Parkinson's Disease Detection from Speech

Parkinson's disease (PD) often manifests through speech impairments, facilitating accessible, non-invasive, and cost-effective severity assessment for early diagnosis and progression tracking. Despite advances in speech foundation models (SFMs), their cross-lingual generalization for PD severity multi-class classification remains underexplored due to limited labeled data, a lack of explainable methods and variability across languages and datasets. In this work, we evaluate pre-trained embeddings from four state-of-the-art open-source SFMs across three datasets in zero-shot and k-shot cross-lingual settings for multi-class PD severity assessment. Our results show that pre-trained speech embeddings enable meaningful cross-lingual transfer, although performance is sensitive to dataset properties, preprocessing, and adaptation strategy. Misclassifications under these conditions related to inter-speaker variability and atypical speech patterns highlight the need for more robust feature extraction and modeling for PD severity assessment while emphasizing the importance of explainability for reliable clinical insights.

Speech Large Language Models (Speech LLMs) have shown strong performance across diverse tasks, yet their utility for pathological speech analysis remains underexplored. In this work, we investigate the effectiveness of internal representations from encoder and decoder components of Speech LLMs for Parkinson's Disease (PD) detection across multilingual and cross-lingual settings. Our findings reveal that encoder representations consistently outperform their decoder counterparts in most models and settings and that pathological cues may be progressively attenuated as audio representations are projected into the language model space. We further show that generative outputs are less reliable for clinical tasks compared to internal representations. To leverage information spread across multiple layers, we propose a Squeeze-and-Excitation (SE)-based dynamic layer aggregation framework, which surpasses best-layer selection in multiple experiments, suggesting that PD-relevant acoustic cues are distributed across transformer layers rather than concentrated in one.

Self-supervised learning (SSL) speech representations achieve strong performance for Parkinson's disease (PD) detection within individual corpora. However, it remains unclear whether these models capture disease-related characteristics or exploit dataset-specific confounds, particularly since most SSL backbones are pretrained exclusively on healthy speech. To investigate this question, we perform a layer-wise analysis of nine SSL speech backbones using a low-capacity logistic regression probe across three languages. We structure the evaluation as multiple scenarios that progressively introduce distribution shifts in participant identity, recording conditions, language, and pathology. Our results reveal two key findings. First, layer selection is highly corpus-dependent: the optimal representation layer is determined primarily by the source dataset rather than by the SSL architecture itself. Second, the transferred discriminative signal lacks pathological specificity: classifiers trained to detect PD assign similarly high probabilities to both PD and dementia speech in the target corpus. These results highlight critical limitations that must be addressed before speech-based pathology recognition models can be reliably deployed in clinical settings.

Parkinson's disease (PD) is the second most common neurodegenerative disorder. Typical machine learning screening methods require PD labels, but the available data is limited by privacy concerns and the need for expert annotation. We propose a label-free face-plus-voice PD screen built entirely on frozen pretrained encoders--a face-expression Vision Transformer and HuBERT--in which no PD label touches any fit; the reference is training controls only. The voice modality uses a synthetic-dysarthria contrastive activation addition (CAA) direction built from time-stretch and breathy degradation of healthy speech; the face modality uses a k-nearest-neighbor anomaly score to the control embedding cluster. We introduce the alignment principle, a post-hoc analysis showing that a synthetic-degradation CAA detector works when the cosine similarity between the synthetic and real disease directions exceeds zero. Measured on the YouTubePD benchmark, this cosine is +0.37 for voice (CAA works, AUROC 0.765) and -0.48 for face (CAA fails; anomaly succeeds, AUROC 0.751). Equal-weight late fusion reaches AUROC 0.802 (95% CI [0.70,0.89]) with NPV 0.95, supporting a rule-out triage interpretation. An overfitting audit shows the voice detector transfers cleanly, while the face-side--and thus fused--AUROC is potentially optimistic pending external validation.

Parkinson's disease (PD) is a progressive neurodegenerative disorder that frequently causes speech impairments associated with hypokinetic dysarthria. As speech production relies on the precise coordination of complex neuromuscular mechanisms, speech analysis has emerged as a promising non-invasive and cost-effective biomarker for early PD detection. Recent deep learning approaches have shown encouraging results; however, most existing methods rely on a single speech representation, potentially overlooking complementary pathological information encoded across different feature spaces. In this work, we propose a multi-branch deep learning framework for automatic PD detection from speech. Each recording is segmented into 5-second chunks and represented using three complementary modalities: Log-Mel spectrograms, MFCCs, and HuBERT embeddings extracted from raw waveforms. The spectrograms are processed using a pre-trained ResNet-18 encoder, MFCC sequences are modeled through a BiLSTM network, and raw speech is encoded using a pre-trained HuBERT model. To effectively integrate these heterogeneous representations, we introduce a context-guided cross-modal attention mechanism that dynamically weights temporal HuBERT embeddings according to the global acoustic context derived from the spectrogram and MFCC branches. Experiments conducted on the publicly available Spanish PC-GITA corpus under strict speaker-independent 5-fold cross-validation demonstrate the effectiveness of the proposed approach. The proposed architecture achieves an accuracy of 91.51%, an F1-score of 91.24%, and an AUC of 95.97%. Furthermore, ablation studies confirm the contribution of both the proposed context-guided cross-modal attention mechanism and the integration of complementary speech representations. These findings highlight the potential of heterogeneous speech modeling for robust and clinically reliable PD detection.

Large audio and language models have recently demonstrated zero-shot reasoning capabilities across various domains. However, it remains unclear how the form of audio input, whether handcrafted acoustic features extracted from speech or the raw audio waveform itself, affects performance for Parkinson's disease (PD) detection across different languages. In this study, we systematically compare two input modalities for zero-shot PD detection: (i) handcrafted acoustic features extracted from speech recordings analyzed by a general-purpose LLM, and (ii) direct waveform input analyzed by audio-capable models. Experiments on PD speech datasets in four languages show that performance varies across input modalities, speech tasks, and languages. Handcrafted acoustic features provide more stable performance in a low-resource language (e.g., Bengali), whereas audio input yields dataset-dependent gains. These findings highlight the impact of input modality on zero-shot PD detection from speech.

Early-stage Parkinson's disease (EarlyPD) detection from speech is clinically meaningful yet underexplored, and published results are hard to compare because studies differ in datasets, languages, tasks, evaluation protocols, and EarlyPD definitions. To address this issue, we propose the first benchmark for speech-based EarlyPD detection, with a speaker-independent split designed for fair and replicable cross-method evaluation on researcher-accessible datasets. The benchmark covers three common speech tasks and evaluates methods under different training-resource settings. We also present multi-dimensional evaluation breakdowns by dataset, aggregation level, gender, and disease stage to support fine-grained comparisons and clinical adoption. Our results provide a replicable reference and actionable insights, encouraging the adoption of this publicly available benchmark to advance robust and clinically meaningful EarlyPD detection from speech.

The limited availability of dysarthric speech data makes cross-lingual detection an important but challenging problem. A key difficulty is that speech representations often encode language-dependent structure that can confound dysarthria detection. We propose a representation-level language shift (LS) that aligns source-language self-supervised speech representations with the target-language distribution using centroid-based vector adaptation estimated from healthy-control speech. We evaluate the approach on oral DDK recordings from Parkinson's disease speech datasets in Czech, German, and Spanish under both cross-lingual and multilingual settings. LS substantially improves sensitivity and F1 in cross-lingual settings, while yielding smaller but consistent gains in multilingual settings. Representation analysis further shows that LS reduces language identity in the embedding space, supporting the interpretation that LS removes language-dependent structure.

Automatic detection of Parkinson's disease (PD) from speech is a promising non-invasive diagnostic tool, but it raises significant privacy concerns. Speaker anonymization mitigates these risks, but it may suppress the pathological information necessary for PD detection. We assess the trade-off between privacy and PD detection for two anonymizers (STT-TTS and kNN-VC) using two Spanish datasets. STT-TTS provides better privacy but severely degrades PD detection by eradicating prosodic information. kNN-VC preserves macro-prosodic features such as duration and F0 contours, achieving F1 scores only 3-7% lower than original baselines, demonstrating that privacy-preserving PD detection is viable when using appropriate anonymization. Finally, an acoustic distortion analysis characterizes specific weaknesses in kNN-VC, offering insights for designing anonymizers that better preserve PD information.

Voice-based digital biomarkers can enable scalable, non-invasive screening and monitoring of Parkinson's disease (PD) and Amyotrophic Lateral Sclerosis (ALS). However, models trained on one cohort or device often fail on new acquisition settings due to cross-device and cross-cohort domain shift. This challenge is amplified in real-world scenarios with partial-label mismatch, where datasets may contain different disease labels and only partially overlap in class space. In addition, voice-based models may exploit demographic cues, raising concerns about gender-related unfairness, particularly when deployed across heterogeneous cohorts. To tackle these challenges, we propose a hybrid framework for unified three-class (healthy/PD/ALS) cross-domain voice classification from partially overlapping cohorts. The method combines style-based domain generalization with conditional adversarial alignment tailored to partial-label settings, reducing negative transfer. An additional adversarial gender branch promotes gender-invariant representations. We conduct a comprehensive evaluation across four heterogeneous sustained-vowel datasets, spanning distinct acquisition settings and devices, under both domain generalization and unsupervised domain adaptation protocols. The proposed approach is compared against twelve state-of-the-art machine learning and deep learning methods, and further evaluated through three targeted ablations, providing the first cross-cohort benchmark and end-to-end domain-adaptive framework for unified healthy/PD/ALS voice classification under partial-label mismatch and fairness constraints. Across all experimental settings, our method consistently achieves the best external generalization over the considered evaluation metrics, while maintaining reduced gender disparities. Notably, no competing method shows statistically significant gains in external performance.

Early detection of PD remains particularly challenging in resource-constrained settings, where voice-based analysis has emerged as a promising non-invasive and cost-effective alternative. However, existing studies predominantly focus on English or other major languages; notably, no voice dataset for PD exists for Bengali -- a language spoken by over 230 million people worldwide -- posing a significant barrier to culturally inclusive and accessible healthcare solutions. We present BenSparX, the first Bengali conversational speech dataset for PD detection, along with a robust and explainable ML framework tailored for early diagnosis. The proposed framework incorporates diverse acoustic feature categories, systematic feature selection methods, and state-of-the-art ML classifiers with extensive hyperparameter optimization. Furthermore, to enhance interpretability and trust in model predictions, the framework incorporates SHAP (SHapley Additive exPlanations) analysis to quantify the contribution of individual acoustic features toward PD detection. Our framework achieves state-of-the-art performance, yielding an accuracy of 95.67%, F1 score of 95.62%, and AUC of 0.990. We further validated our approach by applying the framework to existing PD datasets in other languages, where it consistently outperforms state-of-the-art approaches. This study lays the foundation for identifying subtle yet clinically meaningful vocal biomarkers, particularly in low-resource settings such as Bengali-speaking populations, and represents a significant step toward equitable, explainable, and robust digital health diagnostics for neurodegenerative disorders. The labelled acoustic-feature dataset derived from the audio recordings in this study is available at https://github.com/riadEDU/BenSParX.