Developing a large scale population screening tool for the assessment of Parkinson's disease using telephone-quality voice

Recent studies have demonstrated that analysis of laboratory-quality voice recordings can be used to accurately differentiate people diagnosed with Parkinson's disease (PD) from healthy controls (HC). These findings could help facilitate the development of remote screening and monitoring tools for PD. In this study, we analyzed 2759 telephone-quality voice recordings from 1483 PD and 15321 recordings from 8300 HC participants. To account for variations in phonetic backgrounds, we acquired data from seven countries. We developed a statistical framework for analyzing voice, whereby we computed 307 dysphonia measures that quantify different properties of voice impairment, such as, breathiness, roughness, monopitch, hoarse voice quality, and exaggerated vocal tremor. We used feature selection algorithms to identify robust parsimonious feature subsets, which were used in combination with a Random Forests (RF) classifier to accurately distinguish PD from HC. The best 10-fold cross-validation performance was obtained using Gram-Schmidt Orthogonalization (GSO) and RF, leading to mean sensitivity of 64.90% (standard deviation, SD 2.90%) and mean specificity of 67.96% (SD 2.90%). This large-scale study is a step forward towards assessing the development of a reliable, cost-effective and practical clinical decision support tool for screening the population at large for PD using telephone-quality voice.Comment: 43 pages, 5 figures, 6 table

Assessing Parkinson’s Disease at Scale Using Telephone-Recorded Speech:Insights from the Parkinson’s Voice Initiative

Numerous studies have reported on the high accuracy of using voice tasks for the remote detection and monitoring of Parkinson’s Disease (PD). Most of these studies, however, report findings on a small number of voice recordings, often collected under acoustically controlled conditions, and therefore cannot scale at large without specialized equipment. In this study, we aimed to evaluate the potential of using voice as a population-based PD screening tool in resource-constrained settings. Using the standard telephone network, we processed 11,942 sustained vowel /a/ phonations from a US-English cohort comprising 1078 PD and 5453 control participants. We characterized each phonation using 304 dysphonia measures to quantify a range of vocal impairments. Given that this is a highly unbalanced problem, we used the following strategy: we selected a balanced subset (n = 3000 samples) for training and testing using 10-fold cross-validation (CV), and the remaining (unbalanced held-out dataset, n = 8942) samples for further model validation. Using robust feature selection methods we selected 27 dysphonia measures to present into a radial-basis-function support vector machine and demonstrated differentiation of PD participants from controls with 67.43% sensitivity and 67.25% specificity. These findings could help pave the way forward toward the development of an inexpensive, remote, and reliable diagnostic support tool for PD using voice as a digital biomarker

Balance and gait in Parkinson’s disease : from perceptions to performance

The overall aim of this thesis was to explore perceptions and performance of balance and gait in people with Parkinson’s disease (PwPD), and to evaluate both the current evidence for exercise-induced neuroplasticity and the feasibility of investigating exercise-induced neuroplastic changes among PwPD. This thesis includes four papers of different designs; a qualitative interview study (paper I), a systematic review and meta-analysis (paper II), a pilot RCT (paper III) and a crosssectional study (paper IV). Participants in papers I, III & IV were recruited through advertisement in newspapers and through the Parkinson association in Stockholm (sample sizes n=18, n=13 and n=93, respectively), whereas paper II selected studies from database searches (included studies n=13, total participant sample n=213). Five themes emerged from the qualitative content analysis of the interviews, the underlying patterns of which formed the overarching theme “Focus and determination to regain control over shifting balance”. In paper II, the narrative synthesis revealed that a majority of the studies indicated that exercise can possibly induce positive neuroplastic changes in PwPD, but the evidence according to the GRADE analysis was very low. In paper III we found that a proposed design to explore associations between changes in behavioral outcomes and neuroplasticity after ten weeks of the HiBalance training was feasible and acceptable given a few modifications ahead of the RCT. Finally paper IV showed that people with mild to moderate PD exhibited impaired performance across most domains of gait when simultaneously having to concentrate on a cognitive task (dual tasking). Impaired cognitive function was associated with higher costs on gait, as well as a tendency to use a posture-second prioritization in which the cognitive task was prioritized over walking. Balance was perceived as both bodily equilibrium and a mind-body interplay. The meaning of balance was described through concepts of control and the ability to control one’s body in everyday life. Regarding exercise-induced neuroplasticity in PD, published studies showed promising results, but more high-quality RCTs, using scientifically sound methodology are needed in order to drive this research field forward. Our proposed RCT design to evaluate neuroplastic changes after the HiBalance training was feasible, but needed strengthening regarding blinding procedures, the MRI paradigm and the dual task gait assessment. Walking while simultaneously concentrating on a cognitive task impaired performance on both tasks, especially among those with cognitive impairment. These findings provide preliminary evidence to suggest that dual task training and assessment should be planned and instructed differently according to cognitive status in PwPD

Relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease

Aim: To assess the relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease. Introduction: Speech and communication difficulties, as well as cognitive impairment, are prevalent in Parkinson’s. The contributions of cognitive impairment and acoustic speech characteristics remain equivocal. Relationships between Impairment and Participation levels of the International Classification of Functioning, Disability and Health (ICF) have not been thoroughly investigated. Methods: 45 people with Parkinson’s and 29 familiar controls performed read, mood and conversational speech tasks as part of a multimethod investigation. Data analysis formed three main parts. Depression, cognition and communication were assessed using questionnaires. Phonetic analysis was used to produce an acoustic characterisation of speech. Listener assessment was used to assess conveyance of emotion and intelligibility. Qualitative Content Analysis was used to provide a participant’s insight into speech and communicative difficulties associated with Parkinson’s disease. Results: Cognitive status was significantly associated with certain read speech acoustic characteristics, emotional conveyance and communicative participation. No association was found with intelligibility or conversational speech acoustic characteristics. The only acoustic speech characteristics that predicted intelligibility were intensity and pause in the read speech condition. The contribution of intelligibility to communicative participation was modest. People with Parkinson’s disease reported a range of psychosocial, cognitive and physical factors affecting their speech and communication. Conclusions: I provide evidence for a role for cognitive status in emotional conveyance and communicative participation, but not necessarily general speech production, in Parkinson’s disease. I demonstrate that there may not be a strong relationship between ICF Impairment level speech measures and functional measures of communication. I also highlight the distinction between measures of communication at the ICF Activity and Participation levels. This study demonstrates that reduced participation in everyday communication in Parkinson’s disease appears to result from a complex interplay of physical, cognitive and psychosocial factors. Further research is required to apply these findings to contribute to future advances in speech and language therapy for Parkinson’s disease

Integrated and patient-centred management of Parkinson’s disease:a network model for reshaping chronic neurological care

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