Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

Abstract

Introduction The ability of people with Parkinson's Disease (PWPD) to perceive and identify impairments related to communication and swallowing is often impaired. This impairment prolongs the time to diagnosis of dysphonia and dysphagia, and can delay implementation of speech or swallowing therapy. We have limited knowledge of how different motor phenotypes of PD impact speech, voice and swallowing, nor how PWPD perceive these impacts. The purpose of this study was to identify how perceptions of speech and voice impairments predict dysphagia in PD, and how those perceptions differ between motor phenotypes. Methods 38 PWPD completed clinical surveys including V-RQOL, DHI, and a speech, voice, and swallow symptom questionnaire. Participants were categorized as either tremor dominant (TD) or non-tremor dominant (NTD) phenotypes. Multiple regression and MANOVA were utilized to identify predictors of dysphagia perceptions, and for differentiating between motor phenotype based on perceptual severity. Results Perceptions of speech and voice impairment predicted perceptions of swallow impairment regardless of phenotype ( p < .05, CI = 0.08–0.77). NTD participants reported significantly more communication and swallowing impairments than TD ( p < .05) and perceived communication impairment severity was the strongest predictor of group classification (OR = 0.50). The survey battery displayed a robust discriminatory ability between phenotype (AUC = 0.87, CI = 0.76–0.98). Conclusion The use of a noninvasive and cost-efficient survey battery may be useful in predicting patient perceived swallow impairment in PWPD. Speech, voice, and swallow impairments based on survey responses were found to differ between motor phenotypes.

Progression of Self-Perceived Speech and Swallowing Impairment in Early Stage Parkinson's Disease: Longitudinal Analysis of the Unified Parkinson's Disease Rating Scale

“…Recent studies have reported an effect of PD motor phenotype on subjective (self-perceived) and objective (instrumental) measures of speech and swallowing, which supported previous reports that motor phenotype is a predictor of the rate of disease severity progression (Burk & Watts, 2019;Dumican & Watts, 2020;Foltynie et al, 2002;Selikhova et al, 2009). Motor phenotype has been used to categorize people with PD (PWPD) into those with different clusters of motor impairments, including individuals with tremor-dominant characteristics and those with nontremor dominant characteristics such as gait impairment and postural instability.…”

“…Previous reports of dissociations between self-perceived and instrumental measures of dysarthria and dysphagia may have resulted from issues with the sensitivity of response items in the surveys used to assess selfperceptual measures. A recent study found that a detailed questionnaire specific to speech and swallowing changes was able to identify self-perceived dysarthria and dysphagia symptoms in a group of PWPD at nonadvanced stages of the disease (Dumican & Watts, 2020). Accurate assessment of self-perceived impairment and resulting quality of life are important for the process of dysarthria and dysphagia treatment as patient-reported perceptions and outcomes remain a central pillar of evidence-based practice and the evaluation of treatment effectiveness (Francis et al, 2017).…”

Laryngeal symptoms related to motor phenotypes in Parkinson's disease: A systematic review

“…Brown and Spencer 18 found no differences between phenotypes, while Burk and Watts 19 found lower cepstral peak prominence in the PIGD phenotype. Finally, one study (20%) included self‐assessment of vocal symptoms 21,23 . Dumican and Watts 21 found worse voice quality, as assessed by the Voice‐Related Quality of Life and a custom questionnaire, in the PIGD‐phenotype.…”

“…None of these established questionnaires displayed significant differences between phenotypes in any study. Dumican and Watts 21 and Sung et al 25 implemented custom dysphagia questionnaires to measure patient perceptions of swallowing dysfunction. Only Dumican and Watts 21 found significant differences in swallowing function through a custom questionnaire, with PIGD phenotype reporting significantly worse swallowing severity (reporting more severe dysphagia symptoms) compared to TD.…”

“…14,15 It has also been suggested that TD and PIGD phenotypes differ based on characteristics of their laryngeal dysfunction such as voice [18][19][20] and swallowing. 8,20,21 A comprehensive summary of the effects of PD phenotype related to laryngeal function for voice and swallowing is lacking. Consequently, this study aims to critically review the available evidence on how different PD phenotypes are associated with the laryngeal disorders in PD, namely dysphagia and dysphonia.…”