Dr. Kara Smith is a Movement Disorders neurologist at the University of Massachusetts Medical School (UMMS) whose goal is to become an independent investigator focused on early cognitive impairment in Parkinson disease (PD). Her long-term goal is to develop speech markers of cognitive impairment in PD. Cognitive impairment occurs in the majority of PD patients, leading to increased mortality and decreased quality of life. The current diagnostic tools are resource-intensive and have limited sensitivity. Treatments are often offered late in the course of cognitive decline and do not provide optimal benefit. Speech markers could improve detection, monitoring and treatment of cognitive impairment in PD. Speech markers could be monitored frequently and remotely via mobile technology, capturing sensitive, quantitative data about cognitive function in the context of patients? daily life and in response to therapeutics. Dr. Smith?s role as a clinical movement disorders specialist ideally positions her to lead the application of advanced speech and language research to feasible, patient-oriented tools for real-life clinical practice and clinical trials. Dr. Smith has assembled an expert interdisciplinary mentorship team ideally suited for the goals of this innovative proposal. Dr. Smith and her team have previously shown that a) speech acoustic markers are associated with cognitive function in non-demented PD patients, and b) PD patients with mild cognitive impairment had linguistic deficits including pauses within utterances and grammaticality. Building on these results, Dr. Smith proposes to study speech and language more comprehensively in PD patients with and without mild cognitive impairment and controls to confirm these preliminary results and identify additional biomarkers.
The aims of this study will be 1) to develop algorithms using speech acoustic markers to categorize by cognitive status, 2) to identify linguistic markers associated with mild cognitive impairment in PD, and 3) to assess on-line syntactic processing in PD subjects with mild cognitive impairment. The overall goal of the proposal is to identify speech and language markers of early cognitive dysfunction that can be further refined, validated and implemented using mobile technology into a larger scale, longitudinal R01 proposal. Further work will also address the underlying neurobiological mechanisms of these speech markers. Dr. Smith?s rigorous training plan includes a Master?s degree, linguistics and speech motor physiology courses, and experience in signal processing and speech acoustic analysis. Through her training goals, she will advance her knowledge and skills in patient-centered outcomes measures and instrument validation. She will gain experience in research leadership, presentation and dissemination of scientific work, and in grant writing, culminating in an R01 proposal. This K23 award will be critical for Dr. Smith to establish an independent career as a PD clinician-scientist at the unique intersection of speech and language science and cognitive impairment.
Speech markers have the potential to improve diagnosis, monitoring and treatment of cognitive impairment in Parkinson?s disease (PD). Although the majority of PD patients will develop cognitive impairment, the tools available to assess and treat this disabling complication are fraught with limitations. As a detailed and quantitative assessment tool, speech markers may increase sensitivity to early cognitive dysfunction and to changes over time compared with current measures. They may be automated and then implemented through mobile technology to increase patients? access to cognitive symptom monitoring outside of the clinic setting. Dr. Smith?s proposed career development plan has potential to fill a major gap in PD research by making inexpensive and easy-to-use cognitive assessment tools accessible to patients in rural and international settings, and by fueling clinical trials to discover new therapeutics capable of slowing cognitive decline in PD.
