Narrative analysis in individuals with Parkinson's disease following intensive voice treatment: secondary outcome variables from a randomized controlled trial

Abstract

Communication is often impaired in individuals with Parkinson's disease (PD), typically secondary to sensorimotor deficits impacting voice and speech. Language may also be diminished in PD, particularly for production and comprehension of verbs. Evidence exists that verb processing is influenced by motor system modulation suggesting that verb deficits in PD are underpinned by similarities in the neural representations of actions that span motor and semantic systems. Conversely, subtle differences in cognition in PD may explain difficulty in processing of complex syntactic forms, which increases cognitive demand and is linked to verb use. Here we investigated whether optimizing motor system support for vocal function (improving loudness) affects change in lexical semantic, syntactic, or informativeness aspects of spoken discourse. Picture description narratives were compared for 20 Control participants and 39 with PD, 19 of whom underwent Lee Silverman Voice Treatment (LSVT LOUD®). Treated PD narratives were also contrasted with those of untreated PD and Control participants at Baseline and after treatment. Controls differed significantly from the 39 PD participants for verbs per utterance, but this difference was largely driven by untreated PD participants who produced few utterances but with verbs, inflating their verbs per utterance. Given intervention, there was a significant increase in vocal loudness but no significant changes in language performance. These data do not support the hypothesis that targeting this speech motor system results in improved language production. Instead, the data provide evidence of considerable variability in measures of language production across groups, particularly in verbs per utterance.

Keywords: Parkinson’s disease; language; narrative discourse; speech treatment; vocal loudness.

Figure 1

Multiple differences across groups existed for verbs per utterance, generally reflecting little change over time in the Controls, decrease over time in the UNTXPD, and increase over time in the TXPD group. However, given the considerable variance in this measure, the only significant change was the decrease in VPU observed in the UNTXPD group.

Figure 2

Estimates for verbs per utterance demonstrate considerable variability in verbs per utterance in the PD participants across quantiles, with the UNTXPD producing significantly more verbs per utterance than either of the other groups at Baseline, but those significantly decreased at 1-month for the 50th, 75th, and 90th quantiles.