Objective: Analyse the effects of levodopa on speech and its possible relationship with motor features and dyskinesias in a group of advanced Parkinson’s disease (PD) patients.

Background: Speech changes can be very disabling symptoms in PD patients in particular in the advanced stage of the disease. Unfortunately, the effect of levodopa on speech varies greatly, depending on the existing speech and clinical profile of individual patients.

Method: We retrospectively evaluated data from 50 PD patients admitted to our department for a preoperative evaluation for Subtalamic Nucleus Deep Brain Stimulation. Disease severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores in the ON-state and OFF-state. L-dopa responsiveness was evaluated with a drug-challenge test and ON-state dyskinesias were assessed with the Clinical Dyskinesia Rating Scale (CDRS). Each patient was evaluated ON and OFF-state and performed the following speech tasks: monologue, diadochokinesis, reading of a passage and sustained phonation. A perceptual and acoustic analysis was performed using a standardized protocol and 13 parameters were evaluated, applying PRAAT, a free software for the analysis of speech, for the acoustical part. Statistical analysis was performed using Pearson correlation coefficient and paired t test.

Results: The severity of speech impairment, expressed by the item 18 of the UPDRS Part III (speech subscore) in the OFF-state, correlated negatively with the OFF-state maximum phonation time (p= 0,0296, r-value: -0,3080) and the ON-state mean intensity of sustained phonation (p= 0,0340, r-value: -0,3100). In the ON-state, UPDRS speech subscore correlated positively with the Shimmer Local dB (p= 0,0129, r-value: 0,3720). Furthermore, we found a positive correlation between the ON-state UPDRS axial subscore and ON-state speech mean frequency (p= 0.0055, r-value: 0.4114). The total CDRS score and the CDRS subscore related to axial (face, neck and trunk) dyskinesias strongly correlated with the ON-state Shimmer Local dB (p= 0.0141, r-value: 0.3677; p= 0.0030, r-value: 0.4369 respectively).

Conclusion: Our data confirm that the intensity and location of ON-state dyskinesias could negatively influence the ON-state speech quality in PD, with axial dyskinesia that could negatively influence the pneumo-phono-articulatory system.

References: 1: Ho AK, Bradshaw JL, Iansek R. For better or worse: The effect of levodopa on speech in Parkinson’s disease. Mov Disord. 2008 Mar 15;23(4):574-580. 2: Defer GL, Widner H, Marié RM, Rémy P, Levivier M. Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT‐PD). Mov Disord 1999;14:572–584. 3: Fahn S, Elton RL, UPDRS program members. Unified Parkinsons. Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M,. Calne DB, editors. Recent developments in Parkinsons disease, vol. 2. Florham Park, NJ: Macmillan Healthcare Information; 1987. p. 153–163. 4: Hagell P, Widner H. Clinical rating of dyskinesias in Parkinson’s disease: use and reliability of a new rating scale. Mov Disord. 1999;14:448-455. Similar poster presented at the XXIII World Congress on Parkinson’s Disease and Related Disorders, August 19 –22 2018; Lyon, France. Abstract also submitted to the 5th Congress of LIMPE-DISMOV Academy, May 22-24 2019; Catania, Italy. (acceptance pending)

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-levodopa-on-speech-in-advanced-parkinsons-disease-acoustic-analysis-and-correlation-with-motor-features-and-dyskinesia/