How do I sound to me? Perceived changes in communication in Parkinson's disease

Objective: To examine self and carer perceived changes in communication associated with Parkinson's disease and relate these to speech intelligibility, gender, age and other disease measures. Design: Cross-sectional survey of a hospital- and community-based sample of 176 people with Parkinson's disease and their carers using a questionnaire based on semantic differential techniques. Participants: One hundred and four people with Parkinson's disease with no history of communication difficulties prior to onset of their Parkinson's disease and 45 primary carers who returned completed questionnaires. Main outcome measures: Differences in ratings for `before' the onset of Parkinson's disease versus present status. Results: There was a strong perception of negative impact on communication between `before' and `now', irrespective of age and gender and largely independent of disease severity and duration, intelligibility and cognitive status. Activities of daily living (assessed by Unified Parkinson's Disease Rating Scale (UPDRS) II) and depression rating scale scores had the strongest association with change (adjusted R 2 0.27). There was a significant correlation between the rank order of perceived change in features examined in people with Parkinson's disease versus their carers, though in general carers rated change as having less impact. Conclusions: Parkinson's disease exercises a strong influence on communication even before apparent alterations to intelligibility or motor status

Swallowing problems in Parkinson's disease: frequency and clinical correlates

Background Changes to the efficiency and integrity of swallowing mechanisms are inevitable in Parkinson's disease (PD). It remains unclear how many people with PD are at risk of dysphagia. Aims To establish the frequency of impaired swallowing on a bedside screening test in people with PD and the relationship of performance to indicators of disease progression. Methods 137 individuals with PD from a community and hospital based cohort were asked to drink 150ml of water as quickly as possible whilst in an 'off drug' state. Performance was timed live. Measures of swallow speed and volumes were derived. Outcomes were compared to published norms. Results Thirty-one (23%) could not complete the full 150ml. Swallowing rate (ml/sec) fell >-1SD below published norms for 115 (84%) and >-2SD for 44 (32%) subjects. There were moderate correlations between rate of swallow and disease severity (UPDRS, Hoehn and Yahr stage), depression and cognition, but not disease duration. Participants with a postural instability gait disorder (PIGD) phenotype performed significantly poorer. A best fit regression model (multiple R2 0.375) included the variables age, gender, depression, motor phenotype and UPDRS III score. There was poor correspondence between subjective reports of dysphagia and performance on the water swallow test. Conclusions Swallowing problems are frequent in PD. Older women and subjects with a PIGD phenotype are more at risk of dysphagia. Self-report of "no difficulty" is not a reliable indicator of swallowing status. Studies employing more objective assessment of aspiration (risk) to compare with water swallow test performance are advocated

Prevalence and pattern of perceived intelligibility changes in Parkinson's disease

Background Changes to spoken communication are inevitable in Parkinson’s disease (PD). It remains unclear what consequences changes have for intelligibility of speech. Aims To establish the prevalence of impaired speech intelligibility in people with PD and the relationship of intelligibility decline to indicators of disease progression. Methods 125 speakers with PD and age matched unaffected controls completed a diagnostic intelligibility test and described how to carry out a common daily activity in an “off drug” state. Listeners unfamiliar with dysarthric speech evaluated responses. Results 69.6% (n = 87) of people with PD fell below the control mean of unaffected speakers (n = 40), 51.2% (n = 64) by more than −1 SD below. 48% (n = 60) were perceived as worse than the lowest unaffected speaker for how disordered speech sounded. 38% (n = 47) placed speech changes among their top four concerns regarding their PD. Intelligibility level did not correlate significantly with age or disease duration and only weakly with stage and severity of PD. There were no significant differences between participants with tremor dominant versus postural instability/gait disorder motor phenotypes of PD. Conclusions Speech intelligibility is significantly reduced in PD; it can be among the main concerns of people with PD, but it is not dependent on disease severity, duration or motor phenotype. Patients’ own perceptions of the extent of change do not necessarily reflect objective measures

Orthostatic hypotension in Parkinson's disease: association with cognitive decline?

BACKGROUND Orthostatic hypotension is common in Lewy body disorders and may be related to disease progression and the spread of Lewy body pathology. We therefore hypothesize that PD patients with orthostatic hypotension (OH) have a different cognitive profile compared to PD patients without OH. METHODS This cross-sectional study included 175 PD patients. Blood pressure (BP) was measured with a validated digital blood pressure monitor and patients with a systolic BP drop of > or =20 mmHg or a systolic pressure of <90 mm Hg after standing were considered to have OH. Cognition was assessed using MMSE extended by a selection of computerized cognitive tests focusing on reaction time, sustained attention, working memory and episodic verbal and visual memory. RESULTS Eighty-seven (49.7%) of the PD patients had OH. These patients were significantly more impaired in sustained attention and visual episodic memory compared to PD patients without OH. CONCLUSION We conclude that there are differences in the neuropsychological performance of patients with PD and OH, supporting the hypothesis that OH might be a marker for disease progression and cognitive decline in PD