Rusz Jan, Tykalova Tereza, Novotny Michal, Zogala David, Sonka Karel, Ruzicka Evzen, Dusek Petr
From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Neurology. 2021 Nov 23;97(21):e2124-e2135. doi: 10.1212/WNL.0000000000012878. Epub 2021 Oct 4.
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.
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.
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 ( = 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 ( = 0.002).
Distinct speech phenotypes in de novo PD reflect divergent underlying mechanisms and allow prediction of response of speech impairment to levodopa therapy.
This study provides Class II evidence that, in patients with newly diagnosed PD with speech impairment, speech phenotype is associated with levodopa responsiveness.
帕金森病（PD）患者的言语障碍模式在个体间差异很大，尚未得到系统研究。我们的目的是识别初治PD患者的言语亚型，并研究他们对长期多巴胺能治疗的反应。
我们记录了总共111例新发PD患者的言语数据；其中83例参与者完成了12个月的随访（69例接受稳定多巴胺能药物治疗的PD患者和14例未治疗的PD对照）。对通过定量声学分析检测的运动减少型构音障碍的8个不同参数进行无监督k均值聚类分析。
检测到三种不同的言语亚型，其患病率、症状持续时间和运动严重程度相似：韵律型、发声-韵律型和发音-韵律型。除了每个亚型中常见的单音调和平响度外，发声-韵律型（以发音障碍为主）和发音-韵律型（以辅音发音不精确为主）的言语障碍比韵律型更严重。临床上，韵律型亚型的特征是女性患病率高且年龄较轻，而发音-韵律型亚型的特征是男性患病率高、年龄较大、轴性步态症状更严重且认知表现较差。发声-韵律型亚型在年龄上表现为中间状态，主要是男性且认知表现保留。虽然未治疗的PD对照的言语在1年内恶化（P = 0.02），但长期多巴胺能药物治疗使韵律型和发音-韵律型亚型的言语障碍严重程度保持稳定，并改善了发声-韵律型亚型患者的言语表现（P = 0.002）。
新发PD中不同的言语表型反映了不同的潜在机制，并有助于预测言语障碍对左旋多巴治疗的反应。
本研究提供了II类证据，即在新诊断的有言语障碍的PD患者中，言语表型与左旋多巴反应性相关。
