Pathomechanisms and compensatory efforts related to Parkinsonian speech.
Pathomechanisms and compensatory efforts related to Parkinsonian speech.
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DOI：
10.1016/j.nicl.2013.10.016
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kell CA
中科院分区：
文献类型：
--
作者：
Arnold C;Gehrig J;Gispert S;Seifried C;Kell CA
帕金森病（PD）患者的语音和言语通常受到发音减退、韵律障碍和构音障碍的影响。这些致残症状的潜在病理机制还不清楚。为了识别与病理生理学和代偿相关的功能异常，我们比较了尚未出现语音或言语症状的早期PD患者和匹配对照组的语音相关脑活动和有效连接。在功能磁共振成像20 PD患者和20名控制参与者的左旋多巴和关闭阅读75个句子隐蔽，公开与中性，或快乐的语调。线索-目标阅读范式允许任务准备与执行分离。我们发现病理性减少纹状体-前额叶预备有效连接与早期PD患者皮层下（关闭状态）或皮层（打开状态）的代偿网络。在说话时，PD患者表现出对外部听觉反馈的监测减少的迹象。在情感韵律的产生过程中，腹侧和背侧纹状体之间的功能耦合减少。我们的研究结果表明，三种病理机制影响语音PD：虽然减少的基础上的纹状体-前额叶连接不足，功能失调的自我监测机制可能是发音减退，构音障碍可能会导致衰落的言语运动表征，因为他们没有足够好地更新外部听觉反馈。边缘系统和感觉运动纹状体之间的病理性相互作用可能会干扰言语程序的情感调节，从而影响情感韵律的产生。然而，早期PD患者表现出代偿机制，可能有助于改善未来的语言治疗。PD患者的语音网络在出现语音症状之前就发生了改变。发音减退与由于纹状体-前额叶耦合减少而导致的听觉活动减少有关。PD患者表现出听觉反馈监测减少的特征。构音障碍可能是由于反馈对运动表征的不精确塑造造成的。外部治疗模型有助于正常化与语言相关的神经异常。
Voice and speech in Parkinson's disease (PD) patients are classically affected by a hypophonia, dysprosody, and dysarthria. The underlying pathomechanisms of these disabling symptoms are not well understood. To identify functional anomalies related to pathophysiology and compensation we compared speech-related brain activity and effective connectivity in early PD patients who did not yet develop voice or speech symptoms and matched controls. During fMRI 20 PD patients ON and OFF levodopa and 20 control participants read 75 sentences covertly, overtly with neutral, or with happy intonation. A cue-target reading paradigm allowed for dissociating task preparation from execution. We found pathologically reduced striato-prefrontal preparatory effective connectivity in early PD patients associated with subcortical (OFF state) or cortical (ON state) compensatory networks. While speaking, PD patients showed signs of diminished monitoring of external auditory feedback. During generation of affective prosody, a reduced functional coupling between the ventral and dorsal striatum was observed. Our results suggest three pathomechanisms affecting speech in PD: While diminished energization on the basis of striato-prefrontal hypo-connectivity together with dysfunctional self-monitoring mechanisms could underlie hypophonia, dysarthria may result from fading speech motor representations given that they are not sufficiently well updated by external auditory feedback. A pathological interplay between the limbic and sensorimotor striatum could interfere with affective modulation of speech routines, which affects emotional prosody generation. However, early PD patients show compensatory mechanisms that could help improve future speech therapies. Speech networks are altered in PD patients before they develop speech symptoms. Hypophonia relates to reduced energization due to reduced striato-prefrontal coupling. PD patients show signatures of reduced monitoring of auditory feedback. Dysarthria may result from imprecise shaping of motor representations by feedback. External therapeutic models help normalizing speech-related neural anomalies.
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影响因子：
3.2
作者：
de Frias, Cindy M.;Marklund, Petter;Nyberg, Lars
通讯作者：
Nyberg, Lars
DOI：
10.1155/2012/391946
发表时间：
2012
期刊：
Parkinson's disease
影响因子：
--
作者：
Fox C;Ebersbach G;Ramig L;Sapir S
通讯作者：
Sapir S
影响因子：
5.3
作者：
CILIAX, BJ;HEILMAN, C;LEVEY, AI
通讯作者：
LEVEY, AI
影响因子：
16.2
作者：
Dosenbach, Nico U. F.;Visscher, Kristina M.;Petersen, Steven E.
通讯作者：
Petersen, Steven E.
影响因子：
4.8
作者：
FOLSTEIN, MF;FOLSTEIN, SE;MCHUGH, PR
通讯作者：
MCHUGH, PR