Defining Speech Subtypes in De Novo Parkinson Disease Response to Long-term Levodopa Therapy

Background and Objectives Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy. Methods We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis. Results Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002). Discussion Distinct speech phenotypes in de novo PD reflect divergent underlying mechanisms and allow prediction of response of speech impairment to levodopa therapy. Classification of Evidence This study provides Class II evidence that, in patients with newly diagnosed PD with speech impairment, speech phenotype is associated with levodopa responsiveness.

Automated summary

This study identified three distinct speech subtypes in treatment-naive patients with PD, including prosodic, phonatory-prosodic, and articulatory-prosodic subtypes. Untreated controls with PD showed deteriorated speech over 1 year, while long-term dopaminergic medication maintained stable speech impairment severity in some subtypes and improved speech performance in others.