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Sprache · Stimme · Gehör 2015; 39(04): 182-186
DOI: 10.1055/s-0041-102793
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Die Dysarthrie des Morbus Parkinson: Klinische Präsentation, pathophysiologische und diagnostische Aspekte

Dysarthria in Parkinson’s Disease: Clinical Presentation, Pathophysiological and Diagnostic Aspects
S. Skodda
1   Neurologische Universitätsklinik Knappschaftskrankenhaus
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Publikationsverlauf

Publikationsdatum:
22. Dezember 2015 (online)

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Zusammenfassung

Bei der hypokinetischen Dysarthrie des Morbus Parkinson handelt es sich um eine multidimensionale Störung, die bei der Mehrzahl der Patienten zu einer relevanten Kommunikationsstörung und damit Beeinträchtigung der Lebensqualität führen kann. Neben dem pathognomonischen Befund einer leisen, monotonen Sprechweise kommt es in unterschiedlichem Ausmaß auch zu Beeinträchtigungen von Sprechatmung, Stimmbildung (Phonation), Aussprache (Artikulation), Sprechgeschwindigkeit und -rhythmus. Muster und Ausmaß der Dysarthrie können individuelle Unterschiede aufweisen und zeigen im Krankheitsverlauf eine Progressionstendenz. Die Pathophysiologie ist bislang nicht vollständig bekannt, ist aber nicht ausschließlich durch einen Dopaminmangel zu erklären. Therapie der Wahl ist eine Stimm-/Sprechtherapie. Die Diagnostik beruht im klinischen Alltag zumeist auf einer perzeptuellen Analyse, die je nach individueller Fragestellung um akustische Analyse, physiologische Messungen und/oder funktionelle Bildgebung ergänzt werden kann.

Abstract

Hypokinetic dysarthria of Parkinson’s disease is a multidimensional impairment associated with considerable communication deficits with great impact on quality of life in the majority of patients. The typical pattern of Parkinsonian dysarthria includes a reduction in loudness and intonation variability (“monopitch and monoloudness”) often combined with impaired speech respiration, phonation, articulation and temporal aspects of speech such as speech rate and rhythm. Pattern and degree of dysarthria can differ to some extent from individual to individual and show progressive deterioration over the course of disease progression. The underlying pathophysiology is still not fully understood; however, it cannot be explained by dopaminergic deficits alone. Speech/language therapy is the treatment of choice for Parkinsonian dysarthria. The diagnostic approach is based on perceptual analysis of speech in the clinical setting, but can be complemented by acoustic analyses, physiologic measures and functional neuro-imaging.

Schlüsselwörter

Morbus Parkinson - hypokinetische Dysarthrie - Dopaminmangel - Stimm-/Sprechtherapie

Key words

parkinson’s disease - hypokinetic dysarthria - dopaminergic deficit - speech therapy

Ergänzendes Material

 

  • Literatur

  • 1 Farlow J, Pankratz ND, Wojcieszek J et al. Parkinson Disease Overview. In: Pagon RA, Adam MP, Ardinger HH, et al. Eds. Seattle (WA); University of Washington: Seattle; 1993–2015 [Letztes Update 27.2.2014]
    Google Scholar
  • 2 Ho A, Iansek R, Marigliani C et al. Speech impairment in a large sample of people with Parkinson’s disease. Behav Neurol 1998; 11: 131-137
    PubMedGoogle Scholar
  • 3 Sapir S. Multiple Factors Are Involved in the Dysarthria Associated With Parkinson’s Disease: A Review With Implications for Clinical Practice and Research. JSLHR 2014; 57: 1330-1343
    PubMedGoogle Scholar
  • 4 Duffy JR. Hypokinetic dysarthria. In: Duffy JR. (Ed.). Motor Speech Disorders, substrates, differentials diagnosis and management. St. Louis: Elsevier Mosby; 2005: 187-215
    Google Scholar
  • 5 Darley FL, Aronson AE, Brown JR. Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 1969; 12: 462-496
    CrossrefPubMedGoogle Scholar
  • 6 Goberman AM, Coelho C. Acoustic analysis of parkinsonian speech I: speech characteristics and L-Dopa therapy. NeuroRehabilitation 2002; 17: 237-246
    CrossrefPubMedGoogle Scholar
  • 7 Holmes RJ, Oates J, Phyland D et al. Voice characteristics in the progression of Parkinson’s disease. Int J Lang Commun Disord 2000; 35: 417-418
    PubMedGoogle Scholar
  • 8 Huber JE, Spruill J. Respiratory function and variability in individuals with Parkinson’s disease: pre- and post-Lee Silverman Voice Treatment. J Med Speech Lang Pathol 2003; 11: 185-192
    PubMedGoogle Scholar
  • 9 Ackermann H, Konczak J, Hertrich I. The temporal control of repetitive articulatory movements in Parkinson’s disease. Brain Lang 1997; 57: 312-319
    PubMedGoogle Scholar
  • 10 Skodda S. Aspects of speech rate and regularity in Parkinson’s disease. J Neurol Sci 2011; 310: 231-236
    CrossrefPubMedGoogle Scholar
  • 11 Rusz J, Cmejla R, Růžičková H et al. Evaluation of speech impairment in early stages of Parkinson’s disease: a prospective study with the role of pharmacotherapy. J Neural Transm 2013; 120: 319-329
    CrossrefPubMedGoogle Scholar
  • 12 Ho AK, Bradshaw JL, Iansek R. For better or worse: The effect of levodopa on speech in Parkinson’s disease. Mov Disord 2008; 15 23: 574-580
    CrossrefPubMedGoogle Scholar
  • 13 Skodda S, Grönheit W, Mancinelli N et al. Progression of voice and speech impairment in the course of Parkinson’s disease: a longitudinal study. Parkinsons Dis 2013; 2013 389195
    PubMedGoogle Scholar
  • 14 Goberman AM, Blomgren M. Parkinsonian speech disfluencies: effects of L-dopa-related fluctuations. J Fluency Disord 2003; 28: 55-70
    CrossrefPubMedGoogle Scholar
  • 15 Ho AK, Iansek R, Bradshaw JL. Motor instability in Parkinsonian speech intensity. Neuropsychiatry Neuropsychol Behav Neurol 2001; 14: 109-116
    PubMedGoogle Scholar
  • 16 Goberman AM, Elmer WE. Acoustic analysis of clear versus conversional speech in individuals with Parkinson’s disease. J Commun Disord 2005; 38: 215-230
    CrossrefPubMedGoogle Scholar
  • 17 Ho AK, Bradshaw JL, Iansek R et al. Speech volume regulation in Parkinson’s disease: effects of implicit cues and explicit instructions. Neuropsychologia 1999; 37: 1453-1460
    CrossrefPubMedGoogle Scholar
  • 18 Kempler D, Van Lancker D. Effect of speech task on intelligibility in dysarthria: a case study of Parkinson’s disease. Brain Lang 2002; 80: 449-464
    CrossrefPubMedGoogle Scholar
  • 19 Fox CM, Ramig LO, Ciucci MR et al. The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang 2006; 27: 283-299
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 McNamara P, Obler LK, Au R et al. Speech monitoring skills in Alzheimer’s disease, Parkinson’s disease, and normal aging. Brain Lang 1992; 42: 38-51
    CrossrefPubMedGoogle Scholar
  • 21 Poewe W. The natural history of Parkinson’s disease. J Neurol 2006; 253 (Suppl. 07) VII2-VII6
    CrossrefPubMedGoogle Scholar
  • 22 Braak H, Del Tredici K, Rüb U et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 2003; 24: 197-211
    CrossrefPubMedGoogle Scholar
  • 23 Jellinger KA. Synuclein deposition and non-motor symptoms in Parkinson disease. J Neurol Sci 2011; 310: 107-111
    CrossrefPubMedGoogle Scholar
  • 24 Darley FL, Aronson AE, Brown JR.. Differential diagnostic patterns of dysarthria. J Speech Hear Res 1969; 12: 246-269
    CrossrefPubMedGoogle Scholar
  • 25 Metter J, Hanson W. Clinical and acoustical variability in hypokinetic dysarthria. J Commun Disord 1986; 19: 347-366
    CrossrefPubMedGoogle Scholar
  • 26 Skodda S, Visser W, Schlegel U. Gender-related patterns of dysprosody in Parkinson’s disease and correlation between speech variables and motor symptoms. J Voice 2011; 25: 76-82
    CrossrefPubMedGoogle Scholar
  • 27 Logemann JA, Fisher HB, Boshes B et al. Frequency and co-occurrence of vocal tract dysfunction in the speech of a large sample of parkinsonian patients. J Speech Hearing Disord 1978; 43: 47-57
    PubMedGoogle Scholar
  • 28 Hertrich I, Ackermann H. Gender-specific vocal dysfunction in Parkisnon’s disease: Electroglottographic and acoustical analyses. An Oto Rhino Laryngol 1995; 104: 197-202
    PubMedGoogle Scholar
  • 29 Tanaka Y, Nishio M, Niimi S. Vocal acoustic characteristics of patients with Parkinson’s disease. Folia Phoniatr Logop 2011; 63: 223-230
    CrossrefPubMedGoogle Scholar
  • 30 Hovestadt A, Bogaard JM, Meerwaldt J et al. Pulmonary function in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1989; 52: 329-333
    CrossrefPubMedGoogle Scholar
  • 31 Baker KK, Ramig LO, Luschei ES et al. Thyroarytenoid muscle activity associated with hypophonia in Parkinson’s disease and aging. Neurology 1998; 51: 1592-1598
    CrossrefPubMedGoogle Scholar
  • 32 Hanson DG, Gerrat BR, Ward PH. Cinegraphic observations of laryngeal function in Parkinson’s disease. Laryngoscope 1984; 94: 348-353
    PubMedGoogle Scholar
  • 33 Perez KS, Ramig LO, Smith ME et al. The parkinson larynx: tremor and videoscopic findings. J Voice 1996; 10: 354-361
    CrossrefPubMedGoogle Scholar
  • 34 McClean MD, Beukelman DR, Yorkston KM. Speech-muscle visuomotor tracking in dysarthric and nonimpaired speakers. J Speech Hear Res 1987; 30: 276-282
    CrossrefPubMedGoogle Scholar
  • 35 Forrest K, Weismer G, Turner GS. Kinematic acoustic and perceptual analyses of connected speech produced by parkinsonian and normal geriatric adults. J Acoust Soc Am 1989; 85: 2608-2622
    CrossrefPubMedGoogle Scholar
  • 36 Hunker C, Abbs J, Barlow S. The relationship between parkinsonian rigidity and hypokinesia in the orofacial system: a quantitative analysis. Neurology 1982; 2: 749-754
    PubMedGoogle Scholar
  • 37 Sapir S, Spielman JL, Ramig LO et al. Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 2007; 50: 899-912
    CrossrefPubMedGoogle Scholar
  • 38 Skodda S, Visser W, Schlegel U. Vowel articulation in Parkinson’s disease. J Voice 2011; 25: 467-472
    CrossrefPubMedGoogle Scholar
  • 39 Hirose H, Kiritani S, Sawashima M. Velocity of articulatory movements in normal and dysarthric subjects. Folia Phoniatr Logop 1982; 34: 210-215
    CrossrefPubMedGoogle Scholar
  • 40 Ludlow CL, Connor NP, Bassich CJ. Speech timing in Parkinson’s and Huntington’s disease. Brain Lang 1987; 32: 195-214
    CrossrefPubMedGoogle Scholar
  • 41 Flasskamp A, Kotz SA, Schlegel U et al. Acceleration of syllable repetition in Parkinson’s disease is more prominent in the left-side dominant patients. Parkinsonism Relat Disord 2012; 18: 343-347
    CrossrefPubMedGoogle Scholar
  • 42 Benke T, Butterworth B. Palilalia and repetitive speech: two case studies. Brain Lang 2001; 78: 62-81
    CrossrefPubMedGoogle Scholar
  • 43 Majdinasab F, Karkheiran S, Moradi N et al. Relation between Voice Handicap Index (VHI) and disease severity in Iranian patients with Parkinson’s disease. Med J Islam Repub Iran 2012; 26: 157-163
    PubMedGoogle Scholar
  • 44 Miller N, Noble E, Jones D et al. Life with communication changes in Parkinson’s disease. Age Ageing 2006; 35: 235-239
    CrossrefPubMedGoogle Scholar
  • 45 Gallena S, Smith PJ, Zeffiro T et al. Effects of levodopa on laryngeal muscle activity for voice onset and offset in Parkinson’s disease. J Speech Lang Hear Res 2001; 44: 1284-1299
    CrossrefPubMedGoogle Scholar
  • 46 Goberman A, Coelho C, Robb M. Phonatory characteristics of parkinsonian speech before and after morning medication: the ON and OFF states. J Commun Disord 2002; 35: 217-239
    CrossrefPubMedGoogle Scholar
  • 47 Tykalová T, Rusz J, Čmejla R et al. Effect of dopaminergic medication on speech dysfluency in Parkinson’s disease: a longitudinal study. J Neural Transm 2015; Jan 13. [Epub ahead of print]
    PubMedGoogle Scholar
  • 48 Louis ED, Winfield L, Fahn S et al. Speech dysfluency exacerbated by levodopa in Parkinson’s disease. Mov Disord 2001; 16: 562-565
    CrossrefPubMedGoogle Scholar
  • 49 Goberman AM, Blomgren M. Parkinsonian speech disfluencies: effects of L-dopa-related fluctuations. J Fluency Disord 2003; 28: 55-70
    CrossrefPubMedGoogle Scholar
  • 50 Obeso JA, Marin C, Rodriguez-Oroz C et al. The basal ganglia in Parkinson’s disease: current concepts and unexplained observations. Ann Neurol 2008; 64 (Suppl. 02) S30-46
    PubMedGoogle Scholar
  • 51 Gaig C, Tolosa E. When does Parkinson’s disease begin?. Mov Disord 2009; 24 (Suppl.2) S656-S664
    CrossrefPubMedGoogle Scholar
  • 52 Ackermann H, Ziegler W. Articulatory deficits in Parkinsonian dysarthria. J Neurol Neurosurg Psychiatry 1991; 54: 1093-1098
    CrossrefPubMedGoogle Scholar
  • 53 Caligiuri MP. The influence of speaking rate on articulatory hypokinesia in parkinsonian dysarthria. Brain Lang 1989; 36: 493-502
    CrossrefPubMedGoogle Scholar
  • 54 Sadagopan N, Huber JE. Effects of loudness cues on respiration in individuals with Parkinson’s disease. Mov Disord 2007; 22: 651-659
    CrossrefPubMedGoogle Scholar
  • 55 Sapir S. Multiple factors are involved in the dysarthria associated with Parkinson’s disease: a review with implications for clinical practice and research. J Speech Lang Hear Res 2014; 57: 1330-1343
    CrossrefPubMedGoogle Scholar
  • 56 Brown P, Marsden CD. What do the basal ganglia do?. Lancet 1998; 351: 1801-1804
    CrossrefPubMedGoogle Scholar
  • 57 Caligiuri M, Abbs JH. Response properties of the perioral reflex in Parkinson’s disease. Exp Neurol 1987; 98: 563-572
    CrossrefPubMedGoogle Scholar
  • 58 Diamond SG, Schneider JS, Markham CH. Oral sensorimotor defects in people with Parkinson’s disease. Adv Neurol 1987; 45: 335-338
    PubMedGoogle Scholar
  • 59 Walshe M, Miller N, Leahy M et al. Intelligibility of dysarthric speech: perceptions of speakers and listeners. Int J Lang Commun Disord 2008; 43: 633-648
    CrossrefPubMedGoogle Scholar
  • 60 Sapir S, Ramig L, Hoyt P et al. Phonatory-respiratory effort (LSVT®) vs. respiratory effort treatment for hypokinetic dysarthria: comparing speech loudness and quality before and 12 months after treatment. Folia Phoniatr 2002; 54: 296-303
    CrossrefPubMedGoogle Scholar
  • 61 Spielman J, Ramig LO, Mahler L et al. Effects of an extended version of the lee silverman voice treatment on voice and speech in Parkinson’s disease. Am J Speech Lang Pathol 2007; 16: 95-107
    CrossrefPubMedGoogle Scholar
  • 62 Rowe J, Stephan KE, Friston K et al. Attention to action in Parkinson’s disease: impaired effective connectivity among frontal cortical regions. Brain 2002; 125 (Pt 2) 276-289
    CrossrefPubMedGoogle Scholar
  • 63 Robbins TW, Cools R. Cognitive deficits in Parkinson’s disease: a cognitive neuroscience perspective. Mov Disord 2014; 29: 597-607
    CrossrefPubMedGoogle Scholar
  • 64 Wertheimer J, Gottuso AY, Nuno M et al. The impact of STN deep brain stimulation on speech in individuals with Parkinson’s disease: the patient’s perspective. Parkinsonism Relat Disord 2014; 20: 1065-1070
    CrossrefPubMedGoogle Scholar
  • 65 Wight S, Miller N., Lee Silverman Voice. Treatment for people with Parkinson’s: audit of outcomes in a routine clinic. Int J Lang Commun Disord 2015; 50: 215-225
    CrossrefPubMedGoogle Scholar
  • 66 Rusz J, Cmejla R, Tykalova T et al. Imprecise vowel articulation as a potential early marker of Parkinson’s disease: effect of speaking task. J Acoust Soc Am 2013; 134: 2171-81
    CrossrefPubMedGoogle Scholar
  • 67 Duffy JR. Hypokinetic dysarthria. In: Duffy JR. (Hrsg.) Motor Speech Disorders, substrates, differentials diagnosis and management. St. Louis. Elsevier Mosby; 2005: 187-215
    Google Scholar