Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia.
Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.
Cerebellum. 2020 Oct;19(5):691-700. doi: 10.1007/s12311-020-01151-5.
Speech production relies on motor control and cognitive processing and is linked to cerebellar function. In diseases where the cerebellum is impaired, such as multiple sclerosis (MS), speech abnormalities are common and can be detected by instrumental assessments. However, the potential of speech assessments to be used to monitor cerebellar impairment in MS remains unexplored. The aim of this study is to build an objectively measured speech score that reflects cerebellar function, pathology and quality of life in MS. Eighty-five people with MS and 21 controls participated in the study. Speech was independently assessed through objective acoustic analysis and blind expert listener ratings. Cerebellar function and overall disease disability were measured through validated clinical scores; cerebellar pathology was assessed via magnetic resonance imaging, and validated questionnaires informed quality of life. Selected speech variables were entered in a regression model to predict cerebellar function. The resulting model was condensed into one composite speech score and tested for prediction of abnormal 9-hole peg test (9HPT), and for correlations with the remaining cerebellar scores, imaging measurements and self-assessed quality of life. Slow rate of syllable repetition and increased free speech pause percentage were the strongest predictors of cerebellar impairment, complemented by phonatory instability. Those variables formed the acoustic composite score that accounted for 54% of variation in cerebellar function, correlated with cerebellar white matter volume (r = 0.3, p = 0.017), quality of life (r = 0.5, p < 0.001) and predicted an abnormal 9HPT with 85% accuracy. An objective multi-feature speech metric was highly representative of motor cerebellar impairment in MS.
言语产生依赖于运动控制和认知处理，与小脑功能有关。在小脑受损的疾病中，如多发性硬化症（MS），言语异常很常见，可以通过仪器评估来检测。然而，言语评估在 MS 中监测小脑损伤的潜力尚未得到探索。本研究旨在构建一个客观测量的言语评分，反映 MS 中的小脑功能、病理学和生活质量。85 名 MS 患者和 21 名对照者参与了这项研究。通过客观声学分析和盲法专家听力评估对言语进行独立评估。通过验证的临床评分测量小脑功能和整体疾病残疾；通过磁共振成像评估小脑病理学；验证后的问卷报告生活质量。选择的言语变量输入回归模型以预测小脑功能。所得模型被浓缩为一个综合言语评分，并对异常 9 孔钉测试（9HPT）进行预测，以及与剩余的小脑评分、成像测量和自我评估的生活质量进行相关性分析。音节重复率慢和自由言语停顿百分比增加是小脑损伤的最强预测因子，发声不稳定也起到补充作用。这些变量构成了声学综合评分，解释了小脑功能变异的 54%，与小脑白质体积相关（r=0.3，p=0.017），与生活质量相关（r=0.5，p<0.001），预测异常 9HPT 的准确率为 85%。客观的多特征言语指标在 MS 中对运动性小脑损伤具有高度代表性。
