Objective: to assess the change of speech and voice after an acute L-dopa challenge in late-stage Parkinson’s disease (LSPD).

Background: PD patients are classically affected by hypophonia, dysprosody and dysarthria that worsens with the clinical progression of the disease due to breath, phonation and articulation dysfunction. The influence of levodopa intake on the quality of speech is inconclusive, and no data are currently available for LSPD patients. 

Methods: LSPD patients (Schwab and England ADL Scale (SE) ≤50 or Hoehn Yahr (HY) Stage >3 (MED ON)), underwent a levodopa challenge test with a supra-maximal dose (150%). Before and after levodopa intake, each participant performed several vocal tasks selected from the European Portuguese version of the Frenchay Dysarthria Assessment version 2. The following parameters were assessed: respiratory support for speech, voice quality, voice stability, voice variability and speech rate; motor performance was evaluated by the MDS-UPDRS part III. All voice samples were recorded in a home environment room using a tabletop unidirectional microphone and subsequently analyzed by a speech and language therapist blinded to patients’ therapeutic condition using the Praat 5.1 software.

Results: Twenty-four (14 men) of the twenty-seven LSPD patients included in the study succeeded in performing the voice tasks. Patients had a median age of 79 [IQR: 71.5-81.7] years and median disease duration of 14.5 [IQR: 11-15.7] years. In MED OFF, the values of respiratory breath support and pith break time of LSPD patients were worse than the normative values of healthy subjects of similar age and matched for gender. A positive strong correlation was found between disease duration and voice quality (R=0.8; p<0.05) and variability (R=0.793; p<0.05).

Levodopa significantly improved the MDS-UPDRS-III score (20%), with a beneficial effect on all axial signs with the exception of speech (MDS-UPDRS item 3.1). Levodopa had no significant improvement in any speech or voice features by means of automated analysis.  

Conclusions: Speech is severely affected among LSPD patients. Although levodopa still had some effect on motor performance including some axial signs, no improvement was found on speech neither by means of a clinician rating scale nor by automated analysis.

References: NA

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MDS Abstracts - https://www.mdsabstracts.org/abstract/speech-and-voice-response-to-levodopa-in-late-stage-parkinsons-disease-patients-report-from-an-acute-levodopa-challenge/