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

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          Abstract

          Purpose

          The 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.

          Method

          67 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.

          Results

          At 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.

          Conclusions

          Measurement 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 references38

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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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            Functional decline in Parkinson disease.

            To determine the overall rate of functional decline and to assess the progression of different signs of Parkinson disease (PD). Patients with clinically diagnosed PD followed up for at least 3 years were included in this study. Demographic and clinical data (including the Unified Parkinson's Disease Rating Scale [UPDRS]) were analyzed by the multivariate unbalanced repeated-measurements design using the mixed-effects model to study the association between different symptoms and various demographic variables. Regression models helped estimate the rates of progression of the disease in relationship to the various components of the UPDRS. Patients were categorized as having tremor-dominant or postural instability-gait difficulty-dominant PD and the 2 categories were compared for progression of their total UPDRS scores. A multivariate mixed-effects model was used to study the relationship between the different symptoms and various demographic variables. Nonparametric statistical tests were used to compare the progression of symptoms in the "on" (good function) state and the "off" (poor function) state groups for 2 age-at-onset categories ( 57 years). Data from 1731 visits on 297 patients (181 men) followed up for an average of 6.36 years (range, 3-17 years) were analyzed. The annual rate of decline in the total UPDRS scores was 1.34 when assessed during the on state and 1.58 when assessed during the off state. Patients with an older age at onset had more rapid progression of PD than those with a younger age at onset. Furthermore, the older-onset group had statistically significantly more progression in mentation, freezing, and parts I (mentation) and II (activities of daily living) UPDRS subscores. Handwriting was the only component of the UPDRS score that did not notably deteriorate during the observation period. Regression analysis of 108 patients whose symptoms were rated during their off state showed a faster rate of cognitive decline as age at onset increased. The slopes (ie, the annual rates of decline) of progression in the UPDRS scores, when adjusted for age at the initial visit, were steeper for the postural instability--gait difficulty--dominant group compared with the tremor-dominant group. Based on longitudinal follow-up data, our findings provide evidence for a variable course of progression of the different PD symptoms, thus implying different biochemical or degenerative mechanisms for the various clinical features associated with PD.
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              Progression of motor impairment and disability in Parkinson disease: a population-based study.

              To investigate risk factors and the rate of progression of motor symptoms and disability in a population-based cohort of patients with Parkinson disease (PD). In all, 232 patients with PD, derived from a community-based prevalence study, were followed prospectively over an 8-year period. Follow-up examinations were done 4 and 8 years after baseline, and 144 patients participated in at least one follow-up examination. Information on motor function and disability was obtained using the Unified Parkinson Disease Rating Scale (UPDRS), the Hoehn and Yahr staging, and the Schwab and England score. Population-averaged logistic regression models were used to describe annual disease progression and to analyze the influence of potential risk factors on functional decline. We found a similar mean annual decline in the UPDRS motor score and the Hoehn and Yahr staging of 3.1% and 3.2%, respectively. Also the UPDRS Activity of Daily Living (ADL) score and the Schwab and England scale changed similarly, with 3.5% and 3.6% per year, respectively. Age, age at onset, disease duration, and excessive daytime somnolence at baseline were strong and independent predictors of greater impairment in motor function and disability. Cognitive impairment at baseline predicted higher disability and higher Hoehn and Yahr scores. Time by age-at-onset interactions were found for the UPDRS motor score and the Hoehn and Yahr staging. Motor function and disability worsened significantly with time, and to a similar extent. Age, age at onset and disease duration, as well as symptoms thought to be due to involvement of non-dopaminergic brain structures, are predictors of more impaired motor function and disability. However, age at disease onset was the main predictor of motor decline in our cohort, indicating a slower and more restricted pathologic disease process in patients with young-onset PD.
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                Author and article information

                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
                : e32132
                Affiliations
                [1]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.

                Article
                PONE-D-11-15871
                10.1371/journal.pone.0032132
                3289640
                22389682
                b3492729-c8cd-42a6-a4f8-3e20da207b73
                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.
                History
                : 14 August 2011
                : 24 January 2012
                Page count
                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
                Uncategorized

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