Expanded Disability Status Scale (EDSS) ranging from 1 to 6.5 and 70 matched healthy controls. Objective acoustic speech assessment including subtests on phonation, oral diadochokinesis, articulation and prosody was performed. Results: The prevalence of dysarthria in our MS cohort was 56% while the severity was generally mild and primarily consisted of a combination of spastic and ataxic components. Prosodic-articulatory disorder presenting with monopitch, articulatory decay, excess loudness variations and slow rate was the most salient. Speech disorders reflected subclinical motor impairment with 78% accuracy in discriminating between a subgroup of asymptomatic MS (EDSS < 2.0) and control speakers. Speech disorder severity was related to the severity of neurological involvement. Decreased articulation rate was moderately correlated to EDSS as well as all subtests of the multiple sclerosis functional composite. The strongest correlation was observed between irregular oral diadochokinesis and the 9-Hole Peg Test (r = -0.65, p < 0.001). Irregular oral diadochokinesis and excess loudness variations significantly separated pure pyramidal and mixed pyramidal-cerebellar MS subgroups. Conclusions: Automated speech analyses may provide valuable biomarkers of disease progression in MS as dysarthria represents common and early manifestation that reflects disease disability and underlying pyramidal-cerebellar pathophysiology.

Background: Although pallidal deep brain stimulation (GPi-DBS) is an effective treatment for dystonia, it may cause important stimulation-induced side-effects such as hypokinetic dysarthria or stuttering. However, the reasons behind the occurrence of these side-effects remain unknown. Objective: To objectively investigate the impact of GPi-DBS on patients with dystonia on speech fluency, intelligibility, and key aspects of hyperkinetic and hypokinetic dysarthria. Methods: Speech was systematically evaluated in 19 dystonic patients with GPi-DBS. Each patient was tested twice within one day in both the GPi-DBS ON and GPi-DBS OFF stimulation conditions. A control sample of 19 matched healthy speakers underwent the same speech assessment. Results: We observed an improvement of hyperkinetic dysarthria symptoms in 47% and an aggravation of hypokinetic dysarthria symptoms in 26% of patients with the GPi-DBS switched ON. A higher stimulus intensity was found in a group of patients in whom the hypokinetic dysarthria worsened with the GPi-DBS ON when compared to other dystonic patients (p=0.02). Furthermore, we revealed a significant increase of dysfluent words in the GPi-DBS ON when compared to OFF condition (p=0.001) associated with the shorter distance of the active contact localization along the medio-lateral direction (r=-0.70, p=0.005). Conclusion: This study provides evidence of dualistic effects of GPi-DBS on speech in dystonia manifested as an improvement of hyperkinetic or a deterioration of hypokinetic dysarthria. Our findings suggest that lower stimulation parameters and placement of active contacts more laterally in the internal globus pallidus should be preferred to avoid the possible side effects of hypokinetic dysarthria and dysfluency.

Although smartphone technology provides new opportunities for the recording of speech samples in everyday life, its ability to capture prodromal speech impairment in persons with a high risk of developing Parkinson's disease (PD) has never been investigated. Speech data were acquired through a smartphone as well as a professional microphone with a linear frequency response from 50 participants with a rapid eye movement sleep behavior disorder that are at a high risk of developing PD and related neurodegenerative disorders. Additionally, recordings of 30 newly diagnosed, untreated PD patients and 30 healthy participants were evaluated. Acoustic assessment of 11 speech dimensions representing the key aspects of hypokinetic dysarthria in the early stages of PD was performed. Smartphone allowed the detection of speech abnormalities in participants with a high risk of developing PD. Acoustic measurements related to fundamental frequency variability, duration of pause intervals, and rate of speech timing extracted from spontaneous speech were sufficiently sensitive to significantly separate groups (area under curve of 0.85 between PD and controls) and showed very strong correlation and reliability between the professional microphone and the smartphone. Speech-based biomarkers collected through smartphones may have the potential to revolutionize the diagnostic process in neurodegenerative diseases and improve stratification for future neuroprotective therapy in PD.

For generations, the evaluation of speech abnormalities in neurodegenerative disorders such as Parkinson’s disease (PD) has been limited to perceptual tests or user-controlled laboratory analysis based upon rather small samples of human vocalizations. Our study introduces a fully automated method that yields significant features related to respiratory deficits, dysphonia, imprecise articulation and dysrhythmia from acoustic microphone data of natural connected speech for predicting early and distinctive patterns of neurodegeneration. We compared speech recordings of 50 subjects with rapid eye movement sleep behaviour disorder (RBD), 30 newly diagnosed, untreated PD patients and 50 healthy controls, and showed that subliminal parkinsonian speech deficits can be reliably captured even in RBD patients, which are at high risk of developing PD or other synucleinopathies. Thus, automated vocal analysis should soon be able to contribute to screening and diagnostic procedures for prodromal parkinsonian neurodegeneration in natural environments.

It is currently unknown whether speech and limb motor effectors in Parkinson’s disease (PD) are controlled by similar underlying brain processes. Based on computerized objective analysis, the aim of this study was to evaluate potential correlation between speech and mechanical tests of upper limb motor function. Speech and upper limb motor tests were performed in 22 PD patients and 22 healthy controls. Quantitative acoustic analyses of eight key speech dimensions of hypokinetic dysarthria, including quality of voice, sequential motion rates, consonant articulation, vowel articulation, average loudness, loudness variability, pitch variability, and number of pauses, were performed. Upper limb movements were assessed using the motor part of the Unified Parkinson’s Disease Rating Scale, contactless three-dimensional motion capture system, blinded expert evaluation, and the Purdue Pegboard Test. Significant relationships were observed between the quality of voice assessed by jitter and amplitude decrement of finger tapping (r = 0.61, p = 0.003), consonant articulation evaluated using voice onset time and expert rating of finger tapping (r = 0.60, p = 0.003), and number of pauses and Purdue Pegboard Test score (r = 0.60, p = 0.004). The current study supports the hypothesis that speech impairment in PD shares, at least partially, similar pathophysiological processes with limb motor dysfunction. Vocal fold vibration irregularities appeared to be influenced by mechanisms similar to amplitude decrement during repetitive limb movements. Consonant articulation deficits were associated with decreased manual dexterity and movement speed, likely reflecting fine motor control involvement in PD.

Distinct speech characteristics that may aid in differentiation between Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) remain tremendously under-explored. Here, the patterns and degree of consonant articulation deficits across voiced and voiceless stop plosives in 16 PD, 16 PSP, 16 MSA and 16 healthy control speakers were evaluated using acoustic and perceptual methods. Imprecise consonant articulation was observed across all Parkinsonian groups. Voice onset time of voiceless plosives was more prolonged in both PSP and MSA compared to PD, presumably due to greater severity of dysarthria and slower articulation rate. Voice onset time of voiced plosives was significantly shorter only in MSA, likely as a consequence of damage to cerebellar structures. In agreement with the reduction of pre-voicing, MSA manifested increased number of voiced plosives misclassified as voiceless at perceptual evaluation. Timing of articulatory movements may provide important clues about the pathophysiology of underlying disease. (C) 2016 Elsevier Inc. All rights reserved.

Parkinson’s disease (PD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA) are distinctive neurodegenerative disorders, which manifest similar motor features. Their differentiation is crucial but difficult. Dysfunctional speech, especially dysprosody, is a common symptom accompanying PD, PSP, and MSA from early stages. We hypothesized that automated analysis of monologue could provide speech patterns distinguishing PD, PSP, and MSA. We analyzed speech recordings of 16 patients with PSP, 20 patients with MSA, and 23 patients with PD. Our findings revealed that deviant pause production differentiated between PSP, MSA, and PD. In addition, PSP showed greater deficits in speech respiration when compared to MSA and PD. Automated analysis of connected speech is easy to administer and could provide valuable information about underlying pathology for differentiation between PSP, MSA, and PD.

Recently, based on voice cepstral analysis, (Benba et al, 2016) have reported discrimination between patientswith Parkinson’s disease and different neurological disorderswith high classificationaccuracyup to 90%. Using the same approach, wewere able to experimentally separate two groups of normal healthy speakers with 96% classification accuracy and showed that the method proposed by Benba et al. may not be appropriate for discrimination between different neurological diseases. In particular, voice cepstral analysis appears to be sensitive to specific speakers’ characteristics such as gender or age. Our findings emphasize several assumptions that can be considered as basic necessary conditions for research reporting speech data in progressive neurodegenerative diseases.

The indexical function of speech prosody signals the membership of a speaker in a social group. The factors of age and gender are relatively easy to establish but their reflection in speech characteristics can be less straightforward as they interact with other social aspects. Therefore, diverse speaker communities should be investigated with the aim of their subsequent comparison. Our study provides data for the population of adult speakers of Czech – a West Slavic language of Central Europe. The sample consists of six age groups (20 to 80 years of age) with balanced representation of gender. The search for age and gender related attributes covered both global acoustic descriptors and linguistically informed prosodic feature extraction. Apart from commonly used measures and methods we also exploited Legendre polynomials, k-means clustering and a newly designed Cumulative Slope Index (CSI). The results specify general deceleration of articulation rate with age and lowering of F0 in aging Czech women, and reveal an increase in CSI of both F0 tracks and intensity curves with age. Furthermore, various melodic shapes were found to be distributed unequally across the age groups.

Článek se zabývá dlouhodobou studií věkově závislých charakteristik akustických řeči v promluvách získaných z filmových databází zaznamenaných v letech 1985 až 2014. Věková závislost fonace je analyzována pomocí parametrů základní frekvence, jitteru a shimmeru. Pro posouzení artikulace je použito poměru formantů u vokálů a délka exploze palatálních souhlásek. Pro prozódii nebyly nalezeny žádné charakteristiky, které by byly použitelné na základě analýzy filmových archivů. Výsledky věkových závislostí jsou v souladu s předpoklady a závěry uvedenými v literatuře. Tento pilotní projekt potvrzuje možnost tvorby hodnotné studie z veřejně dostupných zdrojů.

Although speech disorders represent an early and common manifestation of Parkinson’s disease (PD), little is known about their progression and relationship to dopaminergic replacement therapy. The aim of the current study was to examine longitudinal motor speech changes after the initiation of pharmacotherapy in PD. Fifteen newly-diagnosed, untreated PD patients and ten healthy controls of comparable age were investigated. PD patients were tested before the introduction of antiparkinsonian therapy and then twice within the following 6 years. Quantitative acoustic analyses of seven key speech dimensions of hypokinetic dysarthria were performed. At baseline, PD patients showed significantly altered speech including imprecise consonants, monopitch, inappropriate silences, decreased quality of voice, slow alternating motion rates, imprecise vowels and monoloudness. At follow-up assessment, preservation or slight improvement of speech performance was objectively observed in two-thirds of PD patients within the first 3–6 years of dopaminergic treatment, primarily associated with the improvement of stop consonant articulation. The extent of speech improvement correlated with l-dopa equivalent dose (r = 0.66, p = 0.008) as well as with reduction in principal motor manifestations based on the Unified Parkinson’s Disease Rating Scale (r = −0.61, p = 0.02), particularly reflecting treatment-related changes in bradykinesia but not in rigidity, tremor, or axial motor manifestations. While speech disorders are frequently present in drug-naive PD patients, they tend to improve or remain relatively stable after the initiation of dopaminergic treatment and appear to be related to the dopaminergic responsiveness of bradykinesia.

Objective: Patients with idiopathic rapid eye movement sleep behaviour disorder (RBD) are at substantial risk developing Parkinson’s disease (PD) or related neurodegenerative disorders. Speech is an important indicator of motor function and movement coordination and therefore may be an extremely sensitive early marker of changes due to prodromal neurodegeneration. Methods: Speech data were acquired from 16 RBD subjects and 16 age- and sex-matched healthy control subjects. Objective acoustic assessment of 15 speech dimensions representing various phonatory, articulatory and prosodic deviations was performed. Statistical models were applied to characterize speech disorders in RBD and estimate sensitivity and specificity in differentiating between RBD and control subjects. Results: Some form of speech impairment was revealed in 88% of RBD subjects. Articulatory deficits were the most prominent findings in RBD. In comparison to controls, RBD group showed significant alteration in irregular alternating motion rates (p=0.009) and articulatory decay (p=0.01). The combination of four distinctive speech dimensions including aperiodicity, irregular alternating motion rates, articulatory decay and dysfluency led to 96% sensitivity and 79% specificity in discriminating between RBD and control subjects. Speech impairment was significantly more pronounced in RBD subjects with the motor score of the Unified Parkinson's Disease Rating Scale greater than 4 points when compared to other RBD individuals. Conclusion: Simple quantitative speech motor measures may be suitable for the reliable detection of prodromal neurodegeneration in subjects with RBD, and therefore may provide important outcomes for future therapy trials.

Objectives: Although rehabilitative training is a necessary adjunct in the management of gait ataxia, it remains unknown whether the possible beneficial effect of intensive coordinative training may translate to activities of daily living, which are closely connected with postural alignment. The aim of the present study was to examine the effectiveness of a 2-week intensive coordinative motor training on speech production. Methods: Speech and motor performances in a cohort of 10 individuals with cerebellar degeneration were examined three times; before the introduction of training; directly and four weeks after the last training session. Each patient was instructed to perform a speaking task of fast syllable repetition and monologue. Objective acoustic analyses were used to investigate six key aspects of speech production disturbed in ataxic dysarthria including accuracy of consonant articulation, accuracy of vowel articulation, irregular alternating motion rates, prolonged phonemes, slow alternating motion rates and inappropriate segmentation. Results: We found that coordinative training had a mild beneficial effect on speech in cerebellar patients. Immediately after the last training session, slight speech improvements were evident in all 10 patient. Furthermore, follow-up assessment performed 4 weeks later revealed that 90% of the patients showed better speech performance than before initiation of the therapy.

Although the full etiological nature of developmental stuttering is still unknown, the key role of disturbed basal ganglia function along with the role of dopamine system have been thoroughly discussed. Therefore, the aim of the current study was to survey the characteristics of neurogenic stuttering based on patients with Parkinson's disease (PD) and compared them to the characteristics of developmental stuttering. The database consists of 14 persons with developmental stuttering (pDS) and 14 patients with idiopathic PD. In addition, 14 sex-matched healthy controls (HC) were recruited. Each participant was instructed to perform two-minutes long monolog on given topic. Analysis of dysfluency was conducted according to the Lidcombe behavioral taxonomy of stuttering. Our results showed that pDS subjects manifested significantly more vocal blocs (p 0.01) and filling words (p 0.05) compared to PD patients. On the other hand, the neurogenic stuttering of PD was mainly characterized by incomplete syllable repetitions (p 0.05) and prolongations (p 0.01) as compared to HC. In conclusion, our study demonstrates that there seems to be more differences rather than similarities between neurogenic and developmental stuttering.

Although speech dysfluencies have been hypothesized to be associated with abnormal function of dopaminergic system, the effects of dopaminergic medication on speech fluency in Parkinson's disease (PD) have not been systematically studied. The aim of the present study was, therefore, to investigate the long-term effect of dopaminergic medication on speech fluency in PD. Fourteen de novo PD patients with no history of developmental stuttering and 14 age- and sex-matched healthy controls (HC) were recruited. PD subjects were examined three times; before the initiation of dopaminergic treatment and twice in following 6 years. The percentage of dysfluent words was calculated from reading passage and monolog. The amount of medication was expressed by cumulative doses of L-dopa equivalent. After 3-6 years of dopaminergic therapy, PD patients exhibited significantly more dysfluent events compared to healthy subjects as well as to their own speech performance before the introduction of dopaminergic therapy. In addition, we found a strong positive correlation between the increased occurrence of dysfluent words and the total cumulative dose of L-dopa equivalent. Our findings indicate an adverse effect of prolonged dopaminergic therapy contributing to the development of stuttering-like dysfluencies in PD. These findings may have important implication in clinical practice, where speech fluency should be taken into account to optimize dopaminergic therapy.

Huntington’s disease (HD) is an autosomal-dominant neurodegenerative disorder characterized by the impairment of voluntary and involuntary movements, behavioral disorders and cognitive decline. Besides the main motor symptoms, voice and speech disorders have been documented in a large majority of patients with HD. The animal model of pigs is often used in preclinical studies. Although there are obvious differences in the anatomy of the articulation organs between pigs and humans, the same trends in pathophysiological mechanisms can be expected in both grunting and human phonation. The main aim of the study was therefore to design a suitable experiment that would allow for acquisition of a sufficiently long recording of grunting from as many pigs as possible. The second goal was to perform the final version of the experiment in all available pigs and to evaluate the amount and quality of the acquired recordings. The database consists of 17 HD transgenic minipigs and 16 healthy siblings. Tested variants of the experiment, performed on subgroup of four sows, were divided into four subgroups: (a) positive – feeding, (b) positive – sound stimulation, (c) negative – hindering in movement, (d) negative – unpleasant touch. The evaluation of the quality of the elicited recording was performed using audio software where pure pig grunting was selected and all acoustic artefacts deleted. The best results were reached using the experiment in which: (i) a recording device is put on the pig’s body, (ii) the pig is left alone for few minutes in the pen in order to calm down, and (iii) a person enters the room and tries to offer the pig food while walking backwards. As a result, the pig follows the person and grunts. Sufficiently long (20 single grunts or more) and clear recordings were received from 24 out of 33 pigs (73%). The realisation of the experiment is therefore possible.

Although speech disorder is frequently an early and prominent clinical feature of Parkinson's disease (PD) as well as atypical parkinsonian syndromes (APS) such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), there is a lack of objective and quantitative evidence to verify whether any specific speech characteristics allow differentiation between PD, PSP and MSA. Speech samples were acquired from 77 subjects including 15 PD, 12 PSP, 13 MSA and 37 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analysis of 16 speech dimensions. Dysarthria was uniformly present in all parkinsonian patients but was more severe in PSP and MSA than in PD. While PD speakers manifested pure hypokinetic dysarthria, ataxic components were more affected in MSA while PSP subjects demonstrated severe deficits in hypokinetic and spastic elements of dysarthria. Dysarthria in PSP was dominated by increased dysfluency, decreased slow rate, inappropriate silences, deficits in vowel articulation and harsh voice quality whereas MSA by pitch fluctuations, excess intensity variations, prolonged phonemes, vocal tremor and strained-strangled voice quality. Objective speech measurements were able to discriminate between APS and PD with 95% accuracy and between PSP and MSA with 75% accuracy. Dysarthria severity in APS was related to overall disease severity (r=0.54, p=0.006). Dysarthria with various combinations of hypokinetic, spastic and ataxic components reflects differing pathophysiology in PD, PSP and MSA. Thus, motor speech examination may provide useful information in the evaluation of these diseases with similar manifestations.

Huntingtonova nemoc (HN) je vzácné dědičné neurodegenerativní onemocnění mozku charakteristické nekoordinovanými trhavými pohyby těla a snížením mentálních schopností. Vedle hlavních motorických příznaků se poruchy hlasu a řeči vyskytují až u 90 % pacientů. Pro studium nemoci, lze též využít transgenních mini-prasátek. Ačkoli hlasové a artikulační ústrojí mezi prasátkem a člověkem se liší, dají se očekávat podobné trendy v patofyziologii mezi lidských hlasem a chrochtáním prasátek. Cílem studie je návrh vhodného experimentu, který by umožnil nahrání dostatečně dlouhého záznamu chrochtání prasátek od co největšího počtu jedinců. Testované varianty experimentu byly rozděleny do tří podskupin: (a) pozitivní - jídlo, (b) pozitivní - zvuková stimulace, (c) negativní - ignorace. Z výsledků experimentu vyplývá, že nejvíce se osvědčil experiment s pozitivní stimulací jídlem ve známé nádobě s pomocnou zvukovou stimulací. Získání nahrávek s dostatečným počtem zachrochtání je tedy realizovatelné.

Objectives. Although reduced stress is thought to be one of the most deviant speech dimensions in hypokinetic dysarthria associated with Parkinson’s disease (PD), the mechanisms of stress production in PD have not been thoroughly explored by objective methods. The aim of the present study was to quantify the effect of PD on prosodic characteristics and to describe contrastive stress patterns in parkinsonian speech. Methods. The ability of 20 male speakers with early PD and 16 age- and gender-matched healthy controls (HCs) to signal contrastive stress was investigated. Each participant was instructed to unnaturally emphasize five key words while reading a short block of text. Acoustic analyses were based on the measurement of pitch, intensity, and duration. In addition, an innovative measurement termed the stress pattern index (SPI) was designed to mirror the effect of all distinct acoustic cues exploited during stress production. Results. Although PD patients demonstrated a reduced ability to convey contrastive stress, they could still notably increase pitch, intensity, and duration to emphasize a word within a sentence. No differences were revealed between PD and HC stress productions using the measurements of pitch, intensity, duration, and intensity range. However, restricted SPI and pitch range were evident in the PD group. Conclusions. A reduced ability to express stress seems to be the distinctive pattern of hypokinetic dysarthria, even in the early stages of PD. Because PD patients were able to consciously improve their speech performance using multiple acoustic cues, the introduction of speech therapy may be rewarding.

Although motor speech impairment is a common manifestation of Huntington’s disease (HD), its description remains limited. The aim of the current study was therefore to estimate the occurrence and characteristics of speech disorder in HD and to explore the influence of antipsychotic medication on speech performance. Speech samples, including reading passage and monologue, were acquired from 40 individuals diagnosed with HD and 40 age- and sex-matched healthy controls. Objective acoustic analyses were used to evaluate key aspects of speech including vowel articulation, intensity, pitch and timing. A predictive model was constructed to detect the occurrence and most prominent patterns of speech dysfunction in HD. We revealed that 93 % of HD patients manifest some degree of speech impairment. Decreased number of pauses, slower articulation rate, imprecise vowel articulation and excess intensity variations were found to be the most salient patterns of speech dysfunction in HD. We further demonstrated that antipsychotic medication may induce excessive loudness and pitch variations perceptually resembling excess patterns of word stress, and may also accentuate general problems with speech timing. Additionally, antipsychotics induced a slight improvement of vowel articulation. Specific speech alterations observed in HD patients indicate that speech production may reflect the pathophysiology of the disease as well as treatment effects, and may therefore be considered a valuable marker of functional disability in HD.

Parkinsonova nemoc (PN) je neurodegenerativní onemocnění, které přímo souvisí s úbytkem nervových buněk v části mozku nazvané substantia nigra. Pro zmírnění příznaků PN, zejména zlepšení hybnosti, se nasazuje lék zvaný levodopa, který se v mozku přeměňuje na dopamin. Získaná (neurogenická) koktavost vzniká až v dospělém věku jako důsledek neurologických událostí, jako například zranění hlavy, výskyt nádoru, mozková mrtvice či jako důsledek roztroušené sklerózy nebo Parkinsonovi nemoci. Přesná příčina koktavosti je dosud neznámá, zdá se však, že zde hrají roli jak genetické, tak neuropsychologické faktory. Velké pozornost vědecké veřejnosti je též věnována souvislosti mezi špatnou funkcí bazálních ganglií a výskytem koktavosti. Jedna z předchozích studií [Wu, J., 1997] se též zabývala teorií, že zvýšené množství dopaminu v mozku může souviset s výskytem koktavosti. Hlavním cílem této práce je proto hledat souvislosti mezi mírou koktavosti a dávkou levodopy u 14 pacientů s Parkinsonovou nemocí, kteří v dětství netrpěli vývojovou koktavostí. Míra koktavosti je vyhodnocena na základě čteného textu a monologu. Množství užívané levodopy je zjištěno z klinických záznamů lékařů. Součástí příspěvku je také prezentace výsledků a interpretace závěrů.

Huntingtonova nemoc (HN) je vzácné dědičné neurodegenerativní onemocnění, které je charakteristické nekoordinovanými trhavými pohyby těla. Mezi hlavní motorické příznaky patří chorea, bradykineze a ve vyšších stádiích pak i rigidita, dystonie a ztráta stability. Poruchy hlasu a řeči, označované jako hyperkinetická dysartrie, jsou dalším běžným projevem HN a rozvíjejí se v průběhu nemoci až u 90% pacientů. Mezi charakteristické deficity vyskytující se v hlasu osob s HN patří tzv. voice break (nízkofrekvenční segmenty fonace, ve kterých dochází ke zhruba jedno oktávovému poklesu proti běžnému hlasu) a vocal arrest (segmenty fonace, ve kterých dochází k úplnému zastavení funkce hlasivek). Nepřesná artikulace hlásek u HN je charakterizována zejména poklesem F1a, F2a a F2i a zvýšením F2u frekvence. Tyto změny odrážejí sníženou schopnost pacientů s HN pohyboval mluvidly, zejména jazykem, v rozsahu odpovídajícímu zdravým normám a mohou vést k výraznému snížení srozumitelnosti řeči. Mezi nejčastěji pozorované poruchy v oblasti prosodie patří zpomalená rychlost řeči, větší počet pauz, neschopnost udržet jednoduchý rytmus, neschopnost vyjádřit větný důraz a zvýšená variabilita v hlasitosti a délce slabik . Akustické analýzy jsou neinvazivní, objektivní, citlivá a jednoduchá metoda pro hodnocení hlasu a řeči u neurologických onemocnění. Matlab může být vhodným programem pro návrh algoritmů pro automatickou detekci řečových parametrů.

One common finding in Huntington's disease (HD) is related to phonatory disruptions that can be perceptually characterized by harshness, strained strangled voice quality, and pitch fluctuations. These alterations of voice occur mainly as a consequence of underlying involuntary contractions, variable muscle tone, or even tremor of laryngeal musculature. Recently, several new acoustic analysis methods have been introduced to capture different aspects of these phonatory abnormalities. In this report, we summarize objective acoustic metrics suitable for assessment of phonatory dysfunction and provide their classification accuracy in separation between patients with HD and healthy controls. For this purpose, data consists of 272 phonations collected from 34 individuals with HD and 34 healthy controls. As impairment of phonatory function in HD was found across all investigated measurements, voice analysis may potentially serve as a marker of disease progression.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive lost of dopaminergic neurons in substantia nigra. Up to 90% of individuals with PD developed an alteration of speech. In the current study, we evaluated 16 Czech male PD speakers in the early stage of the disease compared to 16 age- and gender-matched healthy controls. Each participant was required to read ten short sentences according to specific emotions. The speaking task of emotional prosody was chosen, as we assumed positive effect of speaking task on statistical differentiation between HC and PD groups due to increase of intensity and pitch variability. However, this hypothesis was not entirely fulfilled, as the statistically significant differences were found only under 2 conditions from total of 32 measurements. Therefore, the speaking task of emotional prosody may be consider as inappropriate for acoustic analysis in early PD. It might be concluded that the ability to express emotions is not seriously affected in early stages of disease.

Přestože hypokinetická dysartrie u Parkinsonovy nemoci (PN) se projevuje v mnoha řečových dimenzích, snížená schopnost vyjádření důrazu je považována za druhý nejvíce postižený řečový aspekt. Této studie se zúčastnilo 20 osob mužského pohlaví s diagnózou PN v brzké fázi a 16 zdravých jedinců srovnatelného věku. Cílem této práce, bylo ověřit vhodnost měření prvních tří formantových frekvencí a délky samohlásky pro hodnocení schopnosti vyjádřit důraz u osob s PN. Během nahrávání byl každý účastník studie požádán o přečtení krátkého úryvku textu s cílem nepřirozeně zdůraznit 5 klíčových slov vyznačených v textu. Pro akustické analýzy bylo využito čtyř řečových parametrů; délka samohlásky, první formantová frekvence, druhá formantová frekvence a třetí formantová frekvence. Pro statistické vyhodnocení bylo využito programu MATLAB. Pro nalezení statisticky významných rozdílů mezi skupinami PN a KS byla použita vícesměrná analýza rozptylu. Výsledky ukázaly, že přestože osoby s PN nepřesně artikulují, jsou-li požádáni o důrazné přečtení textu, dokáží cíleně zlepšit svůj řečový výkon a přiblížit se ke zdravým jedincům. Tento efekt byl zřetelný u všech měření s výjimkou měření délky samohlásky a nejvýrazněji se projevil u měření třetího formantu.

The purpose of this study was to analyze vowel articulation across various speaking tasks in a group of 20 early Parkinson’s disease (PD) individuals prior to pharmacotherapy. Vowels were extracted from sustained phonation, sentence repetition, reading passage, and monologue. Acoustic analysis was based upon measures of the first (F1) and second (F2) formant of the vowels /a/, /i/, and /u/, vowel space area (VSA), F2i/F2u and vowel articulation index (VAI). Parkinsonian speakers manifested abnormalities in vowel articulation across F2u, VSA, F2i/F2u, and VAI in all speaking tasks except sustained phonation, compared to 15 age-matched healthy control participants. Findings suggest that sustained phonation is an inappropriate task to investigate vowel articulation in early PD. In contrast, monologue was the most sensitive in differentiating between controls and PD patients, with classification accuracy up to 80%. Measurements of vowel articulation were able to capture even minor abnormalities in speech of PD patients with no perceptible dysarthria. In conclusion, impaired vowel articulation may be considered as a possible early marker of PD. A certain type of speaking task can exert significant influence on vowel articulation. Specifically, complex tasks such as monologue are more likely to elicit articulatory deficits in parkinsonian speech, compared to other speaking tasks.

Purpose: Although speech motor changes are reported as a common sign of Huntington’s disease (HD), the most prominent signs of voice dysfunction remain unknown. The aim of the current study was to explore specific changes in phonatory function in subjects with HD. Method: 34 subjects with HD and 34 age- and sex-matched healthy controls were examined. Participants performed sustained vowel phonation for subsequent analyses of airflow insufficiency, aperiodicity, irregular vibrations of vocal folds, signal perturbations, increased noise, and articulation deficiency. In total, 272 phonations were collected and 12 voice parameters were extracted. Subsequently, a predictive model was built to find the most salient patterns of voice disorders in HD. The results were also correlated with disease severity according to the Unified HD Rating Scale (UHDRS) motor score. Results: Subjects with HD showed deterioration in all investigated phonatory functions. Irregular pitch fluctuations, sudden phonation interruption, increased noise, and misplacement of articulators were found to be most significant patterns of phonatory dysfunction in HD (p < 0.001). The combination of these four dysphonia aspects contributed to the best classification performance of 94.1 % (sensitivity: 95.1 %; specificity: 93.2 %) in the separation of HD patients from healthy participants. Our results further indicated stronger associations between sudden phonation interruption and voluntary components of the UHDRS (r = - 0.48, p < 0.01) and between misplacement of articulators and involuntary components of the UHDRS (r = 0.52, p < 0.01). Conclusions: Our configuration of phonatory features can detect subtle voice abnormalities in subjects with HD. As impairment of phonatory function in HD was found to parallel increasing motor involvement, a qualitative description of voice dysfunction may be helpful to gain better insight into the pathophysiology of the vocal mechanism.

Dysprosody in Parkinson's disease (PD) is characterized by several symptoms. One of these symptoms is disability to produce precise stress pattern. A group of 20 untreated patients in the early stages of PD was compared to a group of 17 healthy age-matched controls to quantify possible acoustic changes in speech production secondary to PD. All participants produced a standardized speaking task of contrastive stress. The standard used measurements of amplitude, fundamental frequency and duration were performed. Moreover, the novel measurement of Stress Pattern Index (SPI) that combines amplitude, fundamental frequency, and duration characteristics was designed. The measurements of F0 range, Intensity range, Duration, and SPI differentiate between PD and healthy controls (HC) across many conditions in the group of stressed and unstressed tokens. On the other hand, only SPI was sufficiently sensitive to distinguish between PD and HC group for stress tokens that was normalized by normal reading tokens. To summarize, acoustic changes of prosodic stress appear to occur from early stages of PD.

Poruchy v prosodii u Parkonsonovy nemoci jsou charakteristické několika symptomy. Jeden z nich je neschopnost vyjádřit důraz.

Poruchy řeči u Parkinsonovy nemoci (PN), označované jako hypokinetická dysartrie, se projevují zhoršením řeči ve všech řečových subsystémech, tj. fonaci, respiraci, artikulaci a prozodii. Vývoj hypokinetické dysartrie v průběhu nemoci je předpokládán u 70 - 90 % osob trpících PN a její přítomnost byla prokázána již v brzkých stádiích nemoci. U pacientů s PN dochází v jejich promluvách k těmto charakteristickým příznakům: nepřesná artikulace, snížená melodičnost, snížená hlasitost, nepravidelnosti v držení rytmu, chrapot, dyšnost a další projevy, které snižují celkovou srozumitelnost řeči. Přestože poruchy řeči u PN se mohou vyskytovat individuálně, tj. pouze v některých subsystémech, zhoršení v oblasti prozodie bývá považováno za nejvýraznější.

Poruchy prosodie u Parkinsonovy nemoci (PN) jsou charakteristické změnami v základní hlasivkové frekvenci, amplitudě a časování řeči. Problémy s časováním řeči se pak projevují mimo jiné zhoršenou schopností přesného vnímání a vyjádření rytmu. Této studie se zúčastnilo 18 osob s diagnózou PN v brzké fázi a 16 zdravých jedinců srovnatelného věku. Cílem studie bylo vyhodnocení deficitů v řeči, které vznikající v důsledku rozvoje PN. Každý účastník studie byl požádán o rytmické přečtení krátkého textu o čtyřech rýmech dle předem stanoveného rytmu referenční nahrávky.

Parkinsonova nemoc je pomalu progresivní onemocnění nervového systému, které celosvětově postihuje více než 8 miliónů jednotlivců...

Problematika analýzy a zpracování řečového signálu je na katedře teorie obvodů ČVUT FEL systematicky řešena od počátku devadesátých let minulého století.

Dysartrie u Parkinsonovy nemoci (PN) je vícerozměrná porucha řeči postihující různé aspekty jako jsou respirace, fonace, artikulace a prozodie. Nepřesná artikulace samohlásek je jedním z hlavních důvodů snížené srozumitelnosti řeči u pacientů s výskytem PN. Předchozí studie ukázaly významnost kinematických a akustických měření pro hodnocení artikulace samohlásek u parkinsoniků. Nedávný výzkum také potvrdil důležitost měření založených na bázi artikulace samohlásek při monitorování efektů léčby. Cílem této studie je akustická analýza artikulace samohlásek u brzké neléčené PN.