Background/Aims: Early detection and intervention may alter the disease course of subcortical vascular cognitive impairment (SVCI). Patients with SVCI have white matter ischemia that disrupts connections between the cortex and subcortical gray matter and therefore manifest various symptoms such as motor disturbances and behavioral/cognitive dysfunction. Reduced vocal loudness, or hypophonia, is one of the common motor symptoms of SVCI, but few studies have systematically investigated it in this patient population. The main purpose of this investigation was to identify neural pathways underlying hypophonia in patients with SVCI. Methods: Eighty-eight patients with SVCI and 21 normal controls performed phonation tasks. Diffusion tensor imaging data from 73 patients were utilized to measure white matter changes associated with hypophonia. Results: Correlational analyses between white matter fractional anisotropy values and the decibel level of the “sustained phonation” task identified the left midbrain cerebral peduncle (corticobulbar tract), external capsule, corona radiata/internal capsule, and bilateral frontal white matter as possible neural correlates for hypophonia. Conclusion: Our results support the notion that hypophonia in SVCI patients might be caused by the impairment of the pyramidal and extrapyramidal systems. This study provides a unique contribution towards understanding the neuropathology of hypophonic features in this population.

Keywords:
Hypophonia, Phonation, Subcortical, Vascular, Dementia, Stroke
1.
Logemann JA, Fisher HB, Boshes B, Blonsky ER: Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. J Speech Hear Disord 1978; 43:47–57.
2.
Liotti M, Ramig LO, Vogel D, New P, Cook CI, Ingham RJ, et al: Hypophonia in Parkinson’s disease: neural correlates of voice treatment revealed by PET. Neurology 2003; 60:432–440.
3.
Blacker DJ: Softly spoken strokes: two patients with marked hypophonia as a feature of strokes involving the anterior thalamus. J Clin Neurosci 2003; 10:243–245.
4.
Posteraro L, Pezzoni F, Varalda E, Fugazza G, Mazzucchi A: A case of unilateral opercular syndrome associated with a -subcortical lesion. J Neurol 1991; 238:337–339.
5.
Jurgens U: Neural pathways underlying vocal control. Neurosci Biobehav Rev 2002; 26:235–258.
6.
Seo SW, Ahn J, Yoon U, Im K, Lee JM, Tea Kim S, et al: Cortical thinning in vascular mild cognitive impairment and vascular dementia of subcortical type. J Neuroimaging 2010; 20:37–45.
7.
Kim SH, Seo SW, Go SM, Chin J, Lee BH, Lee JH, et al: Pyramidal and extrapyramidal scale (PEPS): a new scale for the assessment of motor impairment in vascular cognitive impairment associated with small vessel disease. Clin Neurol Neurosurg 2011; 113:181–187.
8.
Kim SH, Park JS, Ahn HJ, Seo SW, Lee JM, Kim ST, et al: Voxel-based analysis of diffusion tensor imaging in patients with subcortical vascular cognitive impairment: correlates with cognitive and motor deficits. J Neuroimaging 2011; 21:317–324.
9.
Roman GC, Erkinjuntti T, Wallin A, Pantoni L, Chui HC: Subcortical ischaemic vascular dementia. Lancet Neurol 2002; 1:426–436.
10.
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56:303–308.
11.
Kang Y, Na DL: Seoul Neuropsychological Screening Battery. Incheon, Human Brain Research & Consulting Co., 2003.
12.
Kim H: “Perceptual, acoustical, and physiological tools in ataxic dysarthria management: a case report”, in Proceedings on the 2nd Conference in the Korean Society of Phonetic Sciences and Speech Technology. vol. 2, 1996 pp 9–22.
13.
Kreiman J, Gerratt BR, Precoda K, Berke GS: Individual differences in voice quality perception. J Speech Hear Res 1992; 35:512–520.
14.
Hillenbrand J, Cleveland RA, Erickson RL: Acoustic correlates of breathy vocal quality. J Speech Hear Res 1994; 37:769–778.
15.
Rabinov CR, Kreiman J, Gerratt BR, Bielamowicz S: Comparing reliability of perceptual ratings of roughness and acoustic measure of jitter. J Speech Hear Res 1995; 38:26–32.
16.
Chin J, Suh MK, Seo SW, Na DL: A new scale for Frontal-Behavioral Syndrome for dementia patients: Frontal Executive Dysfunction, Disinhibition and Apathy Scale. Front Hum Neurosci Conference Abstract: The 20th Annual Rotman Research Institute Conference, The frontal lobes, 2010.
17.
Russell A, Penny L, Pemberton C: Speaking fundamental frequency changes over time in women: a longitudinal study. J Speech Hear Res 1995; 38:101–109.
18.
Pyo H: A study on the speech intelligibility of voice disordered patients according to the severity and utterance level. Speech Sci 2008; 15:101–110.
19.
Son Y, Yun Y, Kwon J, Chu K: The effect of frequency and intensity of /a/phonation on the result of acoustic analysis. J Korean Soc Laryngol Phoniatr Logoped 1997; 8:12–17.
20.
Lee S, Ko D: The effects of vocal loudness on nasalance measures of normal adults. Speech Sci 2003; 6:191–203.
21.
Linville SE, Skarin BD, Fornatto E: The interrelationship of measures related to vocal function, speech rate, and laryngeal appearance in elderly women. J Speech Hear Res 1989; 32:323–330.
22.
Morris RJ, Brown WS Jr: Age-related differences in speech variability among women. J Commun Disord 1994; 27:49–64.
23.
Huber JE: Effects of utterance length and vocal loudness on speech breathing in older adults. Respir Physiol Neurobiol 2008; 164:323–330.
24.
Bauer G, Gerstenbrand F, Hengl W: Involuntary motor phenomena in the locked-in syndrome. J Neurol 1980; 223:191–198.
25.
Urban PP, Hopf HC, Connemann B, Hundemer HP, Koehler J: The course of cortico-hypoglossal projections in the human brainstem: functional testing using transcranial magnetic stimulation. Brain 1996; 119:1031–1038.
26.
Saposnik G, Mauriño J, Rey RC, Sica RE: [Hypophonia in lacunar stroke]. Rev Neurol 2001; 33:735–736.
27.
Tomić G, Stojanović M, Pavlović A, Stanković P, Zidverc-Trajković J, Pavlović D, et al: Speech and language disorders secondary to diffuse subcortical vascular lesions: neurolinguistic and acoustic analysis. A case report. J Neurol Sci 2009; 283:163–169.
28.
Bogousslavsky J, Regli F, Uske A: Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology 1988; 38:837–841.
29.
Wildgruber D, Ackermann H, Klose U, Kardatzki B, Grodd W: Functional lateralization of speech production at primary motor cortex: a fMRI study. Neuroreport 1996; 7:2791–2795.
30.
Riecker A, Ackermann H, Wildgruber D, Dogil G, Grodd W: Opposite hemispheric lateralization effects during speaking and singing at motor cortex, insula and cerebellum. Neuroreport 2000; 11:1997–2000.
31.
Alcock KJ, Wade D, Anslow P, Passingham RE: Pitch and timing abilities in adult left-hemisphere-dysphasic and right-hemisphere-damaged subjects. Brain Lang 2000; 75:47–65.
32.
Herholz K, Pietrzyk U, Karbe H, Würker M, Wienhard K, Heiss WD: Individual metabolic anatomy of repeating words demonstrated by MRI-guided positron emission tomography. Neurosci Lett 1994; 182:47–50.
33.
Bookheimer SY, Zeffiro TA, Blaxton T, Gaillard W, Theodore W: Regional cerebral blood flow during object naming and word reading. Hum Brain Mapp 1995; 3:96–106.
34.
Price CJ, Wise RJ, Warburton EA, Moore CJ, Howard D, Patterson K, et al: Hearing and saying: The functional neuroanatomy of auditory word processing. Brain 1996; 119:919–932.
35.
Yoshitake T, Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K, et al: Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995; 45:1161–1168.
36.
Kiyohara Y: [Prevalence, incidence, and risk factors of vascular dementia: the Hisayama study]. Rinsho Shinkeigaku 1999; 39:47–49.
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