The Relationship between Cognitive Function, Syntax, and Severity of Dysarthria in Persian-Speaking Patients with Multiple Sclerosis
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Abstract
Introduction: Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Patients with MS experience several difficulties in the fields of speech, language, and cognitive abilities. This study aimed to investigate the relationship between cognitive functions, syntax, and the severity of dysarthria in Persian-speaking patients with relapsing-remitting multiple sclerosis (RRMS), as well as comparisons with healthy non-patient individuals.
Materials and Methods: This cross-sectional study compared 31 patients diagnosed with RRMS to 31 healthy adults matched with the patient group based on age, gender, and education level. Participants were assessed using the montreal cognitive assessment (MoCA), as well as the syntax comprehension subtest from the bilingual aphasia test and the sentence production test. Additionally, the presence of dysarthria was evaluated through the Frenchay dysarthria assessment (FDA-2), and the dysarthria’s severity was determined using the visual analog scale (VAS) by three Speech and language pathologists based on the recorded speech samples.
Results: The findings revealed a significant difference between MS patients and the control group (P≤0.05). Additionally, the results showed a significant correlation between dysarthria severity and both syntax comprehension (P=0.002, Cohen’s d=0.803) and syntax production (P=0.005, Cohen’s d=0.820), as well as the MoCA (P = 0.001, Cohen’s d = 0.579). Furthermore, significant correlations were also found between the MoCA and both syntax comprehension and syntax production within the patient group (P≤0.05). The data was analyzed by SPSS software, version 26. The difference between the two groups was calculated using the independent t-test, and the correlation between them was analyzed using the Spearman test at a significance level of P≤0.05.
Conclusion: Syntactic challenges in MS patients might be linked to underlying cognitive impairments, and as the severity of dysarthria increases in patients, their syntactic problems also escalate. The results of this study can help speech and language pathologists in clinical evaluations and in providing comprehensive treatment plans for patients with MS.
Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology. 2008; 7(12):1139-51. [DOI:10.1016/S1474-4422(08)70259-X]
Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Multiple Sclerosis. 2020; 26(14):1816-21. [DOI:10.1177/1352458520970841] [PMID]
Motaharifard F, & Zeinali R. The impact of mental practice on sleep quality, fatigue, functional balance and gaiting in patient with multiple sclerosis: A case report. Koomesh. 2016; 17(4):944-9. [Link]
Ebrahimipour M. [Speech therapy in MS (Persian)]. Tehran: Setayesh Hasti; 2010. [Link]
Etemadifar M, Janghorbani M, Shaygannejad V, Ashtari F. Prevalence of multiple sclerosis in Isfahan, Iran. Neuroepidemiology. 2006; 27(1):39-44. [DOI:10.1159/000094235]
Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology. 2014; 83(3):278-86. [DOI:10.1212/WNL.0000000000000560] [PMID]
Summers M, Fisniku L, Anderson V, Miller D, Cipolotti L, Ron M. Cognitive impairment in relapsing-remitting multiple sclerosis can be predicted by imaging performed several years earlier. Multiple Sclerosis. 2008; 14(2):197-204. [DOI:10.1177/1352458507082353] [PMID]
El-Wahsh S, Ballard K, Kumfor F, Bogaardt H. Prevalence of self-reported language impairment in multiple sclerosis and the association with health-related quality of life: An international survey study. Multiple sclerosis and related disorders. 2020; 39:101896. [DOI:10.1016/j.msard.2019.101896] [PMID]
Laakso K, Brunnegård K, Hartelius L, Ahlsén E. Assessing high-level language in individuals with multiple sclerosis: A pilot study. Clinical Linguistics & Phonetics. 2000; 14(5):329-49. [DOI:10.1080/02699200050051065]
Carotenuto A, Arcara G, Orefice G, Cerillo I, Giannino V, Rasulo M, et al. Communication in multiple sclerosis: Pragmatic deficit and its relation with cognition and social cognition. Archives of Clinical Neuropsychology. 2017; 33(2):194-205. [DOI:10.1093/arclin/acx061] [PMID]
Klugman TM, & Ross E. Perceptions of the impact of speech, language, swallowing, and hearing difficulties on quality of life of a group of South African persons with multiple sclerosis. Folia Phoniatrica et logopaedica. 2002; 54(4):201-21. [DOI:10.1159/000063194] [PMID]
Rahimifar P, Soltani M, Moradi N, Majdinasab N, Latifi S. [A comparative study of repetition of long sentences skill in Persian-speaking multiple sclerosis patients and healthy subjects (Persian)]. Koomesh. 2017; 19(1):122-8. [Link]
Soltani M, Rahimifar P. Language disorders in multiple sclerosis. In: Baloyannis S, editor. Multiple sclerosis. London: IntechOpen; 2020. [Link]
Šubert M, Novotný M, Tykalová T, Srpová B, Friedová L, Uher T, et al. Lexical and syntactic deficits analyzed via automated natural language processing: The new monitoring tool in multiple sclerosis. Therapeutic Advances in Neurological Disorders. 2023; 16:17562864231180719. [DOI:10.1177/17562864231180719] [PMID]
Arrondo G, Sepulcre J, Duque B, Toledo J, Villoslada P. Narrative speech is impaired in multiple sclerosis. The European Neurological Journal. 2010; 2(1):1. [Link]
Jongen PJ, Ter Horst AT, Brands AM. Cognitive impairment in multiple sclerosis. Minerva medica. 2012; 103(2):73-96. [PMID]
Langdon DW. Cognition in multiple sclerosis. Current Opinion in Neurology. 2011; 24(3):244-9. [DOI:10.1097/WCO.0b013e328346a43b]
Grigoriadis P, Bakirtzis C, Nteli E, Boziki MK, Kotoumpa M, Theotokis P, Kesidou E, Stavrakaki S. Morphosyntactic Abilities and Cognitive Performance in Multiple Sclerosis. Brain Sciences. 2024; 14(3):237. [DOI:10.3390/brainsci14030237] [PMID]
Smith MM, Arnett PA. Dysarthria predicts poorer performance on cognitive tasks requiring a speeded oral response in an MS population. Journal of Clinical and Experimental Neuropsychology. 2007; 29(8):804-12. [DOI:10.1080/13803390601064493]
King KA. Syntactic complexity in persons with multiple sclerosis [master thesis]. Provo: Brigham Young University; 2009. [Link]
Feenaughty L, Guo LY, Weinstock-Guttman B, Ray M, Benedict RHB, Tjaden K. Impact of cognitive impairment and dysarthria on spoken language in multiple sclerosis. Journal of the International Neuropsychological Society. 2021; 27(5):450-60. [DOI:10.1017/S1355617720001113]
Feenaughty L, Tjaden K, Weinstock-Guttman B, Benedict RHB. Separate and combined influence of cognitive impairment and dysarthria on functional communication in multiple sclerosis. American Journal of Speech-Language Pathology. 2018; 27(3):1051-65. [DOI:10.1044/2018_AJSLP-17-0174]
Brochet B, Ruet A. Cognitive impairment in multiple sclerosis with regards to disease duration and clinical phenotypes. Frontiers in neurology. 2019; 10:261. [DOI:10.3389/fneur.2019.00261]
Renauld S, Mohamed-Saïd L, Macoir J. Language disorders in multiple sclerosis: A systematic review. Multiple sclerosis and Related Disorders. 2016; 10:103-11. [DOI:10.1016/j.msard.2016.09.005] [PMID]
Mehri A, Esmaeli M, Jalaei SH. [Adaptation and validity and reliability of frenchay dysarthria assessment 2 in Persian dysarthric patients (Persian)]. Paper presented as: The 17th Iranian Speech Therapy Conference; 2019 November 30; Tehran, Iran. [Link]
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 2005; 53(4):695-9. [DOI:10.1111/j.1532-5415.2005.53221.x]
Mehri A, Ghorbani A, Darzi A, Jalaie S, Ashayeri H. Comparing the production of complex sentences in Persian patients with post-stroke aphasia and non-damaged people with normal speaking. Iranian Journal of Neurology. 2016; 15(1):28. [PMID]
Paradis M, Paribakht T, Nilipour R. [The bilingual aphasia test (Persian)]. Hillsdale: Lawrence Erlbaum. 1987. [Link]
Jamalpour S, Baharlooie N, Ashtari F, Shamsian F, Sedehi M. C[omparison some of the syntactic skills in Relapsing Remitting Multiple sclerosis and normal adults resident in Esfahan Province (Persian)]. Journal of Research in Rehabilitation Sciences. 2014; 9(5):886-75. [DOI: 10.22122/jrrs.v9i5.1220]
Zivadinov R, Sepcic J, Nasuelli D, De Masi R, Bragadin LM, Tommasi MA, et al. A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry. 2001; 70(6):773-80. [DOI:10.1136/jnnp.70.6.773] [PMID]
Sonkaya AR, Bayazit ZZ. Language aspects of patients with multiple sclerosis. Eurasian Journal of Medical Investigation. 2018; 2(03):133-8. [DOI:10.14744/ejmi.2018.96158]
Mackenzie C, Green J. Cognitive-linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis. International Journal of Language & Communication Disorders. 2009; 44(4):401-20. [DOI:10.1080/13682820802697879]
Noffs G, Perera T, Kolbe SC, Shanahan CJ, Boonstra FMC, Evans A, et al. What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis. Autoimmunity Reviews. 2018; 17(12):1202-9. [DOI:10.1016/j.autrev.2018.06.010] [PMID]
| Issue | Vol 20 No 1 (2026) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v20i1.21026 | |
| Keywords | ||
| Multiple Sclerosis Cognition Syntax Dysarthria Persian language | ||
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