Objective: To determine if measures of arytenoid cartilage position/movement on laryngeal four-dimensional CT (4D-CT) are correlated with the duration and/or severity (as assessed by MDS-UPDRS part III scores) in people with Parkinson’s disease (pwPD).

Background: The lack of biomarkers of disease progression in PD hampers the search for disease-modifying treatments. There is evidence that voice dysfunction is the earliest sign of motor impairment in PD.  Laryngeal CT is a potential technique to study these voice changes. Our previous study using laryngeal CT during vocalization found differences in measures of arytenoid cartilage position between pwPD and controls. However, that study provided no insight into how these measures change with disease duration and severity.

Method: In a cross-sectional design, 31 pwPD of varying duration/severity and 19 controls underwent laryngeal 4D-CT whilst repeatedly phonating. Measures of laryngeal position and movement including the glottic area (GA), inter-arytenoid distance (IAD) and arytenoid cartilage velocities were extracted.

Results: Comparing pwPD to controls, significant reductions were seen in the mean IAD (Mdn = 4.24 vs 5.21, p = 0.006) and minimum IAD (Mdn = 2.66 vs 3.69, p = 0.009), while mean GA (Mdn = 53.0 vs 21.2, p = 0.024) and minimum GA (Mdn = 23.2 vs 3.60, p = 0.002) were increased. Arytenoid cartilage velocities were not significantly different.

Spearman correlation analysis demonstrates moderately strong and significant negative correlations between minimum IAD with advancing disease duration and severity, while mean/minimum GA showed moderately strong and significant positive correlations. These findings were confirmed on linear mixed regression models, with IAD being predicted by both disease duration (b = -0.011, SEb = -0.011, 95% CI [-0.022, 0], t(27) = -2.101, p=0.045) and severity (b = -0.069, SEb = -0.069, 95% CI [-0.135,-0.004], t(27) = -2.169, p=0.039), while disease duration and severity were also both significant predictors for the square root of the GA.

Conclusion: With increasing disease duration and severity of PD, the IAD decreases while the GA increases, likely reflecting the phenomenon of vocal fold bowing in the condition. Arytenoid cartilage velocities were not significantly different between pwPD and controls. Our findings indicate potential utility for laryngeal 4D-CT in assessing disease progression in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/progressive-changes-in-laryngeal-posturing-and-dynamics-as-biomarkers-of-progression-in-parkinsons-disease/