Objective: Differences in motor speech profiles may aid in diagnosis of atypical parkinsonisms. This is a retrospective study that characterizes ante-mortem motor speech profiles in postmortem confirmed atypical parkinsonisms.

Background: Motor speech disorders (MSD; i.e., dysarthria and apraxia of speech) affect up to 93% of individuals with parkinsonism (Petroi-Bock et al., 2024). The accurate diagnosis of MSDs, including type(s) and severity, relies on refined audio-perceptual skills (e.g., a “trained ear”). Importantly, the MSD of people with atypical parkinsonism differs in type and severity compared with iPD, and there is increasing evidence that an accurate diagnosis of MSD profile can aid in differential diagnosis, likely reflecting the pathophysiology of the underlying disease (Rodriguez-Porcel et al., 2026). However, because definitive diagnosis of pathology can only be confirmed with autopsy, this hypothesis has not been empirically tested. This study aimed to elucidate the relationship between the antemortem MSD of people with confirmed pathological parkinsonism diagnosis at autopsy.

Method: We performed a retrospective electronic health record review of 38 patients with post-mortem confirmed MSA (n =15; 8 male) or PSP (n =23; 16 male). We extracted the results of the motor speech evaluation (MSD type, severity, and subsystem characteristics) from the initial speech-language pathologist (SLP) consult at the UF Health Norman Fixel Institute for Neurological Diseases. Associations between MSD type, severity, and clinicopathologic confirmed parkinsonism diagnosis were examined using descriptive statistics.

Results: For patients with clinicopathologic diagnosis of MSA, nearly all (n=14) had either hypokinetic (n=6), ataxic (n=7), or mixed hypokinetic-ataxia dysarthria (n=1) whereas the majority of those with PSP had either hypokinetic (n=9), spastic (n=1), or mixed hypokinetic-spastic dysarthria (n=11). In those 14 of 15 MSA patients with dysarthria, 11 had mild-to-moderate (n=6) or more severe dysarthria. In those with PSP, 16 had moderate (n=11) or more severe dysarthria.

Conclusion: In post-mortem confirmed MSA or PSP, ante-mortem speech evaluation revealed differential dysarthria presentations of ataxic dysarthria components in MSA and spastic dysarthria components in PSP, with or without a hypokinetic dysarthria. These findings were present at their first SLP evaluation indicating speech changes early on in MSA and PSP.

References: 1. Petroi-Bock, D., Clark, H. M., Stierwalt, J. A. G., Botha, H., Ali, F., Whitwell, J. L., & Josephs, K. A. (2024). Influences of motor speech impairments on the presentation of dysphagia in progressive supranuclear palsy. International journal of speech-language pathology, 26(2), 278–288. https://doi.org/10.1080/17549507.2023.2221407
2. Rodriguez-Porcel, F., Ali, F., Bruno, M., Cuevas, H. D., Dhall, R., Dunne-Platero, K., Golbe, L. I., Haq, I., Herndon, N., Honig, L. S., Kang, K., Kremen, S., Lamotte, G., McFarland, N. R., Mir, M., Montaser-Kouhsari, L., Pantelyat, A., Page, J., Pickett, H., Verdun, L. P., … as the Diagnosis and Treatment Working Group, CurePSP Center of Care (CoC) Network (2026). Voice and Speech in Atypical Parkinsonian Disorders. Movement disorders clinical practice, 10.1002/mdc3.70515. Advance online publication. https://ddec1-0-en-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fdoi.org%2f10.1002%2fmdc3.70515&umid=3d94f2fb-9cbc-4a8c-a684-bd264cfa5600&rct=1772211765&auth=97fad1ab76126251d3eed843752929f8915193a6-37ec7c225ad22664df2b70198d7d8ed8239768b8
3. Rusz, J., Bonnet, C., Klempíř, J., Tykalová, T., Baborová, E., Novotný, M., Rulseh, A., & Růžička, E. (2015). Speech disorders reflect differing pathophysiology in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy. Journal of neurology, 262(4), 992–1001. https://doi.org/10.1007/s00415-015-7671-1
4. Kluin, K., Gilman, S., Foster, N., Sima, A., D’Amato, C., Bruch, L., Bluemlein, L., Little, R., & Johanns, J. (2001). Neuropathological correlates of dysarthria in progressive supranuclear palsy. Archives of neurology, 58(2), 265–269. https://doi.org/10.1001/archneur.58.2.265

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ante-mortem-motor-speech-profiles-in-postmortem-confirmed-atypical-parkinsonisms/