Poster presented at the International Congress of Parkinson's Disease and Movement Disorders. 4-8 June 2017, Vancouver, CanadaN/

Antonini, Angelo

Cardoso, R.

Coelho, Miguel

Fabbri, Margherita

Ferreira, Joaquim J.

Godinho, Catarina

Guedes, Leonor Correia

Guimarães, Isabel

Rosa, Mario M.

English

Repositório Comum

Speech and voice response to levodopa in late-stage Parkinson’s Disease patients: report from an acute levodopa challengeMargherita Fabbri1,MD, Isabel Guimarães2, SLT, PhD, Miguel Coelho2,3, MD, PhD, Cardoso R4, SLT, Leonor Correia Guedes2,3, MD, Mario M. Rosa2,3,5, MD, PhD, Catarina Godinho, PhD2,7, Angelo Antonini, MD, PhD6,  Joaquim J Ferreira, MD, PhD2,4,511Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal, 2Department of Speech Therapy, Escola superior de Saúde de Alcoitão, Estoril, Portugal; 3Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; 4Campus Neurológico Sénior, Torres Vedras, Portugal; 5Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal 6Fondazione Ospedale San Camillo"-I.R.C.C.S., Parkinson and Movement Disorders Unit, Venice, Italy; 7Center for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal.BACKGROUNDOBJECTIVECONCLUSIONParkinson’s disease (PD) patients are affected by hypokinetic dysarthria, characterized by hypophonia and dysprosody, which worsens with disease progression. Speech disorders affect nearly 90% of PD patients and have a negative impact on quality of life. Levodopa’s (L-dopa) effect on quality of speech is inconclusive; no data are currently available for late-stage PD (LSPD). To assess the modifications of speech and voice in LSPD following an acute L-dopa challenge.METHODSLSPD patients (Schwab and England <50/Hoehn Yahr >3 [MED ON]) performed several vocal tasks before and after an acute L-dopa challenge with a supramaximal dose (150%);The following was assessed during MED OFF and MED ON: a) respiratory support for speech (time duration of vowel /a/ prolongation); b) voice quality (fundamental frequency [F0]); c) voice stability (pitch break time, and jitter); d) voice variability (standard deviation [SD] of speaking F0 during sentences [Sentence F0SD]); e) speech rate (syllables/sec); f) motor performance (MDS-UPDRS-III) and AIMSm. All voice samples were recorded and analyzed by a speech and language therapist blinded to patients’ therapeutic condition using Praat 5.1 software. RESULTSPatients24/27 (14 men) LSPD patients succeeded in performing voice tasks;Median age and disease duration of patients was 79 [IQR: 71.5-81.7] and 14.5 [IQR: 11-15.7] years, respectively;There were no differences in demographic or clinical variables between men and women (Table 1). Baseline voice and speech characteristicsIn MED OFF, respiratory breath support and pitch break time of LSPD patients were worse than the normative values of non-parkinsonian (Table 2). Mean jitter values were in the normal range (Table 2), although results were borderline for men and SD showed a tendency for higher values. F0SD  was in the normal range (Table 2).  However, due to the low level of cooperation of LSPD patients, we adopted an 8-word (14 syllables) declarative sentence (syntactically simple) that in European Portuguese is expected to have a low level of voice variability compared to complex sentences or text reading, which are normally used for this taskVoice features and PD severityA correlation was found between disease duration and voice quality (R=0.51; p=0.013) and speech rate (R= -0.55; p=0.008). Motor impairment (MDS-UPDRS-III) had a moderate significant correlation with respiratory support for speech (R= -0.43; p=0.045) and pitch break time (R= -0.565; p=0.006). L-dopa challenge testL-dopa significantly improved MDS-UPDRS-III score (20%; IQR: 11.5%-32%);Sub-analysis of MDS-UPDRS-III scores for axial signs showed a significant median improvement after L-dopa intake for all the sub-items, except speech;None of voice and speech variables changed significantly after L-dopa intake as assessed by automatic analysis (Table 3). Equally, separate analysis of non-demented and demented patients showed no modification of speech and voice variables following L-dopa intake.Patients data LSPD (n= 24)LSPDMALE (n=14)LSPDFEMALE (n=10)p - valueAge (yrs) 79 [71.5-81.7] 77.5 [70.7-81.2] 79 [73.5-85] nsAge at disease onset (yrs) 64.5 [54.5-69.5]62.5 [55-67] 65 [51.5-71.5] nsDisease duration 14.5 [11-15.7] 13.5 [8.7-17] 15 [11.7-17.2] nsEducation (yrs) 4 [4-11] 4 [4-12] 5 [4-10.5] nsS&E (ON/OFF) 40/35 [40-40.7 / 22.5-40] 40/30 [40-40/ 40-40] 40/30 [27-50 / 17.5-50] nsHY (ON/OFF) 4 [2-4] / 4 [2-4.75] 3 [2-4] / 3 [2-4] 4 [4-5] /4 [4-5] nsPDD (n (%)) 14 (58%) 10 (71%) 4 (40%) nsMMSEMMSE (demented/non-demented)22.5 [21.2-25]22 [17-23.7] / 25 [23-26.7]22.5 [22-24.2]22 [21.7-24.2] / 23 [22.2-25.2]22.5 [16-27.2]17 [13-19.5] / 27 [25-28.5]nsLEDD (mg) 1037 [902-1272] 1100 [990-1303] 905 [742-1257] nsMDS-UPDRS-II 31 [27-38] 32 [29.2 – 38.5] 30 [20.5-38] nsMDS-UPDRS-III (MED ON/MED OFF 50 [40-54]/64 [52-77] 50 [42.5-55.2]/61[53-76] 50 [37.5-62.5] /64 [48-79.5] nsAxial sign (MED ON/MED OFF 8 [6-13] /10 [7-13] 8 [6-13]/10 [7-13.2] 8 [6.5-12]/ 10 [7-13.5] nsMDS-UPDRS-IV 4 [2-9.5] 5 [2-8.5] 4 [0-11.2] nsPD Patients (N=24) Normal valueRespiratory support for speech Vowel duration (sec)5.8 [4.4-11.5.8] 22.97 (1.1) ^Voice stabilityPitch break time (sec)1.24 [0.2-2.6.1] NA*Jitter (%) 0.8 [0.5-1.1] ≤ 0.5-1%Voice variabilityF0SD (Hz)2.4 [1.6-4] 2-4HzVoice quality (Hz) - F0 MALE (N=14) FEMALE (N=10) MALE FEMALE125 [104-152] 202 [160-226.8] 128 (36)** 198 (44)**LSPD patients (N= 24)MED OFF MED ON p - valueMDS-UPDRS-III64 [52-77] 50 [40-54] <0.001Speech2 [1-3] 2 [1-3] 0.83Freezing of gait3 [1-4] 2 [0-3] <0.05 (0.01)Postural Stability3 [2-4] 3 [2-3] <0.05 (0.014)Gait3 [2-4] 3 [2-3] <0.05 (0.01)Axial Signs10 [7-13] 8 [6-13] <0.05 (0.01)HY4 [2-4.75] 4 [2-4] 0.7mAIMS 0 1 [0-6.75] 0.04Voice Respiratory support for speech Vowel duration (sec)5.8 [4.4-11.5] 7 [3.6-10.6] 0.6Voice stabilityPitch break time1.2  [0.2-2.6] 0.8 [0.07-2.5] 0.9Jitter 0.8 [0.5-1.1] 0.7 [0.4-1] 0.5Voice qualityF0154 [123-209] 162 [147-203] 0.2Voice variabilitySentenceSFoSD31 [19-51] 29 [20-40] 0.5Speech rate 5 [3.6-5.6] 5 [4.2-5.7] 0.2Table 1. Demographic anc clinical features. Values are presented as median [IQR, 25th–75th percentile] if no otherwise specified; ns: not significant.  LEDD: L-dopa equivalent daily dose; PDD: Parkinson’s disease with dementia; MMSE: mini mental state examination. S&E: Schwab and England score; HY: Hoehn Yahr Stage; ns: non-significant; P value is the results for male vs. female scores’ comparison. Table 2 . Baseline speech and voice characteristics. Values for LSPD patients are presented as median [IQR, 25th–75th percentile]. Values for healthy subjects are presented as mean (SD), as reported in literature (Maslan J. et al., 2011; BarkanaBD & Zhou JA, 2015, Colton & Casper, 1996; Titze IR, 1993). F0: fundamental frequency; F0SD: fundamental frequency standard deviation; NA*: not available (healthy voices should have no trouble in maintaining voicing during a sustained vowel. Thus is 0% of voice breaks. No standard values are available). ^: normal value for vowel duration are referred to a healthy population aged between 71 and 80 years old. **: normal value for voice quality are referred to a healthy population aged between 55 and 80 years old.Table 3. L-dopa challenge test. Values are presented as median [IQR, 25th–75th percentile]. Statistical significant results are in bold. Axial Signs: sum of item 3.1, 3.10-3.12 of the MDS-UPDRS-III. P – value is the results of MED OFF versus MED ON scores. mAIMS: Modified Abnormal Involuntary Movement Scale.  Speech is severely affected among LSPD patients.  No effect of L-dopa was found on speech and voice by means of both automated analysis and clinical evaluation, although patients had a moderate positive motor response, even present for some axial signs, with the exception of speech.  Our findings highlight the need to assess the efficacy and applicability of alternative non-dopaminergic/non-pharmacologic treatments to specifically target and improve communication of LSPD patients.

Speech and voice response to levodopa in late-stage Parkinson’s Disease patients : report from an acute levodopa challenge

https://comum.rcaap.pt/bitstream/10400.26/29119/1/Poster_CGodinho_2017_10.pdf

Speech and voice response to levodopa in late-stage Parkinson’s Disease patients : report from an acute levodopa challenge

Abstract

Similar works

Full text

Available Versions

Repositório Comum