Mixed Dysarthria

Question 1

Mixed Dysarthrias: Overview

Answer 1

Can result from many conditions within each of the broad etiologic categories.

Can result from combined neurologic events or the co-occurence of 2+ diseases

Question 2

Degenerative Diseases

Answer 2

Because many deg. diseases affect 1+ portion of the motor system, they are commonly associated with mixed dysarthrias.

• ALS
• Progressive Supranuclear Palsy
• Corticobasal Degeneration
• Multiple System Atrophy
• Friedrich’s Ataxia
• Spinocerebellar Ataxias
• CTE

Question 3

Motor Neuron Disease - ALS

Answer 3

Characterized by progressive loss of UMN, LMN, or both.

ALS is most common MND; mixed spastic-flaccid dysarthria (VQ that’s wet or gurgling)

Oral mech abnormalities are usually bilateral

Shortness of breath, excessive yawning

Harsh, breathy, strained/strangled VQ

Question 4

Progressive Supranuclear Palsy

Answer 4

A multi-system degenerative disease of unknown etiology.

Onset approx. 63 years; survival ranging from 6-9 years

Characterized by paralysis of vertical gaze

Dysarthria and dysphagia are common; spastic, ataxic, and hypokinetic dysarthria; among first signs

Hypernasality 
Dysfluency
Monopitch
Hoarseness 
Imprecise articulation

Involuntary vocalizations

Question 5

Corticobasal Degeneration

Answer 5

Uncommon neurodegenerative disease characterized by cortical and extrapyramidial signs.

Limb rigidity and apraxia; postural instability; cognitive deficits

Spastic and hypokinetic dysarthria are common; hyperkinetic and ataxic components can occur.

Question 6

Multiple System Atrophy

Answer 6

Sporadic neurodegenerative condition characterized by combinations of parkinsonism, ataxia, spasticity, and autonomic dysfunction.

Hypokinetic dysarthria, either alone or with spastic and/or ataxic dysarthria.

Question 7

Spinocerebellar Ataxia

Answer 7

Combinations of any of the dysarthria types.

Question 8

CTE

Answer 8

Hypokinetic or ataxic components

Question 9

Vascular Disorders

Answer 9

Multiple strokes have a natural association with mixed dysarthrias.

Any combination of dysarthrias is possible.

Question 10

Multiple Sclerosis

Answer 10

Most common demyelinating disease that can produce any sign/symptom of CNS disease.

Gait, visual, and sensory difficulties are common, along with cerebellar dysfunction, cognitive deficits, CN abnormalities

Dysphagia is uncommon

Any combination of dysarthrias, but often spastic-ataxic.

Question 11

Toxic-Metabolic Conditions

Answer 11

Effects tend to be diffuse

When speech is affected, result can be mixed dysarthria

Question 12

Wilson’s Disease

Answer 12

Autosomal recessive genetic metabolic disorder associated with inadequate processing of dietary copper.

Hypokinetic, spastic, and ataxic are most common

Question 13

Hypoxic Encephalopathy

Answer 13

Diffuse neurologic condition resulting from lack of O2 to the brain due to failure of heart/circulation or lungs/respiration.

Singular or combination of hypo/hyperkinetic or ataxic.

Question 14

Osmotic Demyelination Syndrome

Answer 14

A metabolic disorder that reflects damage to the brain’s myelin.

Associated with alcoholism, liver transplant

Spastic, ataxic, and hyperkinetic can occur

Question 15

Hepatocerebral Degeneration

Answer 15

Can occur in survivors of hepatic coma or those with chronic liver disease.

Clinical signs:

• Limb tremor
• Chorea
• Unsteady gait
• Ataxia

Hypokinetic, hyperkinetic, spastic, or ataxic may be present

Question 16

Neoplasm

Answer 16

Brainstem tumors can be associated with various combinations of spastic, ataxic, and flaccid.

Question 17

TBI

Answer 17

Dysarthria occurs in about 1/3 of TBI patients

Can vary in severity and may/may not be accompanied by language/other cog. disorders

Mixed dysarthrias are common due to diffuse and multifocal injuries.