{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:06:50Z","timestamp":1790165210459,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Objective assessment of emotional responsiveness in Amyotrophic Lateral Sclerosis (ALS) remains limited despite its importance for personalized care. This study investigated whether non-invasive speech analysis could identify digital biomarkers associated with emotional coping behaviors in ALS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 28 ALS patient visits using clinician-rated emotional concern scores, ALS Functional Rating Scale-Revised (ALS-FRS-R), forced vital capacity (FVC), and speech acoustic features. We also evaluated the reliability of large language models (LLMs), including ChatGPT, Gemini, and Claude, for automated concern assessment. Patients were classified relative to functional impairment as congruent, muted, or excessive responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LLMs failed to provide reliable or reproducible assessments of patient concern without expert clinical supervision. Subjective concern levels also showed discordance with objective respiratory measures such as FVC. Excessive responders were predominantly male and required significantly greater clinician interaction time, while muted responders were predominantly female. Acoustic analysis revealed distinct vocal profiles between groups. Muted responders demonstrated high loudness and sharpness with low roughness and fluctuation, whereas excessive responders showed the opposite profile. These findings suggest that dysarthria may function as an acoustic filter modulating emotional expression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Speech-derived acoustic biomarkers may enable objective identification of emotional coping phenotypes in ALS and support earlier, personalized psychosocial interventions. The findings also highlight important limitations of current LLM-based clinical interpretation tools in unsupervised settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1886561","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:33:29Z","timestamp":1786685609000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility study of noninvasive assessment of emotional state in patients with ALS"],"prefix":"10.3389","volume":"8","author":[{"given":"Marc","family":"Garbey","sequence":"first","affiliation":[{"name":"Care Constitution Corp","place":["Houston, TX, United States"]},{"name":"Laboratoire des Sciences de l'Ing\u00e9nieur pour l'Environnement (LaSIE) UMR-CNRS 7356, University of La Rochelle","place":["La Rochelle, France"]},{"name":"Department of Neurology & Rehabilitation Medicine, The George Washington University School of Medicine & Health Sciences","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Lesport","sequence":"additional","affiliation":[{"name":"Care Constitution Corp","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcl\u015fen","family":"\u00d6ztosun","sequence":"additional","affiliation":[{"name":"Department of Neurology & Rehabilitation Medicine, The George Washington University School of Medicine & Health Sciences","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Heidebrecht","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine & Health Sciences","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamyab","family":"Pirouz","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine & Health Sciences","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Bayat","sequence":"additional","affiliation":[{"name":"Department of Neurology & Rehabilitation Medicine, The George Washington University School of Medicine & Health Sciences","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1212\/CPJ.0000000000000957","article-title":"Delivering bad news in amyotrophic lateral sclerosis: proposal of specific technique ALS ALLOW","volume":"11","author":"Edwards","year":"2021","journal-title":"Neurol Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"205","DOI":"10.2147\/JMDH.S134992","article-title":"Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach","volume":"10","author":"Hogden","year":"2017","journal-title":"J Multidiscip Healthc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/S1474-4422(14)70221-2","article-title":"End-of-life management in patients with amyotrophic lateral sclerosis","volume":"14","author":"Connolly","year":"2015","journal-title":"Lancet Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s11920-010-0118-6","article-title":"Psychiatric aspects of amyotrophic lateral sclerosis (ALS)","volume":"12","author":"Norris","year":"2010","journal-title":"Curr Psychiatry Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1177\/0269216313512013","article-title":"Understanding psycho-social processes underpinning engagement with services in motor neurone disease: a qualitative study","volume":"28","author":"Foley","year":"2014","journal-title":"Palliat Med"},{"key":"B6","first-page":"292","volume-title":"Affective Computing","author":"Picard","year":"2000"},{"key":"B7","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/00207594.2012.691977","article-title":"Psychological wellbeing and quality of life in amyotrophic lateral sclerosis: a review","volume":"48","author":"Pagnini","year":"2013","journal-title":"Int J Psychol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"5563099","DOI":"10.1109\/MSP.2010.938102","article-title":"Advances in behavioral science using automated facial image analysis and synthesis [social sciences]","author":"Cohn","year":"2010","journal-title":"IEEE Signal Process Mag"},{"key":"B9","doi-asserted-by":"publisher","first-page":"123328","DOI":"10.1016\/j.jns.2024.123328","article-title":"Improving care for amyotrophic lateral sclerosis with artificial intelligence and affective computing","volume":"468","author":"Garbey","year":"2025","journal-title":"J Neurol Sci"},{"key":"B10","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/WNN.0b013e31804c700b","article-title":"Emotional perception deficits in amyotrophic lateral sclerosis","volume":"20","author":"Zimmerman","year":"2007","journal-title":"Cogn Behav Neurol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"15713","DOI":"10.1038\/s41598-022-19651-1","article-title":"Rate of speech decline in individuals with amyotrophic lateral sclerosis","volume":"12","author":"Eshghi","year":"2022","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0164655","DOI":"10.1371\/journal.pone.0164655","article-title":"Perception of emotional facial expressions in amyotrophic lateral sclerosis (ALS) at behavioural and brain metabolic level. Greenlee MW, editor","volume":"11","author":"Aho-\u00d6zhan","year":"2016","journal-title":"PLoS One"},{"key":"B13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/S0022-510X(99)00210-5","article-title":"The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function","volume":"169","author":"Cedarbaum","year":"1999","journal-title":"J Neurol Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the hospital anxiety and depression scale","volume":"52","author":"Bjelland","year":"2002","journal-title":"J Psychosom Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"B16","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1609\/icwsm.v8i1.14550","article-title":"VADER: a parsimonious rule-based model for sentiment analysis of social media text","volume":"8","author":"Hutto","year":"2014","journal-title":"Proc Int AAAI Conf Web Soc Media"},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-540-68888-4","volume-title":"Psychoacoustics","author":"Fastl","year":"2007"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e44325","DOI":"10.2196\/44325","article-title":"Predicting generalized anxiety disorder from impromptu speech transcripts using context-aware transformer-based neural networks: model evaluation study","volume":"10","author":"Teferra","year":"2023","journal-title":"JMIR Ment Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.3389\/fpsyg.2018.01994","article-title":"Voice stress analysis: a new framework for voice and effort in human performance","volume":"9","author":"Van Puyvelde","year":"2018","journal-title":"Front Psychol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"262","DOI":"10.3390\/brainsci15030262","article-title":"How anxiety state influences speech parameters: a network analysis study from a real stressed scenario","volume":"15","author":"Wang","year":"2025","journal-title":"Brain Sci"},{"key":"B21","first-page":"12","article-title":"Dysarthria in amyotrophic lateral sclerosis: a systematic review of characteristics, speech treatment, and augmentative and alternative communication options","volume":"19","author":"Hanson","year":"2011","journal-title":"J Med Speech-Lang Pathol"},{"key":"B22","first-page":"101","article-title":"Towards remote differential diagnosis of mental and neurological disorders using automatically extracted speech and facial features","author":"Richter","year":"2024","journal-title":"Proc Mach Learn Cogn Ment Health Workshop ML4CMH AAAI 2024"},{"key":"B23","doi-asserted-by":"publisher","first-page":"fcaf232","DOI":"10.1093\/braincomms\/fcaf232","article-title":"Listener effort measures clinically meaningful change of dysarthria in amyotrophic lateral sclerosis","volume":"7","author":"Bingham","year":"2025","journal-title":"Brain Commun"},{"key":"B24","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/S0021-9924(99)00004-0","article-title":"Acoustic studies of dysarthric speech","volume":"32","author":"Kent","year":"1999","journal-title":"J Commun Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1159\/000355867","article-title":"Acoustic and perceptual consequences of clear and loud speech","volume":"65","author":"Tjaden","year":"2013","journal-title":"Folia Phoniatr Logop"},{"key":"B26","first-page":"578","volume-title":"Motor Speech Disorders: Substrates, Differential Diagnosis, and Management","author":"Duffy","year":"2005"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.3390\/brainsci11101356","article-title":"Emotional processing and experience in amyotrophic lateral sclerosis: a systematic and critical review","volume":"11","author":"Carelli","year":"2021","journal-title":"Brain Sci"},{"key":"B28","first-page":"1589","article-title":"A model of the perception of facial expressions of emotion by humans: research overview and perspectives","volume":"13","author":"Martinez","year":"2012","journal-title":"J Mach Learn Res JMLR"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1422807","DOI":"10.3389\/fpsyt.2024.1422807","article-title":"Applications of large language models in psychiatry: a systematic review","volume":"15","author":"Omar","year":"2024","journal-title":"Front Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"108949","DOI":"10.1016\/j.compbiomed.2024.108949","article-title":"Multimodal speech biomarkers for remote monitoring of ALS disease progression","volume":"180","author":"Neumann","year":"2024","journal-title":"Comput Biol Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1080\/21678421.2024.2371986","article-title":"Automated speech analytics in ALS: higher sensitivity of digital articulatory precision over the ALSFRS-R","volume":"25","author":"Stegmann","year":"2024","journal-title":"Amyotroph Lateral Scler Front Degener"},{"key":"B32","doi-asserted-by":"publisher","first-page":"5403","DOI":"10.1007\/s10072-022-06231-4","article-title":"Alteration of interoceptive sensitivity: expanding the spectrum of behavioural disorders in amyotrophic lateral sclerosis","volume":"43","author":"Moretta","year":"2022","journal-title":"Neurol Sci"},{"key":"B33","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1177\/1557988310384609","article-title":"Masculinity and health in late life men","volume":"5","author":"Tannenbaum","year":"2011","journal-title":"Am J Mens Health"},{"key":"B34","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1159\/000206855","article-title":"Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists","volume":"61","author":"Van der Graaff","year":"2009","journal-title":"Eur Neurol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1038\/s41597-024-03597-2","article-title":"Voice signals database of ALS patients with different dysarthria severity and healthy controls","volume":"11","author":"Dubbioso","year":"2024","journal-title":"Sci Data"}],"updated-by":[{"DOI":"10.3389\/fdgth.2026.1977072","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000}}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1886561\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:50:38Z","timestamp":1790164238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1886561\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":35,"alternative-id":["10.3389\/fdgth.2026.1886561"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1886561","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"1886561"}}