Iva Pippa, Fielding Joanne, Clough Meaghan, White Owen, Godic Branislava, Martin Russell, Rajan Ramesh
Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia.
Department of Neuroscience, Central Clinical School, Monash University, Alfred Centre, Melbourne, VIC, Australia.
Front Neurosci. 2020 Dec 23;14:604991. doi: 10.3389/fnins.2020.604991. eCollection 2020.
There is a need for reliable and objective measures of early and mild symptomology in multiple sclerosis (MS), as deficits can be subtle and difficult to quantify objectively in patients without overt physical deficits. We hypothesized that a speech-in-noise (SiN) task would be sensitive to demyelinating effects on precise neural timing and diffuse higher-level networks required for speech intelligibility, and therefore be a useful tool for monitoring sensory and cognitive changes in early MS. The objective of this study was to develop a SiN task for clinical use that sensitively monitors disease activity in early (<5 years) and late (>10 years) stages of MS subjects with mild severity [Expanded Disability Status Scale (EDSS) score < 3]. Pre-recorded Bamford-Kowal-Bench sentences and isolated keywords were presented at five signal-to-noise ratios (SNR) in one of two background noises: speech-weighted noise and eight-talker babble. All speech and noise were presented via headphones to controls ( = 38), early MS ( = 23), and late MS ( = 12) who were required to verbally repeat the target speech. MS subjects also completed extensive neuropsychological testing which included: Paced Auditory Serial Addition Test, Digit Span Test, and California Verbal Learning Test. Despite normal hearing thresholds, subjects with early and late mild MS displayed speech discrimination deficits when sentences and words were presented in babble - but not speech-weighted noise. Significant correlations between SiN performance and standardized neuropsychological assessments indicated that MS subjects with lower functional scores also had poorer speech discrimination. Furthermore, a quick 5-min task with words and keywords presented in multi-talker babble at an SNR of -1 dB was 82% accurate in discriminating mildly impaired MS individuals (median EDSS = 0) from healthy controls. Quantifying functional deficits in mild MS will help clinicians to maximize the opportunities to preserve neurological reserve in patients with appropriate therapeutic management, particularly in the earliest stages. Given that physical assessments are not informative in this fully ambulatory cohort, a quick 5-min task with words and keywords presented in multi-talker babble at a single SNR could serve as a complementary test for clinical use due to its ease of use and speed.
在多发性硬化症（MS）中，需要可靠且客观的早期和轻度症状测量方法，因为在没有明显身体缺陷的患者中，症状可能很细微且难以客观量化。我们假设噪声中的言语（SiN）任务对脱髓鞘对精确神经定时以及言语可懂度所需的弥散性高级网络的影响敏感，因此是监测早期MS感觉和认知变化的有用工具。本研究的目的是开发一种用于临床的SiN任务，以敏感地监测轻度严重程度[扩展残疾状态量表（EDSS）评分<3]的MS受试者早期（<5年）和晚期（>10年）阶段的疾病活动。预先录制的班福德 - 科瓦尔 - 本奇句子和孤立关键词以五种信噪比（SNR）在两种背景噪声之一中呈现：言语加权噪声和八人嘈杂声。所有语音和噪声均通过耳机呈现给对照组（n = 38）、早期MS患者（n = 23）和晚期MS患者（n = 12），他们需要口头重复目标语音。MS受试者还完成了广泛的神经心理学测试，包括：听觉节律性连续加法测试、数字广度测试和加利福尼亚言语学习测试。尽管听力阈值正常，但当句子和单词在嘈杂声中呈现时，早期和晚期轻度MS患者表现出言语辨别缺陷——但在言语加权噪声中则没有。SiN表现与标准化神经心理学评估之间的显著相关性表明，功能评分较低的MS受试者言语辨别能力也较差。此外，一项快速的5分钟任务，其中单词和关键词在信噪比为 -1 dB的多人嘈杂声中呈现，在区分轻度受损的MS个体（中位数EDSS = 0）和健康对照组方面的准确率为82%。量化轻度MS中的功能缺陷将有助于临床医生在适当的治疗管理下，尤其是在最早阶段，最大限度地保留患者神经储备的机会。鉴于在这个完全能走动的队列中身体评估没有信息价值，一项快速的5分钟任务，其中单词和关键词在单一信噪比的多人嘈杂声中呈现，因其易用性和速度，可作为临床使用的补充测试。
