Parkinson's disease or atypical parkinsonism? The importance of acoustic voice analysis in differential diagnosis of speech disorders

Abstract

Introduction: Speech disorder is a common clinical manifestation in patients with Parkinson's disease and atypical parkinsonian syndromes and tends to occur before the onset of the axial parkinsonian symptoms. Due to parkinsonian features that overlap those of Parkinson's disease, the differentiation of voice and a speech disorder is a challenge for clinicians primarily in the early stage of the disease. Methods: Speech samples were obtained from 116 subjects including 30 cases of Parkinson's disease, 30 cases of progressive supranuclear palsy, 30 cases of multiple system atrophy, and control group consisted of 26 subjects. Differential diagnosis of dysarthria subtypes was based on the quantitative, acoustic analysis of particular speech components. Additionally, Voice Handicap Index questionnaire was taken into account to differentiate the severity of voice impairment in the study groups. Results: Our results showed significant differences in the distribution of acoustic parameters between Parkinson's disease and atypical parkinsonian syndromes. A mixed type of dysarthria with a combination of hypokinetic, spastic, and atactic features has been found in patients with atypical parkinsonism. In patients with the clinical diagnosis of the parkinsonian variant of multiple system atrophy, ataxic components of dysarthria were observed. Patients with PD presented pure hypokinetic dysarthria. Some parameters may be used as a marker for the diagnosis of the initial stage of PD. Voice impartment was significantly more frequent and severe in atypical parkinsonism than in Parkinson's disease. Conclusion: Acoustic voice analysis is a very sensitive and noninvasive tool, provides objective information for the assessment of different speech components, has the specific potential to provide quantitative data essential for the improvement of the diagnostic process, and maybe a useful instrument in the differential diagnosis of parkinsonian syndromes.