Abstract
ObjectiveThis study examines reading aloud in patients with amyotrophic lateral sclerosis (ALS) and those with frontotemporal dementia (FTD) in order to determine whether differences in patterns of speaking and pausing exist between patients with primary motor vs. primary cognitive-linguistic deficits, and in contrast to healthy controls.Design136 participants were included in the study: 33 controls, 85 patients with ALS, and 18 patients with either the behavioural variant of FTD (FTD-BV) or progressive nonfluent aphasia (FTD-PNFA). Participants with ALS were further divided into 4 non-overlapping subgroups—mild, respiratory, bulbar (with oral-motor deficit) and bulbar-respiratory—based on the presence and severity of motor bulbar or respiratory signs. All participants read a passage aloud. Custom-made software was used to perform speech and pause analyses, and this provided measures of speaking and articulatory rates, duration of speech, and number and duration of pauses. These measures were statistically compared in different subgroups of patients.ResultsThe results revealed clear differences between patient groups and healthy controls on the passage reading task. A speech-based motor function measure (i.e., articulatory rate) was able to distinguish patients with bulbar ALS or FTD-PNFA from those with respiratory ALS or FTD-BV. Distinguishing the disordered groups proved challenging based on the pausing measures.Conclusions and RelevanceThis study demonstrated the use of speech measures in the identification of those with an oral-motor deficit, and showed the usefulness of performing a relatively simple reading test to assess speech versus pause behaviors across the ALS—FTD disease continuum. The findings also suggest that motor speech assessment should be performed as part of the diagnostic workup for patients with FTD.
Highlights
Pausing while speaking provides insight into the multiple stages of spoken word production
This study demonstrated the use of speech measures in the identification of those with an oral-motor deficit, and showed the usefulness of performing a relatively simple reading test to assess speech versus pause behaviors across the amyotrophic lateral sclerosis (ALS)—frontotemporal dementia (FTD) disease continuum
The findings suggest that motor speech assessment should be performed as part of the diagnostic workup for patients with FTD
Summary
Pausing while speaking provides insight into the multiple stages of spoken word production. Adults, who are fluent speakers, and readers, speak rather rapidly and pause in speech following a predictable pattern. In addition to the cognitive load and the complexity of the linguistic message, speech breathing and pausing are affected by motor processes that are associated with the planning and execution of utterances (e.g., speaking rate and utterance length variation) [6,7,8,9]. Conditions associated with changes in motor control and/or cognitive-linguistic deficits may result in predictable changes in speaking and/or pausing, and the tracking of these resultant changes could potentially serve a role in the diagnosis of such conditions
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