Evaluation of Linguistic Markers of Word-Finding Difficulty and Cognition in Parkinson's Disease Purpose Early cognitive symptoms such as word-finding difficulty (WFD) in daily conversation are common in Parkinson's disease (PD), but studies have been limited by a lack of feasible, quantitative measures. Linguistic analysis, focused on pauses in speech, may yield markers of impairment of cognition and communication in PD. The objective ... Research Article
Research Article  |   July 13, 2018
Evaluation of Linguistic Markers of Word-Finding Difficulty and Cognition in Parkinson's Disease
 
Author Affiliations & Notes
  • Kara M. Smith
    Parkinson Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
    Department of Neurology, University of Massachusetts Memorial Medical Center/UMass Medical School, Worcester
  • Sharon Ash
    Department of Neurology and the Penn Frontotemporal Degenerative Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • Sharon X. Xie
    Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • Murray Grossman
    Department of Neurology and the Penn Frontotemporal Degenerative Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Kara M. Smith: karasmi@gmail.com
  • Editor-in-Chief: Sean Redmond
    Editor-in-Chief: Sean Redmond×
  • Editor: Charles Ellis
    Editor: Charles Ellis×
Article Information
Special Populations / Older Adults & Aging / Attention, Memory & Executive Functions / Language / Research Articles
Research Article   |   July 13, 2018
Evaluation of Linguistic Markers of Word-Finding Difficulty and Cognition in Parkinson's Disease
Journal of Speech, Language, and Hearing Research, July 2018, Vol. 61, 1691-1699. doi:10.1044/2018_JSLHR-L-17-0304
History: Received August 15, 2017 , Revised December 5, 2017 , Accepted March 5, 2018
 
Journal of Speech, Language, and Hearing Research, July 2018, Vol. 61, 1691-1699. doi:10.1044/2018_JSLHR-L-17-0304
History: Received August 15, 2017; Revised December 5, 2017; Accepted March 5, 2018
Web of Science® Times Cited: 1

Purpose Early cognitive symptoms such as word-finding difficulty (WFD) in daily conversation are common in Parkinson's disease (PD), but studies have been limited by a lack of feasible, quantitative measures. Linguistic analysis, focused on pauses in speech, may yield markers of impairment of cognition and communication in PD. The objective of this study was to evaluate the relationship of linguistic markers in semistructured speech to WFD symptoms and cognitive function in PD.

Method Speech recordings of description of the Cookie Theft picture in 53 patients with PD without dementia and 23 elderly controls were analyzed with Praat software. Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), category naming fluency, and confrontation naming tests were administered. Questionnaires rating WFD symptoms and cognitive instrumental activities of daily living were completed. We determined the relationships between (a) pause length and location, (b) MoCA score, and (c) WFD symptoms, using Pearson's correlations and multivariate regression models.

Results Compared with controls, patients with PD had more pauses within utterances as well as fewer words per minute and a lower percentage of well-formed sentences. Pauses within utterances differed significantly between PD–mild cognitive impairment and normal cognition (p < .001). Words per minute and percentage of well-formed sentences were predictive of MoCA in multivariate regression models. Pauses before verbs were associated with patient-reported severity of WFD symptoms (p = .006).

Conclusions Linguistic markers including pauses within utterances distinguish patients with PD with mild cognitive symptoms from elderly controls. These markers are associated with global cognitive function before the onset of dementia. Pauses before verbs and grammatical markers may index early cognitive symptoms such as WFD that may interfere with functional communication.

Supplemental Material https://doi.org/10.23641/asha.6615401

Acknowledgments
This study was funded by a Morris K. Udall Parkinson's Disease Research Center of Excellence grant from the National Institute of Neurological Disorders and Stroke (NS-053488). K. S. was supported by an unrestricted educational grant from Medtronic, Inc. S. X. was supported by NINDS (NS-053488) and National Institutes of Health Grant AG10124. S. A. was supported by NINDS (NS-053488). M. G. was supported by National Institutes of Health (NS-053488, AG017586, AG038490, and AG053940) and was an investigator on the BMS CN002003 Study.
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