Effects of Levodopa on Vowel Articulation in Patients with Parkinson's Disease.

OBJECTIVES The effects of levodopa on articulatory dysfunction in patients with Parkinson's disease remain inconclusive. This study aimed to investigate the effects of levodopa on isolated vowel articulation and motor performance in patients with moderate to severe Parkinson's disease, excluding speech fluctuations caused by dyskinesia. METHODS 21 patients (14 males and 7 females) and 21 age- and sex- matched healthy subjects were enrolled. Together with motor assessment, the patients phonated five Japanese isolated vowels (/a/, /i/, /u/, /e/, and /o/) 20 times before and 1 h after levodopa treatment. We made the frequency analysis of each vowel and measured the first and second formants. From these formants we constructed the pentagonal vowel space area which should be the good indicator for articulatory dysfunction of vowels. In control subjects, only speech samples were analyzed. To investigate the sequential relationship between plasma levodopa concentrations, motor performances, and acoustic measurements after treatment, entire drug cycle tests were performed in 4 patients. RESULTS The pentagonal vowel space area was significantly expanded together with motor amelioration after levodopa treatment, although the enlargement is not enough for the space area of control subjects. Drug cycle tests revealed that sequential increases or decreases in plasma levodopa levels after treatment correlated well with expansion or decrease of the vowel space areas and improvement or deterioration of motor manifestations. CONCLUSIONS Levodopa expanded the vowel space area and ameliorated motor performance, suggesting that dysfunctions in vowel articulation and motor performance in patients with Parkinson's disease are based on dopaminergic pathology.