Longitudinal Changes to Speech in Parkinson's Disease Phenotypes

项目摘要 大约90%的帕金森氏病(PD)患者会出现言语症状 大大降低了生活质量，以及保持有效沟通能力的能力。因此， 帕金森病的这些语音变化对于理解和解决这些问题至关重要。然而，这些进展之间的联系 帕金森病(自诊断以来的年数)、特定运动障碍和特定言语困难的发展 都没有被很好地理解。帕金森病的进展似乎与言语症状的严重程度无关： 通过临床评估得出的总体运动严重程度和帕金森病确诊后的年限并不总是与 功能语音结果(即语音可理解性和自然度)或声学指标的下降 演讲。特别是，这种联系似乎在语音子系统：语音的发音特征上有所不同 与帕金森病的进展有关，而对声音的测量则不相关。然而，目前还不清楚这些发现是否 由于不同的潜在原因或由于帕金森病运动症状的高度个体差异。事实上，最近 研究表明，帕金森病有两种不同的运动表型：姿势不足和步态优势 (PIGD)和以震颤为主(TD)。沟通困难的发生率更高，言语成绩更差 在患有PIGD的扬声器中发现，与TD相比，这可能是喉部肌肉僵硬增加的结果。 因此，重要的是要了解语音症状是如何通过语音子系统在个体内进展的，以及 此外，语言变化如何与帕金森病患者的特定运动症状相关。功能言语结果还可以 由于语音清晰度和自然度受发音影响，因此在不同的PD表型上表现出差异 精确度和音质。目前还没有研究完成语音变化的稳健声学表征 以及随着时间的推移，对同一说话者中患有帕金森病的人的功能言语结果的测量。因此，这 提案将全面研究语音产生的声学特征的纵向变化 与运动表型和功能语音结果相关的语音清晰度和自然度在同一 带PD的扬声器。将收集44名帕金森病患者的语音数据(使用偶数PIGD到TD马达- 表型比)在两个时间点，利用先前的数据库作为第一时间点。目标1将评估 清晰度和声音的声学测量的纵向变化提供了对不同语音的洞察 随着时间的推移，帕金森病患者的运动表型会导致说话者内的损害进展。目标2将决定如何 言语声学指标的纵向变化与帕金森病患者的功能性言语结局有关。这个 AIM 2的结果将阐明哪些特定的声学测量与帕金森病患者的功能性语音结果有关 并增强客观跟踪PD中最关键的沟通特征的能力。这项工作将 阐明帕金森病运动表型与言语症状进展的关系，并提供 为今后帕金森病的治疗研究提供有意义的客观措施。

Project Summary Approximately 90% of individuals with Parkinson's disease (PD) experience speech symptoms that can drastically reduce quality of life, as well as the ability to maintain effective communication abilities. Therefore, these speech changes in PD are vital to understand and address. Yet the associations between the progression of PD (years since diagnosis), specific motor impairments, and the development of specific speech difficulties are not well understood. The progression of PD does not appear to correlate with speech symptom severity: overall motor severity via clinical assessments and the years since PD diagnosis are not always associated with a decline in functional speech outcomes (i.e., speech intelligibility and naturalness) or acoustic measures of speech. In particular, the association appears to differ by speech subsystem: articulatory features of speech relate to the progression of PD, whereas measures of voice do not. However, it is not clear if these findings are due to different underlying causes or because of high individual variability in PD motor symptoms. In fact, recent work suggests that there are two distinct motor phenotypes of PD: postural insufficiency and gait dominant (PIGD) and tremor dominant (TD). A higher incidence of communication difficulties and worse speech scores are found in speakers with PIGD compared to TD, which may be a result of increased laryngeal muscle rigidity. Thus, it is critical to understand how speech symptoms progress within an individual by speech subsystem, and moreover, how speech changes relate to specific motor symptoms in PD. Functional speech outcomes may also show differences across PD phenotype since speech intelligibility and naturalness are affected by articulatory precision and voice quality. No studies have yet completed a robust acoustic characterization of speech changes and measures of functional speech outcomes within the same speakers with PD over time. Therefore, this proposal will comprehensively examine how longitudinal changes in acoustic features of speech production relate to motor phenotype and functional speech outcomes of speech intelligibility and naturalness in the same speakers with PD. Speech data will be collected in 44 speakers with PD (with an even PIGD-to-TD motor- phenotype ratio) at two time points, leveraging a previous database as the first time point. Aim 1 will evaluate longitudinal changes in acoustic measures of articulation and voice to provide insight into how different speech impairments progress in within speakers with PD over time by motor phenotype. Aim 2 will determine how longitudinal changes in acoustic measures of speech are related to functional speech outcomes in PD. The results of Aim 2 will elucidate which specific acoustic measures are tied to functional speech outcomes in PD and enhance the ability to objectively track the most critical features of communication in PD. This work will clarify the relationship between PD motor phenotypes and progression of speech symptoms as well as provide meaningful objective measures for future treatment studies in PD.