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What Causes Speech Problem In A Person With Parkinson's Disease?
Question: HI- I HAVE PARKINSON'S DISEASE FOR 14 YEARS AND JUST HAD A MRI OF MY BRAIN JUST TO SEE WHATS HAPPPENING UP THERE. IT SHOWED MINIMAL CHRONIC MICROVACULAR ISCHEMIC CHANGES. COINSIDENTALLY MY SPEECH IS UNDISCERNABLE FOR THE LAST 6 MONTHS FROM NOON TO DINNER TME. COULD THE ISCHEMIC CHANGES BE XXXXXXX STROKES AND ACCOUNT FOR THE SPEECH PROBLEM. THANKS
Brief Answer:
I don't think they account for speech issue.
Detailed Answer:
I read your question carefully and I understand your concern.
Technically speaking those changes are a subtype of stroke, called small vessel disease, due not to involvement of one particular big vessel, but to diffuse decrease in caliber of small blood vessels with lack of sufficient blood flow in the most affected distant areas.
However such changes of blood vessel walls are common with the passing of the years and are often found after the age of 60 as part of the aging process. The one thing which could be done about them is control of potential factors which can accelerate it such as high blood pressure, diabetes, smoking, high cholesterol.
Coming to whether they are the main cause of your speech issues, my answer is no. It's true that small vessel disease when advanced can cause symptoms which can be confused with Parkinson's, including speech issues. However in the case of minimal changes like yours it usually causes no symptoms and is found incidentally on imaging exams for other reasons like in your case. The fact that your speech problems fluctuate during the day supports that as well, small vessels changes are irreversible, they don't come and go during the day. So I don't think such minimal changes are at the root of your speech problems.
Such speech issues are common in Parkinson's and are part of its clinical picture in your case as well in my opinion, fluctuations corresponding to fluctuations of dopamine levels with treatment.
I remain at your disposal for other questions.
I don't think they account for speech issue.
Detailed Answer:
I read your question carefully and I understand your concern.
Technically speaking those changes are a subtype of stroke, called small vessel disease, due not to involvement of one particular big vessel, but to diffuse decrease in caliber of small blood vessels with lack of sufficient blood flow in the most affected distant areas.
However such changes of blood vessel walls are common with the passing of the years and are often found after the age of 60 as part of the aging process. The one thing which could be done about them is control of potential factors which can accelerate it such as high blood pressure, diabetes, smoking, high cholesterol.
Coming to whether they are the main cause of your speech issues, my answer is no. It's true that small vessel disease when advanced can cause symptoms which can be confused with Parkinson's, including speech issues. However in the case of minimal changes like yours it usually causes no symptoms and is found incidentally on imaging exams for other reasons like in your case. The fact that your speech problems fluctuate during the day supports that as well, small vessels changes are irreversible, they don't come and go during the day. So I don't think such minimal changes are at the root of your speech problems.
Such speech issues are common in Parkinson's and are part of its clinical picture in your case as well in my opinion, fluctuations corresponding to fluctuations of dopamine levels with treatment.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
THANKS. ARE THE ISCHEMIC CHANGES LIKE BLOT CLOTS AND WILL I NEED STATINS OR BLOOD THINNERS?
Brief Answer:
Read below.
Detailed Answer:
Ischemic means due to lack of blood supply independent of the cause. Most often in the case of the classic stroke it is in the setting of a blood clot interrupting blood flow.
In this type of chronic scattered small blood vessel related ischemia, at the origin is more a case of a thickening of blood vessel walls narrowing their lumen, this predisposes to subsequent deposition of small clots, further cutting the blood flow. Atherosclerosis plays a role as well, but vessel wall changes are the main finding as I said.
As for blood thinners like aspirin, clopidogrel or aspirin + dipyridamole combination, they are used but there are fewer studies on their efficacy, which is more proven in stroke involving bigger vessels where the main cause is atherosclerosis, for which they are more specific. The same applies to statin use. But yes, they are still considered beneficial and are generally used.
Read below.
Detailed Answer:
Ischemic means due to lack of blood supply independent of the cause. Most often in the case of the classic stroke it is in the setting of a blood clot interrupting blood flow.
In this type of chronic scattered small blood vessel related ischemia, at the origin is more a case of a thickening of blood vessel walls narrowing their lumen, this predisposes to subsequent deposition of small clots, further cutting the blood flow. Atherosclerosis plays a role as well, but vessel wall changes are the main finding as I said.
As for blood thinners like aspirin, clopidogrel or aspirin + dipyridamole combination, they are used but there are fewer studies on their efficacy, which is more proven in stroke involving bigger vessels where the main cause is atherosclerosis, for which they are more specific. The same applies to statin use. But yes, they are still considered beneficial and are generally used.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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