Objective: To describe the prevalence of self-reported speech difficulties in newly diagnosed Parkinson’s disease (PD) and to explore its associations with dysphagia, hypersalivation (HS) and early gait impairment.

Background: Speech difficulties can appear in the early stages of PD, but prevalence in newly diagnosed untreated (“de novo”) PD is not well explored. Previous studies suggest a shared underlying mechanism between speech difficulties and gait impairment [1], but associations at the early stage remain unclear. Dysphagia and HS are also poorly examined in early PD. Describing the prevalence of speech difficulties and their associated factors in early PD may support more effective referrals to speech and language therapy services.

Method: The cross-sectional study included 58 individuals with de novo PD [mean age (SD): 67 (10.2) years, 25 (43%) females]. Median (q1-q3) UPDRS III score was 20 (14 – 25.5). Speech difficulties, dysphagia and HS were investigated with UPDRS II item 5-7, experience of unsteady turn (UT) with a yes/no question.  Multiple choice questions were dichotomized (0 = no difficulties, ≥ 1 = difficulties). Four multiple logistic regression models were estimated using speech difficulties as the dependent variable and dysphagia, HS, and UT as predictors. All models were adjusted for gender, age, and motor symptoms. Backward selection was then applied to derive the final model, which was also controlled for the same covariates.

Results: 25 (43%) of the subjects reported speech difficulties, 14 (24%) dysphagia, 26 (45%) HS, and 26 (45%) UT.  Speech difficulties were significantly associated with dysphagia (OR=5.3, 95% CI [1.041, 27.141], p=0,045), HS (OR=4.8, 95% CI [1.388, 17.137], p=0.013) and UT (OR=7.4, 95% CI [1.808, 30.324], p=0.005). The backwards selection analysis yielded the final model with dysphagia (OR=8.0, 95% CI [1.191, 54.698] p=0.032) and UT (OR=8.0, 95% CI [1.720, 37.350] p=0.008) as significantly associated with speech difficulties.

Conclusion: In newly diagnosed PD, speech difficulties are common and significantly associated with dysphagia, warranting an early structural approach to assessment of these symptoms. In agreement with earlier research HS seems to be explained by underlying dysphagia. The association between speech difficulties and UT indicates a link between speech and gait impairments already in the early stage.

References: 1. Mekyska, J., Galaz, Z., Kiska, T., Zvoncak, V., Mucha, J., Smekal, Z., Eliasova, I., Kostalova, M., Mrackova, M., Fiedorova, D., Faundez-Zanuy, M., Sole-Casals, J., Gomez-Vilda, P., & Rektorova, I. (2018). Quantitative Analysis of Relationship Between Hypokinetic Dysarthria and the Freezing of Gait in Parkinson’s Disease. COGNITIVE COMPUTATION, 10(6), 1006–1018. https://doi.org/10.1007/s12559-018-9575-8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/speech-and-gait-in-newly-diagnosed-parkinsons-disease-support-for-early-rehabilitation/