Approximately 80–96% of people with amyotrophic lateral sclerosis (ALS) become unable to speak during the disease progression. Assessing upper and lower motor neuron impairment in bulbar regions of ALS patients remains challenging, particularly in distinguishing spastic and flaccid dysarthria. This study aimed to evaluate acoustic voice parameters as useful biomarkers to discriminate ALS clinical phenotypes. Triangular vowel space area (tVSA), alternating motion rates (AMRs), and sequential motion rates (SMRs) were analyzed in 36 ALS patients and 20 sex/age-matched healthy controls (HCs). tVSA, AMR, and SMR values significantly differed between ALS and HCs, and between ALS with prevalent upper (pUMN) and lower motor neuron (pLMN) impairment. tVSA showed higher accuracy in discriminating pUMN from pLMN patients. AMR and SMR were significantly lower in patients with bulbar onset than those with spinal onset, both with and without bulbar symptoms. Furthermore, these values were also lower in patients with spinal onset associated with bulbar symptoms than in those with spinal onset alone. Additionally, AMR and SMR values correlated with the degree of dysphagia. Acoustic voice analysis may be considered a useful prognostic tool to differentiate spastic and flaccid dysarthria and to assess the degree of bulbar involvement in ALS.

A faringometria acústica representa um método atual baseado no principio físico da reflexão acústica, útil à análise volumétrica do espaço orofaringolaringotraqueal. OBJETIVO: Este estudo se propõe a avaliar as variações dos parâmetros faringométricos em indivíduos portadores de distúrbios respiratórios do sono (DRS), para estabelecer uma relação entre as variações morfovolumétricas do espaço orofaringolaríngeo e a existência e gravidade da patologia. FORMA DE ESTUDO: Clínico e experimental. MATERIAL E MÉTODO: Foram examinados 110 pacientes, 70 com DRS e 40 normais, durante o período de Junho/04 a Junho/05. Todos os pacientes foram submetidos à faringometria acústica que permitiu uma avaliação da área oro e hipofaríngea através de um gráfico explicativo. RESULTADOS: Os parâmetros obtidos nos pacientes com DRS mostraram uma importante diferença com respeito ao grupo controle, principalmente na amplitude da I onda (significantemente menor nos pacientes com macroglossia), na extensão do segmento OF, na amplitude do segmento OF e na área hipofaríngea. COLCLUSÃO: A faringometria acústica, mesmo não sendo uma técnica padronizada, pode auxiliar no diagnóstico das síndromes obstrutivas do sono, na localização dos possíveis pontos de obstrução e da gravidade da patologia, e no monitoramento dos pacientes submetidos a cirurgias desobstrutivas das vias aéreas superiores.

Dysphagia and dysarthria are common, co-occurring manifestations in neurodegenerative diseases, resulting from damage to distributed neural networks involving cortical, subcortical, cerebellar, and brainstem regions. These disorders profoundly affect patient health and quality of life through complex sensorimotor impairments. Objective: The aims was to provide a comprehensive, evidence-based review of the neuroanatomical substrates, pathophysiology, diagnostic approaches, and management strategies for dysphagia and dysarthria in neurodegenerative diseases with emphasis on their multisystem nature and integrated treatment approaches. Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases (2000–2024), focusing on Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA). Search terms included “dysphagia”, “dysarthria”, “neurodegenerative diseases”, “neural networks”, “swallowing control” and “speech production.” Studies on neuroanatomy, pathophysiology, diagnostic tools, and therapeutic interventions were included. Results: Contemporary neuroscience demonstrates that swallowing and speech control involve extensive neural networks beyond the brainstem, including bilateral sensorimotor cortex, insula, cingulate gyrus, basal ganglia, and cerebellum. Disease-specific patterns reflect multisystem involvement: PD affects basal ganglia and multiple brainstem nuclei; ALS involves cortical and brainstem motor neurons; MSA causes widespread autonomic and motor degeneration; PSP produces tau-related damage across multiple brain regions. Diagnostic approaches combining fiberoptic endoscopic evaluation, videofluoroscopy, acoustic analysis, and neuroimaging enable precise characterization. Management requires multidisciplinary Integrated teams implementing coordinated speech-swallowing therapy, pharmacological interventions, and assistive technologies. Conclusions: Dysphagia and dysarthria in neurodegenerative diseases result from multifocal brain damage affecting distributed neural networks. Understanding this multisystem pathophysiology enables more effective integrated assessment and treatment approaches, enhancing patient outcomes and quality of life.