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Impairment of Vowel Articulation as a Possible Marker of Disease Progression in Parkinson's Disease

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      Abstract

      PurposeThe aim of the current study was to survey if vowel articulation in speakers with Parkinson's disease (PD) shows specific changes in the course of the disease.Method67 patients with PD (42 male) and 40 healthy speakers (20 male) were tested and retested after an average time interval of 34 months. Participants had to read a given text as source for subsequent calculation of the triangular vowel space area (tVSA) and vowel articulation index (VAI). Measurement of tVSA and VAI were based upon analysis of the first and second formant of the vowels /α/, /i/and /u/ extracted from defined words within the text.ResultsAt first visit, VAI values were reduced in male and female PD patients as compared to the control group, and showed a further decrease at the second visit. Only in female Parkinsonian speakers, VAI was correlated to overall speech impairment based upon perceptual impression. VAI and tVSA were correlated to gait impairment, but no correlations were seen between VAI and global motor impairment or overall disease duration. tVSA showed a similar reduction in the PD as compared to the control group and was also found to further decline between first and second examination in female, but not in male speakers with PD.ConclusionsMeasurement of VAI seems to be superior to tVSA in the description of impaired vowel articulation and its further decline in the course of the disease in PD. Since impairment of vowel articulation was found to be independent from global motor function but correlated to gait dysfunction, measurement of vowel articulation might have a potential to serve as a marker of axial disease progression.

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      Most cited references 46

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      Systematic review of levodopa dose equivalency reporting in Parkinson's disease.

      Interpretation of clinical trials comparing different drug regimens for Parkinson's disease (PD) is complicated by the different dose intensities used: higher doses of levodopa and, possibly, other drugs produce better symptomatic control but more late complications. To address this problem, conversion factors have been calculated for antiparkinsonian drugs that yield a total daily levodopa equivalent dose (LED). LED estimates vary, so we undertook a systematic review of studies reporting LEDs to provide standardized formulae. Electronic database and hand searching of references identified 56 primary reports of LED estimates. Data were extracted and the mean and modal LEDs calculated. This yielded a standardized LED for each drug, providing a useful tool to express dose intensity of different antiparkinsonian drug regimens on a single scale. Using these conversion formulae to report LEDs would improve the consistency of reporting and assist the interpretation of clinical trials comparing different PD medications. © 2010 Movement Disorder Society.
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        What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathologic study.

        Many authorities have drawn attention to the difficulties in clinically distinguishing Parkinson's disease (PD) from other parkinsonian syndromes. We assessed the clinical features of 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic PD according to their pathologic findings. Seventy-six percent of these cases were confirmed to have PD. By using selected criteria (asymmetrical onset, no atypical features, and no possible etiology for another parkinsonian syndrome) the proportion of true PD cases identified was increased to 93%, but 32% of pathologically confirmed cases were rejected on this basis. These observations suggest that studies based on consultant diagnosis of PD, using standard diagnostic criteria, will include cases other than PD, thus distorting results from clinical trials and epidemiologic studies. The strict use of additional criteria can reduce misdiagnosis but at the cost of excluding genuine PD cases.
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          Analysis, synthesis, and perception of voice quality variations among female and male talkers.

          Voice quality variations include a set of voicing sound source modifications ranging from laryngealized to normal to breathy phonation. Analysis of reiterant imitations of two sentences by ten female and six male talkers has shown that the potential acoustic cues to this type of voice quality variation include: (1) increases to the relative amplitude of the fundamental frequency component as open quotient increases; (2) increases to the amount of aspiration noise that replaces higher frequency harmonics as the arytenoids become more separated; (3) increases to lower formant bandwidths; and (4) introduction of extra pole zeros in the vocal-tract transfer function associated with tracheal coupling. Perceptual validation of the relative importance of these cues for signaling a breathy voice quality has been accomplished using a new voicing source model for synthesis of more natural male and female voices. The new formant synthesizer, KLSYN88, is fully documented here. Results of the perception study indicate that, contrary to previous research which emphasizes the importance of increased amplitude of the fundamental component, aspiration noise is perceptually most important. Without its presence, increases to the fundamental component may induce the sensation of nasality in a high-pitched voice. Further results of the acoustic analysis include the observations that: (1) over the course of a sentence, the acoustic manifestations of breathiness vary considerably--tending to increase for unstressed syllables, in utterance-final syllables, and at the margins of voiceless consonants; (2) on average, females are more breathy than males, but there are very large differences between subjects within each gender; (3) many utterances appear to end in a "breathy-laryngealized" type of vibration; and (4) diplophonic irregularities in the timing of glottal periods occur frequently, especially at the end of an utterance. Diplophonia and other deviations from perfect periodicity may be important aspects of naturalness in synthesis.
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            Author and article information

            Affiliations
            Department of Neurology, Knappschaftskrankenhaus, Ruhr-University of Bochum, Bochum, Germany
            University of Leicester, United Kingdom
            Author notes

            Conceived and designed the experiments: SS US. Performed the experiments: SS WG. Analyzed the data: SS WG US. Contributed reagents/materials/analysis tools: SS. Wrote the paper: SS WG US.

            Contributors
            Role: Editor
            Journal
            PLoS One
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, USA )
            1932-6203
            2012
            28 February 2012
            : 7
            : 2
            3289640
            22389682
            PONE-D-11-15871
            10.1371/journal.pone.0032132
            (Editor)
            Skodda et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
            Counts
            Pages: 8
            Categories
            Research Article
            Biology
            Neuroscience
            Neurophysiology
            Medicine
            Anatomy and Physiology
            Neurological System
            Diagnostic Medicine
            Pathology
            General Pathology
            Neurology
            Otorhinolaryngology
            Speech Language Pathology
            Social and Behavioral Sciences
            Linguistics

            Uncategorized

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