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    Analysis of resources assisting in coping with swallowing difficulties for patients with Parkinson's disease: a cross-sectional study. Matsushima Aiko,Matsushima Junichi,Matsumoto Akihisa,Moriwaka Fumio,Honma Sanae,Itoh Kazunori,Yamada Keiko,Shimohama Shun,Ohnishi Hirofumi,Mori Mitsuru BMC health services research BACKGROUND:Malnutrition induced by swallowing difficulties (SD) impairs the quality of life and gives rise to SD-related costs in Parkinson's disease (PD) patients. With results of a swallowing difficulty questionnaire and data of resources specifically obtained such as SD-related costs, caregivers, and dietary therapies, this study is to suggest statistically supported ideas for improvements in arrangements for how participants cope with SD and maintain general well-being. METHODS:We interviewed 237 PD patients. The SD-related costs involved those incurred by the provision of dietary modifications, care oriented foods, alternatives, and supplements. Dietary therapies included rice porridge and commercially available care foods. The relationships between BMI (body mass index) and the severity of SD assumed in this paper as indicators for general well-being and as resources for coping with SD for PD patients were statistically analyzed. RESULTS:A lower BMI was found in participants eating porridge consistency rice (p = 0.003) and eating porridge rice is significantly related to the severity of SD (p < 0.0001) and PD (p = 0.002). The severity of SD increased with age and PD duration (p = 0.035, p = 0.0005). Outlays for dietary modifications are the lowest reported here (p < 0.004) but the number of participants using dietary modifications is the largest among the SD-related items (n = 58). Eating care foods were reported for 11 older participants (p < 0.0001), most female (10/11). No lower BMI was found in participants eating care foods when compared with participants eating ordinary foods. Dietary modifications were performed by caregivers (OR: 6.8, CI: 3.1-15.2, p < 0.0001) and were related to the presence of children (OR: 3.4, CI: 1.2-11.4. p = 0.024). Older participants commonly live with spouses and children. CONCLUSIONS:Severe SD is associated with higher costs of coping with SD. A lower BMI is associated with modified foods, mostly eaten to cope with SD. Presence of caregivers and other persons residing with the participants here are related to dietary modifications but not to care food-related costs. Care foods may be effective in preventing malnutrition although the number who are able to cover the added expenses is limited because of the higher prices and shortage of information on the usefulness of care foods. 10.1186/s12913-016-1467-6
    Rate of aspiration pneumonia in hospitalized Parkinson's disease patients: a cross-sectional study. Martinez-Ramirez Daniel,Almeida Leonardo,Giugni Juan C,Ahmed Bilal,Higuchi Masa-Aki,Little Christopher S,Chapman John P,Mignacca Caroline,Wagle Shukla Aparna,Hess Christopher W,Hegland Karen Wheeler,Okun Michael S BMC neurology BACKGROUND:Aspiration pneumonia is an important cause of morbidity and mortality in Parkinson's disease (PD). Clinical characteristics of PD patients in addition to specific alterations in swallowing mechanisms contribute to higher swallowing times and impairment in the effective clearance of the airway. These issues may render patients more prone to dysphagia and aspiration events. We aimed to determine the frequency of aspiration events in a hospitalized PD cohort, and to report the number of in-hospital swallow evaluations. METHODS:A retrospective single center chart review of 212 PD patients who had 339 hospital encounters was performed from January 2011 to March 2013. Demographics, clinical characteristics, and reasons for encounters were documented. The number of in-hospital aspiration events and the number of swallowing evaluations and also the implementation of aspiration precautions were recorded. RESULTS:The cohort had a mean age of 74.1 (SD = 10.1) years with mean disease duration of 6 (SD = 6.3) years. Fifty-two hospital encounters (15.3%) were related to a pulmonary cause. In-hospital aspiration pneumonia events were reported in 8 (2.4%) of the total encounters. Swallow evaluations were performed in 25% of all cases, and aspiration precautions were initiated in 32% of the encounters. The data revealed that 1/8 patient had swallowing evaluations performed prior to an aspiration event. CONCLUSIONS:In-hospital aspiration pneumonia events were reported in 2.4% of the hospitalized PD cohort. Preventive measures and precautions were not routinely performed, however rates of aspiration were relatively low. The results highlight the need for more research into screening and monitoring of swallowing problems in PD patients during hospital encounters. 10.1186/s12883-015-0362-9
    Gum chewing improves swallow frequency and latency in Parkinson patients: a preliminary study. South Angela R,Somers Stephanie M,Jog Mandar S Neurology BACKGROUND:Reduced swallowing frequency affects secretion management in Parkinson disease (PD). Gum chewing increases saliva flow and swallow frequency. This study uses chewing gum to modify swallow frequency and latency between swallows in patients with PD. OBJECTIVES:1) Assess the frequency and latency of swallow at baseline (BL), during gum chewing (GC), and post gum chewing (PGC) for participants with PD (stage 2-4) nonsymptomatic for prandial dysphagia; and 2) assess carryover after gum is expectorated. METHODS:Twenty participants were studied across 3 tasks, each of 5 minutes in duration: BL, GC, and PGC. Respiratory and laryngeal signals were continuously recorded using PowerLab (version 5.5.5; ADI Instruments, Castle Hill, Australia). Frequency and latency of swallow events were calculated. RESULTS:Differences (analysis of variance) are reported for frequency (p < 0.000001) and latency (p < 0.000001). Swallow frequency (mean +/- SD) increased during GC (14.95 +/- 3.02) compared with BL (3.1 +/- 2.85) and PGC (7.0 +/- 2.57). Latency in seconds (mean +/- SD) decreased during GC (24.1 +/- 4.174) and increased with BL (131.8 +/- 59.52) and PGC (mean = 60.74 +/- 25.25). Intertask comparisons (t test) found differences in swallow frequency and latency between tasks: BL vs GC (p < 0.0001, p < 0.0001), BL vs PGC (p < 0.0011, p < 0.0009), and GC vs PGC (p < 0.0001, p < 0.0002), respectively. Post hoc analysis showed carryover to 5.317 minutes. CONCLUSIONS:Modifying sensorimotor input by chewing gum alters frequency and latency of swallowing and may be an effective strategy for secretion management in Parkinson disease. CLASSIFICATION OF EVIDENCE:This study provides Class III evidence that chewing gum increases swallow frequency and decreases latency of swallowing in an experiment in patients with stage 2 to 4 Parkinson disease who are nonsymptomatic for significant prandial dysphagia. 10.1212/WNL.0b013e3181d9002b
    Implementation of a standardized out-of-hospital management method for Parkinson dysphagia. Wei Hongying,Sun Dongxiu,Liu Meiping Revista da Associacao Medica Brasileira (1992) OBJECTIVE:Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. METHOD:Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. RESULTS:Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). CONCLUSION:Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD. 10.1590/1806-9282.63.12.1076
    Characteristics of Early Oropharyngeal Dysphagia in Patients with Multiple System Atrophy. Lee Hyun Haeng,Seo Han Gil,Kim Kwang-Dong,Lee Seung Hak,Lee Woo Hyung,Oh Byung-Mo,Lee Woong-Woo,Kim Yoon,Kim Aryun,Kim Han-Joon,Jeon Beomseok,Han Tai Ryoon Neuro-degenerative diseases BACKGROUND/AIMS:Dysphagia, a symptom of multiple system atrophy (MSA), is a major clinical concern. In this study, we investigate the characteristics of early oropharyngeal dysphagia (OD) in patients with MSA, and the differences between MSA subtypes. METHODS:Patients enrolled in the study had previously been diagnosed with MSA at the clinic of the Department of Neurology, and had been referred for a videofluoroscopic swallowing study (VFSS), between 2005 and 2014, to check for dysphagia. The clinical characteristics and VFSS findings were analyzed and compared between the MSA subtypes. RESULTS:This study enrolled 59 patients with MSA (24 men; 31 with MSA-P, 21 with MSA-C, and 7 with MSA-PC). Dysphagia symptoms were mostly limited to aspiration symptoms (90.48%) in patients with MSA-C, while difficulty in swallowing, increased mealtime, and drooling were frequent in those with MSA-P. The most common VFSS finding amongst patients was vallecular residue (n = 53, 89.8%), followed by penetration/aspiration (n = 40, 67.8%), and coating of the pharyngeal wall (n = 39, 66.1%). Comparison analysis between subtypes showed that apraxia and vallecular residue were more frequent and severe in MSA-P than in MSA-C (p = 0.033 and p = 0.010, respectively). CONCLUSION:Understanding early OD characteristics in patients with MSA and the differences between MSA subtypes could be helpful in managing dysphagia in patients with MSA. Several dysphagia symptoms similar to those of Parkinson disease were frequently observed in MSA-P, but not in MSA-C. A follow-up study is needed to elucidate the natural course of OD in MSA patients and the difference between MSA subtypes. 10.1159/000487800
    Effects of effortful swallowing on cardiac autonomic control in individuals with neurogenic dysphagia: a prospective observational analytical study. Gomes Livia M S,da Silva Roberta G,Pedroni Cristiane R,Garner David M,Raimundo Rodrigo D,Valenti Vitor E Scientific reports Considering that neurogenic oropharyngeal dysphagia is a prevalent condition with or without cardiac disease we should contemplate issues surrounding cardiovascular difficulties during rehabilitation. This study aims to evaluate the effects of effortful swallowing maneuver (ESM) on heart rate variability (HRV) in subjects with neurogenic oropharyngeal dysphagia. We studied 22 individuals [8 Stroke and 14 Parkinson Disease (PD) subjects aged between 41 and 75 years old] with neurogenic oropharyngeal dysphagia regardless of gender. HRV was assessed under two circumstances: spontaneous swallowing versus ESM. Surface electromyography of the suprahyoid muscles was undertaken to measure the swallowing muscle excitation, which then confirmed higher muscle activity during ESM. We attained no changes in HRV between the two swallowing events [HR: spontaneous swallowing 78.68 ± 13.91 bpm vs. ESM 102.57 ± 107.81 bpm, p = 0.201; RMSSD (root-mean square of differences between adjacent normal RR intervals in a time interval): spontaneous swallowing 16.99 ± 15.65 ms vs. ESM 44.74 ± 138.85 ms, p = 0.312; HF (high frequency): spontaneous swallowing 119.35 ± 273 ms vs. ESM 99.83 ± 194.58 ms, p = 0.301; SD1 (standard deviation of the instantaneous variability of the beat-to-beat heart rate): spontaneous swallowing 12.02 ± 1.07 ms vs. ESM 31.66 ± 98.25 ms, p = 0.301]. The effortful swallowing maneuver did not cause clinically significant changes in autonomic control of HR in this group of subjects with oropharyngeal dysphagia. 10.1038/s41598-020-67903-9
    Relationship between tongue pressure and functional oral intake scale diet type in patients with neurological and neuromuscular disorders. Umemoto George,Fujioka Shinsuke,Arahata Hajime,Kawazoe Miki,Sakae Nobutaka,Sasagasako Naokazu,Furuya Hirokazu,Tsuboi Yoshio Clinical neurology and neurosurgery INTRODUCTION:Patients with neurological and neuromuscular disorders (NNMD) frequently experience swallowing disorders that increase aspiration pneumonia risk and therefore require specialized diets or tube feeding. Diet type level usually is assessed by video fluoroscopic swallowing study (VFSS). To identify a simpler assessment method, we examined the association between diet type (based on the Functional Oral Intake Scale [FOIS]) diet type and maximum tongue pressure (MTP). METHODS:From 2011-2020, FOIS diet type level and MTP were assessed in a sample of 927 patients. Of these patients, 186 had Parkinson's disease (PD), 69 had Parkinson-related disease (PRD), 61 had multiple system atrophy (MSA), 42 had spinocerebellar degeneration (SCD), 147 had amyotrophic lateral sclerosis (ALS), 180 had myotonic dystrophy type 1 (DM1), and 242 had Duchenne muscular dystrophy (DMD). VFSS was conducted while patients swallowed water and foods containing barium. MTP measurements were collected the same day. Participants' diet type level was adjusted based on the VFSS, with some participants requiring multiple examinations. Relationships between diet type level and MTP were tested using univariate and Spearman rank correlation analyses. RESULTS:Mean MTP for the entire NNMD group (25.5 ± 13.1 kPa) was lower than that of healthy elderly individuals, as determined in previous reports. The highest MTP was found in the MSA group (32.2 ± 15.7 kPa) and the lowest in the DM1 group (19.1 ± 9.0 kPa). Diet type level was highest in the MSA group (5.8 ± 1.4) and lowest in the DMD group (5.2 ± 1.7). A significant correlation was observed between diet type level and MTP (R = 0.384, p < 0.001). The optimum MTP cutoff values-detected using ROC curves to predict a requirement to change to a dysphagia diet-was highest in the DMD group (29.0 kPa) and lowest in the ALS group (12.3 kPa). CONCLUSIONS:The decision to change NNMD patients to a dysphagia diet can be made based on MTP. Modifying a patient's oral diet (FOIS level ≤ 5) should be considered for those with a MTP of 10-25 kPa, with the cutoff value varying by disease. 10.1016/j.clineuro.2020.106196
    Targeted exercise therapy for voice and swallow in persons with Parkinson's disease. Russell John A,Ciucci Michelle R,Connor Nadine P,Schallert Timothy Brain research Sensorimotor deficits affecting voice and swallowing ability can have a devastating impact on the quality of life of people with Parkinson disease (PD). Recent scientific findings in animal models of PD pinpoint targeted exercise therapy as a potential treatment to reduce neurochemical loss and decrease parkinsonian symptoms. Although there may be beneficial effects, targeted exercise therapy is not a standard component of therapy for the cranial sensiromotor deficits seen in PD. In this paper, we review the scientific evidence for targeted training for voice and swallowing deficits. The literature search revealed 19 publications that included targeted training for voice and only one publication that included targeted training for swallowing. We summarize 3 main findings: (1) targeted training may be associated with lasting changes in voice behavior; (2) targeted training of sensorimotor actions with anatomical or functional overlap with voice and swallowing may improve voice and swallowing to some degree, but it is unknown whether these effects endure over time; and (3) evidence regarding cranial sensorimotor interventions for Parkinson disease is sparse. We concluded that targeted training for voice and swallow is a promising but understudied intervention for cranial sensorimotor deficits associated with PD and posit that animal models can be useful in designing empirically based studies that further the science on targeted training. 10.1016/j.brainres.2010.03.029
    Skill training for swallowing rehabilitation in patients with Parkinson's disease. Athukorala Ruvini P,Jones Richard D,Sella Oshrat,Huckabee Maggie-Lee Archives of physical medicine and rehabilitation OBJECTIVE:To examine the effects of skill training on swallowing in individuals with dysphagia secondary to Parkinson's disease (PD) and to explore skill retention after treatment termination. DESIGN:Within-subject pilot study with follow-up after 2 weeks of treatment and after a 2-week nontreatment period. SETTING:Clinic in a research institute. PARTICIPANTS:Patients (N=10; mean age, 67.4y) included 3 women (mean Hoehn and Yahr score, 2.6) and 7 men (mean Hoehn and Yahr score, 2.4). INTERVENTION:Patients underwent 10 daily sessions of skill training therapy focused on increasing precision in muscle contraction during swallowing using visual feedback. MAIN OUTCOME MEASURES:Data from the timed water swallow test, Test of Mastication and Swallowing Solids, surface electromyography (sEMG) of submental muscles, and swallowing-related quality of life questionnaire were collected at 2 baseline sessions (conducted 2wk apart) at the end of treatment and after 2 nontreatment weeks to assess skill retention. RESULTS:Immediately after posttreatment, the swallowing rate for liquids (P=.034), sEMG durational parameters of premotor time (P=.003), and preswallow time (P<.001) improved. A functional carryover effect was seen from dry to water swallows (P=.009). Additionally, swallowing-related quality of life improved (P=.018). Reassessment at 2 weeks after treatment termination revealed short-term retention of treatment effects. CONCLUSIONS:A skill-based training approach produced functional, biomechanical, and swallowing-related quality of life improvements in this cohort indicating compelling evidence for the effectiveness of this novel approach for dysphagia rehabilitation in PD. 10.1016/j.apmr.2014.03.001
    A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson's Disease, Alzheimer's Disease, Head Injury, and Pneumonia. Takizawa Claire,Gemmell Elizabeth,Kenworthy James,Speyer Renée Dysphagia Oropharyngeal dysphagia is a common condition after stroke, Parkinson's disease (PD), and Alzheimer's disease (AD), and can cause serious complications including malnutrition, aspiration pneumonia, and premature mortality. Despite its high prevalence among the elderly and associated serious complications, dysphagia is often overlooked and under-diagnosed in vulnerable patient populations. This systematic review aimed to improve understanding and awareness of the prevalence of dysphagia in susceptible patient populations. MEDLINE, EMBASE, the Cochrane library, PROSPERO, and disease-specific websites were systematically searched for studies reporting oropharyngeal dysphagia prevalence or incidence in people with stroke, PD, AD, traumatic brain injury, and community-acquired pneumonia, from the USA, Canada, France, Germany, Italy, Spain, UK, Japan, China, and regional studies. The quality of study descriptions were assessed based on STROBE guidelines. A total of 1207 publications were identified and 33 met inclusion criteria: 24 in stroke, six in PD, two in traumatic brain injury, and one in patients with traumatic brain injury. Dysphagia was reported in 8.1-80 % of stroke patients, 11-81 % of PD, 27-30 % of traumatic brain injury patients, and 91.7 % of patients with community-acquired pneumonia. No relevant studies of dysphagia in AD were identified. This review demonstrates that dysphagia is highly prevalent in these populations, and highlights discrepancies between studies, gaps in dysphagia research, and the need for better dysphagia management starting with a reliable, standardized, and validated method for oropharyngeal dysphagia identification. 10.1007/s00455-016-9695-9
    Risk and prognostic factors for pneumonia and choking amongst Parkinson's disease patients with dysphagia. Goh Kwang-Hwee,Acharyya Sanchalika,Ng Samuel Yong-Ern,Boo Jasmine Pei-Ling,Kooi Amanda Hui-Juan,Ng Hwee-Lan,Li Wei,Tay Kay-Yaw,Au Wing-Lok,Tan Louis Chew-Seng Parkinsonism & related disorders OBJECTIVE:To evaluate the time to hospitalisation and baseline factors associated with pneumonia/choking in Parkinson's Disease (PD) patients. BACKGROUND:Although dysphagia and pneumonia are common problems in PD, scarce research has been performed. METHODS:A total of 194 PD patients who underwent a VFS evaluation were retrospectively selected. The mode of feeding and admissions for pneumonia/choking were analyzed. Baseline clinical and demographic variables were compared between feeding groups. Kaplan-Meier survival analysis was performed to estimate time to pneumonia/choking. Clinical variables significantly associated with pneumonia/choking free survival were identified using Cox regression. RESULTS:Hospitalisation for pneumonia/choking occurred in 89 out of 194 patients, with the highest admission rate in rejected enteral feeding group (66.7%), followed by enteral feeding (61.8%) and oral feeding (38.8%) groups. The estimates of median time to event were 11, 14, and 47 months for rejected enteral feeding, enteral and oral feeding groups respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest risk of pneumonia/choking (HR 4.61, 95%CI:2.33-9.08, p < 0.001), followed by enteral feeding group (HR 2.29, 95%CI:1.25-4.19, p = 0.007), when compared to oral feeding group after adjusting for possible confounders. A stepwise Cox regression showed that the rejected enteral feeding (HR 4.89, 95%CI:2.19-10.88, p < 0.001), enteral mode of feeding (HR 2.43, 95%CI:1.11-5.32, p = 0.026), and Charlson weighted index of co-morbidity (HR 1.27, 95%CI:1.03-1.58, p = 0.028) were independently associated with higher hazard of pneumonia/choking. CONCLUSIONS:Compliance to feeding recommendations is important to reduce the risk of hospitalisation for pneumonia/choking. The recommended mode of feeding and comorbidity index was significantly associated with pneumonia/choking risk. 10.1016/j.parkreldis.2016.05.034
    Clinical Profile of Dysphagia in Patients with Parkinson's Disease, Progressive Supranuclear Palsy and Multiple System Atrophy. Sulena ,Gupta Dipti,Sharma Anjani Kumar,Singh Baltej The Journal of the Association of Physicians of India BACKGROUND:Swallowing changes are commonly observed in Parkinson's and Parkinsonism plus syndromes. Expeditious identification is necessary to provide early intervention in this population to avoid risk of aspiration and swallowing complications. OBJECTIVE:To investigate swallowing problems using detailed case history and swallowing speed on 3 ounce water test in three groups i.e. PD, MSA and PSP groups and further, to compare it with control group. SUBJECT AND METHODS:Cross sectional study design. A total of 73 patients were classified in MSA, PSP and PD for testing aged between 38 yrs and 70 yrs according to respective diagnostic criteria. A simple bedside water swallowing test was performed using 90 cc of water. Detailed assessment was done to check swallowing function. RESULTS:The mean age of both experimental group and control group was 62.4±8.37 yrs. and 61.05±7.07 yrs. Males were affected more in every pathological group compared to females. The dysphagia presented earlier in PSP and MSA groups as compared to PD groups. The water swallowing speed was found to be significantly less than 10ml/sec amongst three neurological groups compared to control group. The patients were found to have significant difficulty in parameters like repetitive swallowing, transferring food bolus through mouth, and food sticking in throat after swallowing. CONCLUSIONS:This is the first study comparing clinical profile of dysphagia in patients with PD, MSA, and PSP. Although there is no specific pattern of dysphagia for each of these disorders, the presence of some findings may provide clue to the diagnosis and necessary intervention.
    Swallowing speed is no adequate predictor of aspiration in Parkinson's disease. Pflug Christina,Niessen Almut,Buhmann Carsten,Bihler Moritz Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society BACKGROUND:There is still a lack of a clinical test to reliably identify patients with Parkinson's disease (PD) being at risk for aspiration. METHODS:In this prospective, controlled, cross-sectional study, we assessed if swallowing speed for water is a useful clinical test to predict aspiration proven by flexible endoscopic evaluation of swallowing (FEES). Due to this, we measured the swallowing speed for 90 mL water in 115 consecutive and unselected PD outpatients of all clinical stages and 32 healthy controls. KEY RESULTS:Average swallowing speed was lower in patients compared with controls (6.5 ± 3.9 mL/s vs 8.5 ± 3.2 mL/s; P < .01). The disease-independent widely used threshold of <10 mL/s showed insufficient sensitivity of 88% and specificity of 19% with high false-positive rates of 63% for patients and 69% for controls. Receiver operating characteristic (ROC) analysis was carried out to define a suitable cutoff value for detection of aspiration of water (area under the curve 0.72, P < .001) in PD patients. The optimized cutoff value was 5.5 mL/s with a sensitivity of 69% and a specificity of 64%. CONCLUSION AND INFERENCES:Measuring swallowing speed is prone to methodological errors and not suitable as a screening instrument to predict aspiration in PD patients. 10.1111/nmo.13713
    At which Hoehn&Yahr stage of Parkinson's disease should the patients be screened for dysphagia? Bahat Gülistan,Erdoğan Tuğba,Karan Mehmet Akif Clinical nutrition (Edinburgh, Scotland) 10.1016/j.clnu.2019.11.020
    Swallowing and deep brain stimulation in Parkinson's disease: a systematic review. Troche Michelle S,Brandimore Alexandra E,Foote Kelly D,Okun Michael S Parkinsonism & related disorders The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson's disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. "on" vs. "off", pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. 10.1016/j.parkreldis.2013.05.001
    Optimising medication for Parkinson's disease patients with dysphagia. Patel Krupa British journal of community nursing In addition to movement disorders, Parkinson's disease (PD) is associated with several nonmotor symptoms, including dysphagia (swallowing difficulties). Dysphagia can make the consumption of solid medicines difficult, which potentially contributes to the poor adherence that is common among people with PD. However, patients may be reluctant to admit that they experience dysphagia. Community nurses should actively enquire into swallowing difficulties among all patients, not only those with PD, and should work with pharmacists and other members of the multidisciplinary team to help optimise medication management to help improve adherence. 10.12968/bjcn.2015.20.7.322
    Dietary habits in Parkinson's disease: Adherence to Mediterranean diet. Cassani Erica,Barichella Michela,Ferri Valentina,Pinelli Giovanna,Iorio Laura,Bolliri Carlotta,Caronni Serena,Faierman Samanta A,Mottolese Antonia,Pusani Chiara,Monajemi Fatemeh,Pasqua Marianna,Lubisco Alessandro,Cereda Emanuele,Frazzitta Giuseppe,Petroni Maria L,Pezzoli Gianni Parkinsonism & related disorders INTRODUCTION:Our objective is to describe the dietary habits, food preferences and adherence to Mediterranean diet (MeDi) of a large sample of Italian Parkinson's Disease (PD) patients compared to a group of controls. METHODS:Dietary habits of 600 PD patients from throughout Italy and 600 controls matched by gender, age, education, physical activity level and geographical residence, were collected using the ON-GP Food Frequency Questionnaire. Then, we compared patients by disease duration and the presence of swallowing disturbances. RESULTS:Overall, adherence of PD patients (males, 53.8%; mean disease duration, 9.2 ± 7.0 years) to MeDi was similar to controls (score, 4.8 ± 1.7 vs. 4.9 ± 1.6; P = 0.294). Patients consumed less alcohol and fish and drank significantly less water, coffee, and milk which resulted also in lower total fluids intake. On the contrary, they ate more fruit, cooked vegetables, cereals and baked items, more dressings and more sweets in general. Disease duration was associated with increased intake of several food groups but it was not associated with changes in MeDi score (P = 0.721). Patients with swallowing disturbances (n = 72) preferred softer and more viscous food but preferences did not result in differences in dietary pattern. However, patients with dysphagia drank less fluids (P = 0.043). DISCUSSION:PD patients presented different dietary habits and food preferences compared to the general population and adherence to MeDi was not associated with disease duration. Self-reported dysphagia was associated with reduced intake of fluids. These aspects may be amenable to change in order to improve the management of nutritional issues in this patient population. 10.1016/j.parkreldis.2017.06.007
    Swallowing in Parkinson's disease: clinical issues and management. Miller Nick Neurodegenerative disease management Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues. 10.2217/nmt-2017-0006
    SARS-CoV-2-Associated New Dysphagia in Parkinson's Disease Requires Exclusion of Differentials. Scorza Fulvio A,Finsterer Josef American journal of physical medicine & rehabilitation 10.1097/PHM.0000000000001927
    Cognitive and Motor Aspects of Parkinson's Disease Associated with Dysphagia. Kim Ji Sun,Youn Jinyoung,Suh Mee Kyung,Kim Tae-Eun,Chin Juhee,Park Suyeon,Cho Jin Whan The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques BACKGROUND:Dysphagia is a common symptom and an important prognostic factor in Parkinson's disease (PD). Although cognitive and motor dysfunctions may contribute to dysphagia in patients with PD, any specific association between such problems and swallowing functions is unclear. Here, we examined the potential relationship between cognitive/motor components and swallowing functions in PD. We evaluated the contributions of cognition and motor function to the components of swallowing via video fluoroscopic swallowing (VFS) experiments. METHODS:We prospectively enrolled 56 patients without dementia having PD. Parkinson's disease severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS). All participants received neuropsychological tests covering general mental status, visuospatial function, attention, language, learning and memory, and frontal executive function. The well-validated "modified barium swallow impairment profile" scoring system was applied during VFS studies to quantify swallowing impairments. Finally, correlations between neuropsychological or motor functions and impairment in swallowing components were calculated. RESULTS:The most significant correlations were found between the frontal/executive or learning/memory domains and the oral phase of swallowing, though a minor component of the pharyngeal phase correlated with frontal function as well. Bradykinesia and the UPDRS total score were associated with both the pharyngeal and oral phases. CONCLUSIONS:Our findings suggest that cognitive dysfunctions are associated with the oral phase of swallowing in patients with early stage PD while the severity of motor symptoms may be associated with overall swallowing function. 10.1017/cjn.2015.304
    Dysphagia in Parkinson's disease. Hisashi Shinobu,Fukumitsu Ryoko,Ishida Mitsuyo,Nodera Atsuko,Otani Takahiro,Maruoka Takahiro,Nakamura Kazumi,Izumi Yuishin,Kaji Ryuji,Nishida Yoshihiko Rinsho shinkeigaku = Clinical neurology Although dysphagia is an important symptom associated with prognosis in patients with Parkinson's disease (PD), dysphagia tends to be overlooked until swallowing difficulties reach an advanced phase. We assessed dysphagia with videofluoroscopic examination of swallowing in 31 patients with mainly mild or moderate PD. Swallowing problems were observed in the pharyngeal phase in 28 patients, oral phase in 19 patients, esophageal phase in 15 patients, and oral preparatory phase in 1 patient. Therefore, dysphagia in the pharyngeal phase was observed in almost all patients with mild or moderate PD. In contrast, no dysfunction was detected in most patients when screening was conducted via questionnaire or other methods. Assessment of clinical parameters in the present study suggests that latent swallowing dysfunction may be present even in the early disease stage in PD. A future prospective study to follow swallowing functions in a pre-symptomatic phase in PD would be fruitful to find whether swallowing dysfunction is one of the prodromal symptoms. 10.5692/clinicalneurol.cn-000871
    Pink1 -/- Rats Show Early-Onset Swallowing Deficits and Correlative Brainstem Pathology. Cullen Kaylee P,Grant Laura M,Kelm-Nelson Cynthia A,Brauer Alexander F L,Bickelhaupt Luke B,Russell John A,Ciucci Michelle R Dysphagia Parkinson disease (PD) compromises oropharyngeal swallowing, which negatively affects quality of life and contributes to aspiration pneumonia. Dysphagia often begins early in the disease process, and does not improve with standard therapies. As a result, swallowing deficits are undertreated in the PD population. The Pink1 -/- rat is used to model PD, and demonstrates widespread brainstem neuropathology in combination with early-onset sensorimotor dysfunction; however, to date, swallowing behaviors have not been evaluated. To test the hypothesis that Pink1 -/- rats demonstrate early-onset differences in swallowing, we analyzed within-subject oropharyngeal swallowing using videofluoroscopy. Pink1 -/- and wildtype (WT) controls at 4 (Pink1 -/- n = 16, WT = 16) and 8 (Pink1 -/- n = 12, WT = 12) months of age were tested. The average and maximum bolus size was significantly increased in Pink1 -/- rats at both 4 and 8 months. Bolus average velocity was increased at 8 months for all animals; yet, Pink1 -/- animals had significantly increased velocities compared to WT at 8 months. The data show a significant reduction in mastication rate for Pink1 -/- rats at 8 months suggesting the onset of oromotor dysfunction begins at this time point. Relationships among swallowing variables and neuropathological findings, such as increased alpha-synuclein protein in the nucleus ambiguus and reductions in noradrenergic cells in the locus coeruleus in the Pink1 -/- rats, were determined. The presence of early oropharyngeal swallowing deficits and relationships to brainstem pathology in Pink1-/- rat models of PD indicate that this may be a useful model of early swallowing deficits and their mechanisms. These findings suggest clinical implications for early detection and management of dysphagia in PD. 10.1007/s00455-018-9896-5
    Systematic Review of Behavioral Therapy to Improve Swallowing Functions of Patients With Parkinson's Disease. Park Myung Sook,Choi Jin Yi,Song Young-Jin,Choi Heejung,Park Eun-Jun,Ji Eun Sun Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates Decreased swallowing function is a common and main cause of malnutrition and aspiration pneumonia in patients with Parkinson's disease. The aims of this systematic review were to summarize and qualitatively analyze the studies that have been published on behavioral therapies for improving swallowing functions in patients with Parkinson's disease. Studies published from January 2000 to December 2015 were identified via electronic database searches using Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and 8 Korean databases. Two reviewers independently evaluated the studies using inclusion criteria. Nine studies were included, of which 6 evaluated rehabilitation technique studies and 3 evaluated compensatory strategies. The 9 studies were evaluated qualitatively using a methodology checklist of the Scottish Intercollegiate Guideline Network, according to which all of the studies had acceptable quality. The available data on the effects of rehabilitation techniques and compensatory strategies remain insufficient. Further randomized controlled studies should be done to investigate the effect of behavioral therapy on improving swallowing functions in patients with Parkinson's disease. 10.1097/SGA.0000000000000358
    Neurologic Conditions: Parkinson Disease. McKinley James E,Perkins Allen FP essentials Parkinson disease (PD) is a complex neurologic disorder that involves motor and nonmotor brain functions. PD is the second most common neurodegenerative disease after Alzheimer disease. Motor symptoms include resting tremor, cogwheel rigidity, extreme slowness of movement, shuffling gait, and impaired balance. Swallowing and speaking difficulties also are common. Nonmotor symptoms include depression, hallucinations, and sleep disturbances that seriously affect quality of life. There is no cure for PD but management of motor and nonmotor symptoms can improve quality of life. Carbidopa-levodopa is an effective initial treatment for motor symptoms of rigidity and resting tremors. Treatments for nonmotor symptoms include antidepressants, antipsychotics, and drugs for dementia. (This is an off-label use of some antidepressants, antipsychotics, and drugs for dementia.) A multidisciplinary approach to optimizing care can include physical and occupational therapy, speech therapy, and psychological therapy.
    Dysphagia in Progressive Supranuclear Palsy. Clark Heather M,Stierwalt Julie A G,Tosakulwong Nirubol,Botha Hugo,Ali Farwa,Whitwell Jennifer L,Josephs Keith A Dysphagia Progressive supranuclear palsy (PSP) is the most common Parkinson-Plus syndrome and is associated with early onset of dysphagia relative to Parkinson Disease. The current study contributes to the growing understanding of swallowing dysfunction in PSP by describing oropharyngeal swallowing characteristics in a large prospective cohort of participants with PSP employing a nationally standardized videofluoroscopy protocol and a disease severity scale developed expressly for PSP. Participants were 51 adults diagnosed with PSP. Each participant underwent a clinical interview and standardized videofluorographic assessment. Swallowing function was characterized with the Modified Barium Swallow Impairment Scale (MBSImP) and Penetration-Aspiration Scale (PAS). Variables of interest were participant-reported difficulties with liquids and/or solids; overall impression score for each of the 17 individual MBSImP components, as well as Oral Total Sum and Pharyngeal Total Sum; and PAS. Data were described with median interquartile range, counts, and proportions. Spearman's rank correlations were calculated between MBSImP scores and participant-reported indices, FOIS, and PSP Rating Scale. Approximately two-thirds of participants reported difficulties with liquids, solids, or both, although fewer than 15% reported modifying consistencies. Videofluorographic findings included predominant oral phase impairments, including back and forth rocking motion of the tongue, delayed initiation of the pharyngeal swallow, and oral residue. Pharyngeal phase impairments were relatively infrequent and comparatively mild, with the exception of reduced tongue base retraction contributing to pharyngeal residue, and mildly disrupted laryngeal vestibule closure. Disease severity correlated significantly with oral (r = .0.42, p = .0.002) and pharyngeal (r = 0.41, p = .0.003) total sum scores as well as with the oral phase components of oral transport (r = .0.33, p = .0.02) and initiation of the pharyngeal swallow (r = .0.38, p = .0.007), and PAS for thin liquids (r = .0.44, p = .0.001). The PSP Rating Scale was not more strongly correlated with swallowing impairment than has been reported for other disease severity rating scales. Dysphagia is a common complaint of patients with PSP. The current findings corroborate and expand upon those reported in the literature, detailing relatively more frequent and more severe oral phase impairments and relatively spared hyolaryngeal excursion. Further research is needed to characterize the progression of dysphagia in PSP and to determine whether dysphagia varies in character or in rate of progression across variants of PSP. 10.1007/s00455-019-10073-2
    Flexible submental sensor patch with remote monitoring controls for management of oropharyngeal swallowing disorders. Kim Min Ku,Kantarcigil Cagla,Kim Bongjoong,Baruah Ratul Kumar,Maity Shovan,Park Yeonsoo,Kim Kyunghun,Lee Seungjun,Malandraki Jaime Bauer,Avlani Shitij,Smith Anne,Sen Shreyas,Alam Muhammad A,Malandraki Georgia,Lee Chi Hwan Science advances Successful rehabilitation of oropharyngeal swallowing disorders (i.e., dysphagia) requires frequent performance of head/neck exercises that primarily rely on expensive biofeedback devices, often only available in large medical centers. This directly affects treatment compliance and outcomes, and highlights the need to develop a portable and inexpensive remote monitoring system for the telerehabilitation of dysphagia. Here, we present the development and preliminarily validation of a skin-mountable sensor patch that can fit on the curvature of the submental (under the chin) area noninvasively and provide simultaneous remote monitoring of muscle activity and laryngeal movement during swallowing tasks and maneuvers. This sensor patch incorporates an optimal design that allows for the accurate recording of submental muscle activity during swallowing and is characterized by ease of use, accessibility, reusability, and cost-effectiveness. Preliminary studies on a patient with Parkinson's disease and dysphagia, and on a healthy control participant demonstrate the feasibility and effectiveness of this system. 10.1126/sciadv.aay3210
    Drooling in Parkinson's Disease: Prevalence and Progression from the Non-motor International Longitudinal Study. van Wamelen Daniel J,Leta Valentina,Johnson Julia,Ocampo Claudia Lazcano,Podlewska Aleksandra M,Rukavina Katarina,Rizos Alexandra,Martinez-Martin Pablo,Chaudhuri K Ray Dysphagia Sialorrhoea in Parkinson's disease (PD) is an often neglected yet key non-motor symptom with impact on patient quality of life. However, previous studies have shown a broad range of prevalence figures. To assess prevalence of drooling in PD and its relationship to quality of life, we performed a retrospective analysis of 728 consecutive PD patients who had a baseline and follow-up assessment as part of the Non-motor International Longitudinal Study (NILS), and for whom drooling presence and severity were available, assessed through the Non-Motor Symptoms Scale (NMSS). In addition, we analysed the prevalence of associated dysphagia through self-reported outcomes. Quality of life was assessed through the PDQ-8 scale. Baseline (disease duration 5.6 years) prevalence of drooling was 37.2% (score ≥ 1 NMSS question 19), and after 3.27 ± 1.74 years follow-up, this was 40.1% (p = 0.17). The prevalence of drooling increased with age (p < 0.001). The severity of drooling, however, did not change (p = 0.12). While in 456 patients without drooling at baseline, only 16% (n = 73) had dysphagia (question 20 of the NMSS), in those with drooling this was 34.3% (p < 0.001). At follow-up, the number of patients with dysphagia had increased, 20.4% with no drooling had dysphagia, and 43.6% with drooling had dysphagia. Both at baseline and follow-up, drooling severity was significantly positively associated with quality of life (PDQ-8; r = 0.199; p < 0.001). In moderately advanced PD patients, subjective drooling occurs in over one-third of patients and was significantly associated with decreased quality of life. Dysphagia occurred significantly more often in patients with drooling. 10.1007/s00455-020-10102-5
    A case of type 1 achalasia associated with Parkinson's disease. Cheval M,Villain C,Gay P,Toméo C,Barrou Z,Verny M Revue neurologique 10.1016/j.neurol.2020.12.011
    Speech and swallowing disorders in Parkinson disease. Sapir Shimon,Ramig Lorraine,Fox Cynthia Current opinion in otolaryngology & head and neck surgery PURPOSE OF REVIEW:To review recent research and clinical studies pertaining to the nature, diagnosis, and treatment of speech and swallowing disorders in Parkinson disease. RECENT FINDINGS:Although some studies indicate improvement in voice and speech with dopamine therapy and deep brain stimulation of the subthalamic nucleus, others show minimal or adverse effects. Repetitive transcranial magnetic stimulation of the mouth motor cortex and injection of collagen in the vocal folds have preliminary data supporting improvement in phonation in people with Parkinson disease. Treatments focusing on vocal loudness, specifically LSVT LOUD (Lee Silverman Voice Treatment), have been effective for the treatment of speech disorders in Parkinson disease. Changes in brain activity due to LSVT LOUD provide preliminary evidence for neural plasticity. Computer-based technology makes the Lee Silverman Voice Treatment available to a large number of users. A rat model for studying neuropharmacologic effects on vocalization in Parkinson disease has been developed. New diagnostic methods of speech and swallowing are also available as the result of recent studies. SUMMARY:Speech rehabilitation with the LSVT LOUD is highly efficacious and scientifically tested. There is a need for more studies to improve understanding, diagnosis, prevention, and treatment of speech and swallowing disorders in Parkinson disease. 10.1097/MOO.0b013e3282febd3a
    [Awareness of dysphagia in Parkinson's disease]. Bayés-Rusiñol Àngels,Forjaz Maria J,Ayala Alba,Crespo M de la Cruz,Prats Anna,Valles Esther,Petit Cristina,Casanovas Mercè,Garolera-Freixa Maite Revista de neurologia INTRODUCTION AND AIM:In order to be able to assess the level of awareness of swallowing disorders in Parkinson's disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. PATIENTS AND METHODS:A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. RESULTS:The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well. The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. CONCLUSIONS:The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis. A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.
    Evidence for adaptive cortical changes in swallowing in Parkinson's disease. Suntrup Sonja,Teismann Inga,Bejer Joke,Suttrup Inga,Winkels Martin,Mehler David,Pantev Christo,Dziewas Rainer,Warnecke Tobias Brain : a journal of neurology Dysphagia is a relevant symptom in Parkinson's disease, whose pathophysiology is poorly understood. It is mainly attributed to degeneration of brainstem nuclei. However, alterations in the cortical contribution to deglutition control in the course of Parkinson's disease have not been investigated. Here, we sought to determine the patterns of cortical swallowing processing in patients with Parkinson's disease with and without dysphagia. Swallowing function in patients was objectively assessed with fiberoptic endoscopic evaluation. Swallow-related cortical activation was measured using whole-head magnetoencephalography in 10 dysphagic and 10 non-dysphagic patients with Parkinson's disease and a healthy control group during self-paced swallowing. Data were analysed applying synthetic aperture magnetometry, and group analyses were done using a permutation test. Compared with healthy subjects, a strong decrease of cortical swallowing activation was found in all patients. It was most prominent in participants with manifest dysphagia. Non-dysphagic patients with Parkinson's disease showed a pronounced shift of peak activation towards lateral parts of the premotor, motor and inferolateral parietal cortex with reduced activation of the supplementary motor area. This pattern was not found in dysphagic patients with Parkinson's disease. We conclude that in Parkinson's disease, not only brainstem and basal ganglia circuits, but also cortical areas modulate swallowing function in a clinically relevant way. Our results point towards adaptive cerebral changes in swallowing to compensate for deficient motor pathways. Recruitment of better preserved parallel motor loops driven by sensory afferent input seems to maintain swallowing function until progressing neurodegeneration exceeds beyond the means of this adaptive strategy, resulting in manifestation of dysphagia. 10.1093/brain/awt004
    Swallowing impairment and pulmonary dysfunction in Parkinson's disease: the silent threats. Monteiro Larissa,Souza-Machado Adelmir,Pinho Patrícia,Sampaio Marília,Nóbrega Ana Caline,Melo Ailton Journal of the neurological sciences INTRODUCTION:Swallowing disorders and respiratory impairment are frequent in Parkinson's disease (PD) patients, and aspiration pneumonia remains the leading cause of death among these subjects. OBJECTIVE:The objective of this study was to investigate whether there is an association between pulmonary impairment and swallowing dysfunction in PD patients. METHODS:A cross-sectional study with a comparison group was conducted with PD patients. Subjects were submitted to demographic questionnaires and underwent spirometric and videofluorographic assessments. Significance level was considered at 95% (p<0.05). RESULTS:Among 35 PD patients, 40% presented with swallowing complaints. However, 22% of the clinically asymptomatic patients presented airway food penetration when submitted to videofluoroscopy. In 20% of PD patients material entered the airways and there was contact with the vocal folds in 7%. However, there was an efficient cleaning with residue deglutition in almost all patients. No penetration/aspiration was detected among the controls. Respiratory parameters were below the normal predicted values in PD patients when compared to the healthy controls. CONCLUSION:These data suggest an association between pulmonary dysfunction and swallowing impairment in PD patients; even in patients without swallowing complaints, impaired pulmonary function can be detected. 10.1016/j.jns.2014.02.004
    Quality of life related to swallowing in Parkinson's disease. Carneiro Danielle,das Graças Wanderley de Sales Coriolano Maria,Belo Luciana Rodrigues,de Marcos Rabelo Aneide Rocha,Asano Amdore Guescel,Lins Otávio Gomes Dysphagia Swallowing difficulties in Parkinson's disease can result in decreased quality of life. The swallowing quality of life questionnaire (SWAL-QOL) is an instrument for specifically assessing quality of life with respect to swallowing, which has been little explored in patients with Parkinson's disease (PD). The goal of this study was to evaluate the quality of life with respect to swallowing in persons with PD compared to controls and at several stages of the disease using the SWAL-QOL. The experimental group was composed of 62 persons with PD at stages 1-4. Forty-one age-matched healthy subjects constituted the control group. The SWAL-QOL scores were significantly lower for the patients with PD than for the controls in all SWAL-QOL domains. Eating duration had the largest difference in score between persons with PD and the controls and the lowest mean score, followed by communication, fatigue, fear, sleep, and food selection. The scores of most domains were lower at later stages of the disease. The scores for eating duration, symptom frequency, and sleep were significantly lower at stage 4 than stages 1 and 2. In conclusion, patients with PD have significantly lower scores in all domains of the SWAL-QOL than normal controls. This means swallowing difficulties occurring in patients with PD negatively affect their QOL. Progression of the disease worsens swallowing QOL, more specifically in the domains of eating duration, symptom frequency, and sleep. This occurs mostly at later stages of the disease. 10.1007/s00455-014-9548-3
    The relationship between limit of Dysphagia and average volume per swallow in patients with Parkinson's disease. Belo Luciana Rodrigues,Gomes Nathália Angelina Costa,Coriolano Maria das Graças Wanderley de Sales,de Souza Elizabete Santos,Moura Danielle Albuquerque Alves,Asano Amdore Guescel,Lins Otávio Gomes Dysphagia The goal of this study was to obtain the limit of dysphagia and the average volume per swallow in patients with mild to moderate Parkinson's disease (PD) but without swallowing complaints and in normal subjects, and to investigate the relationship between them. We hypothesize there is a direct relationship between these two measurements. The study included 10 patients with idiopathic PD and 10 age-matched normal controls. Surface electromyography was recorded over the suprahyoid muscle group. The limit of dysphagia was obtained by offering increasing volumes of water until piecemeal deglutition occurred. The average volume per swallow was calculated by dividing the time taken by the number of swallows used to drink 100 ml of water. The PD group showed a significantly lower dysphagia limit and lower average volume per swallow. There was a significantly moderate direct correlation and association between the two measurements. About half of the PD patients had an abnormally low dysphagia limit and average volume per swallow, although none had spontaneously related swallowing problems. Both measurements may be used as a quick objective screening test for the early identification of swallowing alterations that may lead to dysphagia in PD patients, but the determination of the average volume per swallow is much quicker and simpler. 10.1007/s00455-013-9512-7
    Dysphagia progression and swallowing management in Parkinson's disease: an observational study. Luchesi Karen Fontes,Kitamura Satoshi,Mourão Lucia Figueiredo Brazilian journal of otorhinolaryngology INTRODUCTION:Dysphagia is relatively common in individuals with neurological disorders. OBJECTIVE:To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. METHODS:It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. RESULTS:During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. CONCLUSION:The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series. 10.1016/j.bjorl.2014.09.006
    Comparison of Two Methods for Inducing Reflex Cough in Patients With Parkinson's Disease, With and Without Dysphagia. Hegland Karen W,Troche Michelle S,Brandimore Alexandra,Okun Michael S,Davenport Paul W Dysphagia Aspiration pneumonia is a common cause of death in people with Parkinson's disease (PD). Dysfunctional swallowing occurs in the majority of people with PD, and research has shown that cough function is also impaired. Previous studies suggest that testing reflex cough by having participants inhale a cough-inducing stimulus through a nebulizer may be a reliable indicator of swallowing dysfunction, or dysphagia. The primary goal of this study was to determine the cough response to two different cough-inducing stimuli in people with and without PD. The second goal of this study was to compare the cough response to the two different stimuli in people with PD, with and without swallowing dysfunction. Seventy adults (49 healthy and 21 with PD) participated in the study. Aerosolized water (fog) and 200 μM capsaicin were used to induce cough. Each substance was placed in a small, hand-held nebulizer, and presented to the participant. Each cough stimulus was presented three times. The total number of coughs produced to each stimulus trial was recorded. All participants coughed more to capsaicin versus fog (p < 0.001). A categorical 'responder' and 'non-responder' variable for the fog stimulus, defined as whether or not the participant coughed at least two times to two of three presentations of the stimulus, yields sensitivity of 77.8 % and a specificity of 90.9 % for identifying PD participants with and without dysphagia. The data show a differential response of the PD participants to the capsaicin versus fog stimuli. Clinically, this finding may allow for earlier identification of people with PD who are in need of a swallowing evaluation. As well, there are implications for the neural control of cough in this patient population. 10.1007/s00455-015-9659-5
    Dysphagia predicts poor outcome in late-stage Parkinson's disease. Fabbri Margherita,Coelho Miguel,Abreu Daisy,Guedes Leonor Correia,Rosa Mario M,Godinho Catarina,Cardoso Rita,Guimaraes Isabel,Antonini Angelo,Zibetti Maurizio,Lopiano Leonardo,Ferreira Joaquim J Parkinsonism & related disorders BACKGROUND:Few data exist on the rate of clinical progression for Parkinson's disease (PD) patients who have entered a late stage of the disease. OBJECTIVE:Study the clinical progression of a late-stage PD (LSPD) population over one year follow-up. METHODS:50 LSPD patients (Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 in MED ON) underwent an extensive clinical assessment at baseline and after one year and an acute levodopa test at baseline. RESULTS:Mean age of LSPD patients (female 46%) was 77.5 ± 5.9 years and mean disease duration was 15.5 ± 6.5 years. At baseline, 76% had levodopa-induced motor complications (MC), usually non-troublesome, 68% were demented, 54% had psychosis and 68% depression. Caregiver distress was high. l-dopa responsiveness was mild (18% ± 12 of improvement on MDS-UPDRS-III). After one-year, 20% of the patients were dead, institutionalized or HY 5. MDS-UPDRS-motor mean score worsened 7.2 ± 10.3 points although there was heterogeneity between patients, and there was a global worsening of non-motor symptoms, mostly in cognition/mood, urinary and gastrointestinal domains. Nevertheless, MC improved despite similar levodopa equivalent dose. Functional independence and quality of life worsened. Dysphagia severity at baseline predicted a poor outcome (death, institutionalization or HY 5) (Hazard ratio 2.3, 95% CI 1.12-4.4; p = 0.01), whereas magnitude of l-dopa response of LSPD patients did not. CONCLUSIONS:LSPD patients still present a significant, although heterogeneous, motor and non-motor progression over 1 year. Dysphagia severity predicts the occurrence of additional disease severity milestones and its management must be prioritized. 10.1016/j.parkreldis.2019.02.043
    Dysphagia is associated with presynaptic dopaminergic dysfunction and greater non-motor symptom burden in early drug-naïve Parkinson's patients. Polychronis Sotirios,Dervenoulas Georgios,Yousaf Tayyabah,Niccolini Flavia,Pagano Gennaro,Politis Marios PloS one BACKGROUND:The underlying pathophysiology of dysphagia is multifactorial and evidence clarifying the precise mechanisms are scarce. Dysfunction in dopamine-related and non-dopamine-related pathways, changes in cortical networks related with swallowing and peripheral mechanisms have been implicated in the pathogenesis of dysphagia. We aimed at investigating whether dysphagia is associated with presynaptic dopaminergic deficits, faster motor symptom progression and cognitive decline in a population of early drug-naïve patients with Parkinson's disease. METHODS:By exploring the database of Parkinson's Progression Markers Initiative we identified forty-nine early drug-naïve Parkinson's disease patients with dysphagia. Dysphagia was identified with SCOPA-AUT question 1 (answer regularly) and was assessed with MDS-UPDRS Part-II, Item 2.3 (Chewing and Swallowing). We compared Parkinson's disease patients with dysphagia to Parkinson's disease patients without dysphagia, and investigated differences in striatal [123I]FP-CIT single photon emission computed tomography levels. Using Cox proportional hazards analyses, we also evaluated whether dysphagia can predict motor deterioration and cognitive dysfunction. RESULTS:Parkinson's disease patients with dysphagia, harbored a greater deterioration regarding motor and non-motor symptoms and decreased [123I]FP-CIT binding when compared with patients without dysphagia. Higher burden of dysphagia (MDS-UPDRS-II, item 2.3) was correlated with lower [123I]FP-CIT uptakes within the striatum (rs = -0.157; P = 0.002) and the caudate (rs = -0.156; P = 0.002). The presence of dysphagia was not a predictor of motor progression (Hazard ratio [HR]: 1.143, 95% confidence interval [CI]: 0.848-1.541; P = 0.379) or cognitive decline (HR: 1.294, 95% CI: 0.616-2.719; P = 0.496). CONCLUSIONS:Dysphagia is associated with decreased presynaptic dopaminergic integrity within caudate and greater motor and non-motor symptoms burden in early drug-naïve PD. 10.1371/journal.pone.0214352
    Excessive daytime sleepiness and dysphagia in Parkinson's disease, from the assessment of a risk to a pathophysiological landscape. Motolese Francesco,Gupta Deepak,Marano Massimo Journal of the neurological sciences 10.1016/j.jns.2020.116882
    A comparison of swallow-related submandibular contraction amplitude and duration in people with Parkinson's disease and healthy controls. Kim Julie,Watts Christopher R International journal of speech-language pathology PURPOSE:To compare the contraction amplitude and contraction duration of submandibular muscles during the pharyngeal stage of swallowing in people with Parkinson's disease (PD) compared to normal controls. METHOD:A prospective cross-sectional study design was utilised to recruit 24 participants from the regional area. A total of 14 people with PD and 10 healthy controls (HC) were recruited. Participants swallowed three volumes of thin liquid (5mL, 10mL, 15mL) while the activity of the submandibular muscles was recorded using surface electromyography. Measurements of contraction amplitude ratio (normalised to a maximum voluntary contraction) and contraction duration were computed from recorded electromyographic signals. Receiver Operating Characteristics (ROC) were computed for variables associated with significant main effects. RESULT:Analyses revealed a significant effect of group on contraction amplitude ratio but not contraction duration. There were no significant effects of bolus volume on the dependent variables. ROC analysis indicated that contraction amplitude ratio accurately predicted group assignment in 77% cases. CONCLUSION:Findings revealed that a majority of people with PD in this study utilised a greater percentage of their maximum contraction force in submandibular muscles when swallowing compared to normal controls. Further research is needed to determine if this inefficiency is consistent across larger samples and whether it is due to elevated baseline muscle activity, a compensatory behaviour to accomplish a more effective swallow, or both. 10.1080/17549507.2020.1766566
    Altered pharyngeal muscles in Parkinson disease. Mu Liancai,Sobotka Stanislaw,Chen Jingming,Su Hungxi,Sanders Ira,Adler Charles H,Shill Holly A,Caviness John N,Samanta Johan E,Beach Thomas G, Journal of neuropathology and experimental neurology Dysphagia (impaired swallowing) is common in patients with Parkinson disease (PD) and is related to aspiration pneumonia, the primary cause of death in PD. Therapies that ameliorate the limb motor symptoms of PD are ineffective for dysphagia. This suggests that the pathophysiology of PD dysphagia may differ from that affecting limb muscles, but little is known about potential neuromuscular abnormalities in the swallowing muscles in PD. This study examined the fiber histochemistry of pharyngeal constrictor and cricopharyngeal sphincter muscles in postmortem specimens from 8 subjects with PD and 4 age-matched control subjects. Pharyngeal muscles in subjects with PD exhibited many atrophic fibers, fiber type grouping, and fast-to-slow myosin heavy chain transformation. These alterations indicate that the pharyngeal muscles experienced neural degeneration and regeneration over the course of PD. Notably, subjects with PD with dysphagia had a higher percentage of atrophic myofibers versus with those without dysphagia and controls. The fast-to-slow fiber-type transition is consistent with abnormalities in swallowing, slow movement of food, and increased tone in the cricopharyngeal sphincter in subjects with PD. The alterations in the pharyngeal muscles may play a pathogenic role in the development of dysphagia in subjects with PD. 10.1097/NEN.0b013e318258381b
    Central cholinergic dysfunction could be associated with oropharyngeal dysphagia in early Parkinson's disease. Lee Kyung Duck,Koo Jung Hoi,Song Sun Hong,Jo Kwang Deog,Lee Moon Kyu,Jang Wooyoung Journal of neural transmission (Vienna, Austria : 1996) Dysphagia is an important issue in the prognosis of Parkinson's disease (PD). Although several studies have reported that oropharyngeal dysphagia may be associated with cognitive dysfunction, the exact relationship between cortical function and swallowing function in PD patients is unclear. Therefore, we investigated the association between an electrophysiological marker of central cholinergic function, which reflected cognitive function, and swallowing function, as measured by videofluoroscopic studies (VFSS). We enrolled 29 early PD patients. Using the Swallowing Disturbance Questionnaire (SDQ), we divided the enrolled patients into two groups: PD with dysphagia and PD without dysphagia. The videofluoroscopic dysphagia scale (VDS) was applied to explore the nature of the dysphagia. To assess central cholinergic dysfunction, short latency afferent inhibition (SAI) was evaluated. We analyzed the relationship between central cholinergic dysfunction and oropharyngeal dysphagia and investigated the characteristics of the dysphagia. The SAI values were significantly different between the two groups. The comparison of each VFSS component between the PD with dysphagia group and the PD without dysphagia group showed statistical significance for most of the oral phase components and for a single pharyngeal phase component. The total score on the VDS was higher in the PD with dysphagia group than in the PD without dysphagia group. The Mini-Mental State Examination and SAI values showed significant correlations with the total score of the oral phase components. According to binary logistic regression analysis, SAI value independently contributed to the presence of dysphagia in PD patients. Our findings suggest that cholinergic dysfunction is associated with dysphagia in early PD and that an abnormal SAI value is a good biomarker for predicting the risk of dysphagia in PD patients. 10.1007/s00702-015-1427-z
    Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease. Silverman Erin P,Carnaby Giselle,Singletary Floris,Hoffman-Ruddy Bari,Yeager James,Sapienza Christine Archives of physical medicine and rehabilitation OBJECTIVE:To examine relations between peak expiratory (cough) airflow rate and swallowing symptom severity in participants with Parkinson disease (PD). DESIGN:Cross-sectional study. SETTING:Outpatient radiology clinic at an acute care hospital. PARTICIPANTS:Men and women with PD (N=68). INTERVENTIONS:Participants were cued to cough into an analog peak flow meter then swallowed three 20-mL thin liquid barium boluses. Analyses were directed at detecting potential relations among disease severity, swallowing symptom severity, and peak expiratory (cough) airflow rate. MAIN OUTCOME MEASURES:Peak expiratory (cough) airflow rate and swallow symptom severity. RESULTS:Peak expiratory (cough) airflow rate varied significantly across swallowing severity classifications. Participants with more severe disease displayed a significant, linear decrease in peak expiratory (cough) airflow rate than those participants with earlier stage, less severe disease. Swallowing symptom severity varied significantly across groups when comparing participants with less severe PD with those with more severe PD. Participants with early stage PD demonstrated little to no swallowing symptoms and had the highest measures of peak expiratory (cough) airflow rate. In contrast, participants with the most severe swallowing symptoms also displayed the lowest measures of peak expiratory (cough) airflow rate. CONCLUSIONS:Relations existed among PD severity, swallowing symptom severity, and peak expiratory (cough) airflow rate in participants with PD. Peak expiratory (cough) airflow rate may eventually stand as a noninvasive predictor of aspiration risk in those with PD, particularly those with later stage disease. Inclusion of peak expiratory (cough) airflow rates into existing clinical swallowing assessments may increase the sensitivity and predictive validity of these assessments. 10.1016/j.apmr.2015.10.098
    Dysphagia in Parkinson's Disease. Suttrup Inga,Warnecke Tobias Dysphagia More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists, speech-language therapists, and other clinicians in their daily work with PD patients and associated swallowing difficulties. Furthermore areas with an urgent need for future clinical research are identified. 10.1007/s00455-015-9671-9
    Quantitative Measures of Swallowing Deficits in Patients With Parkinson's Disease. Ellerston Julia K,Heller Amanda C,Houtz Daniel R,Kendall Katherine A The Annals of otology, rhinology, and laryngology OBJECTIVE:Dysphagia and associated aspiration pneumonia are commonly reported sequelae of Parkinson's disease (PD). Previous studies of swallowing in patients with PD have described prolonged pharyngeal transit time, delayed onset of pharyngeal transit, cricopharyngeal (CP) achalasia, reduced pharyngeal constriction, and slowed hyolaryngeal elevation. These studies were completed using inconsistent evaluation methodology, reliance on qualitative analysis, and a lack of a large control group, resulting in concerns regarding diagnostic precision. The purpose of this study was to investigate swallowing function in patients with PD using a norm-referenced, quantitative approach. METHODS:This retrospective study includes 34 patients with a diagnosis of PD referred to a multidisciplinary voice and swallowing clinic. Modified barium swallow studies were performed using quantitative measures of pharyngeal transit time, hyoid displacement, CP sphincter opening, area of the pharynx at maximal constriction, and timing of laryngeal vestibule closure relative to bolus arrival at the CP sphincter. RESULTS:Reduced pharyngeal constriction was found in 30.4%, and a delay in airway closure relative to arrival of the bolus at the CP sphincter was the most common abnormality, present in 62% of patients. Previously reported findings of prolonged pharyngeal transit, poor hyoid elevation, and CP achalasia were not identified as prominent features. 10.1177/0003489415617774
    [Dysphagia in Parkinson's Disease: Pathophysiology, Diagnosis and Therapy]. Suttrup I,Warnecke T Fortschritte der Neurologie-Psychiatrie Oropharyngeal and esophageal dysphagia are a frequent, but seldom diagnosed symptom of Parkinson's disease (PD). More than 80 % of patients with PD develop dysphagia during the course of their disease leading to a reduced quality of life, complicated medication intake, malnutrition and aspiration pneumonia, which is a major cause of death in PD. The underlying pathophysiology is poorly understood. Impaired dopaminergic and non-dopaminergic mechanisms of the cortical swallowing network as well as peripheral neuromuscular involvement have been suggested to contribute to its multifactorial genesis. Diagnostic screening methods include PD-specific questionnaires and a modified water test. Fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), which complement each other, are the gold standard for evaluation of PD-related dysphagia. For evaluation of esophageal dysphagia, the high-resolution manometry (HRM) may be a helpful tool. In addition to dysphagia-specific treatment by speech and language therapists (SLTs), optimized dopaminergic medication is a meaningful therapeutic option. A promising novel method is intensive training of expiratory muscle strength (EMST). Deep brain stimulation does not seem to have a clinically relevant effect on swallowing function in PD. 10.1055/s-0042-107245
    Therapeutic singing as an early intervention for swallowing in persons with Parkinson's disease. Stegemöller E L,Hibbing P,Radig H,Wingate J Complementary therapies in medicine OBJECTIVE:For persons with Parkinson's disease (PD), secondary motor symptoms such as swallow impairment impact the quality of life and are major contributors to mortality. There is a present need for therapeutic interventions aimed at improving swallow function during the early stages of PD. The purpose of this pilot study was to examine the effects of a group therapeutic singing intervention on swallowing in persons with PD with no significant dysphagia symptoms. DESIGN:Cohort study. SETTING:University in the United States. PARTICIPANTS:Twenty-four participants with PD. INTERVENTION:Eight weeks of group therapeutic singing. MAIN OUTCOME MEASURES:Electromyography (EMG) was used to assess muscle activity associated with swallow pre and post the group singing intervention. Swallow quality of life (SWAL-QOL) and the Unified Parkinson's Disease Rating Scale (UPDRS) were also obtained pre- and post-intervention. RESULTS:Participants reported minimal difficulty with swallowing, yet results revealed a significant increase in EMG outcome measures, as well as significant improvement in UPDRS total and UPDRS motor scores. No significant differences were revealed for SWAL-QOL. CONCLUSION:Increases in EMG timing measures may suggest that group singing results in the prolongation of laryngeal elevation, protecting the airway from foreign material for longer periods of time during swallow. Combined with the improvement in UPDRS clinical measures, therapeutic singing may be an engaging early intervention strategy to address oropharyngeal dysphagia while also benefiting additional clinical symptoms of PD. 10.1016/j.ctim.2017.03.002
    [Myasthenia gravis should be considered in cases of Parkinson's disease and progressive dysphagia]. Urban P P,Stammel O Der Nervenarzt We report on four consecutive patients with Parkinson's disease, in whom anti-acetylcholine receptor (AChR) antibody positive bulbar myasthenia gravis (MG) turned out to be responsible for progressive dysphagia. 10.1007/s00115-017-0378-z
    Swallowing in Parkinson's disease: How is it affected? Umay Ebru,Ozturk Erhan,Gurcay Eda,Delibas Oguz,Celikel Feyza Clinical neurology and neurosurgery OBJECTIVES:The aim of this study was to evaluate the swallowing in patients with Parkinson's disease (PD) using comprehensive and multimodal methods. PATIENTS AND METHODS:The present study was conducted on 120 patients and 60 controls between January 2017 and January 2018. All participants' demographic data were recorded, and the swallowing of the subjects was evaluated by using several methods, including clinic, electrophysiologic, endoscopic and ultrasonographic procedure. First, the swallowing functions of the patient and control groups were compared. Subsequently, the patients were divided into two groups as patients with (n = 63) or without (n = 57) dysphagia symptoms according to their clinical evaluation. Finally, the data of these three groups were compared. RESULTS:In comparison with healthy subjects, the swallowing evaluated by all diagnostic methods were affected in patients with PD. This effect was greater in patients with clinically symptomatic dysphagia. No difference was found between patients without dysphagia symptoms and healthy controls based on clinic, endoscopic and some electrophysiologic methods. Interestingly, thickness of all oral phase muscles in healthy controls were significantly higher than both dysphagic and non-dysphagic PD patients according to ultrasonography. CONCLUSION:Although it is widely known that dysphagia symptoms in patients with PD usually occur in advanced stages and cause serious problems for patients, the present study establishes that swallowing functions may have been affected in early stage patients without dysphagia symptoms. Assessment of swallowing functions is important and should be also assessed in patients without dysphagia symptoms. Moreover, ultrasonographic method may be used in the diagnosis and follow-up of patients with PD. 10.1016/j.clineuro.2018.12.015
    Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease. Yiu Yin,Curtis James A,Perry Sarah E,Troche Michelle S The Laryngoscope OBJECTIVES:When swallowing function is compromised in patients with Parkinson's disease (PD), cough plays a crucial role in clearing the airway and preventing pulmonary complications. The aim of this study was to determine the influence of vocal fold atrophy severity as measured by the bowing index (BI) on airway protection in PD. METHODS:Thirty participants with PD completed measures of voluntary and reflex cough. Flexible laryngoscopy with endoscopic evaluation of swallowing allowed for measurement of BI using ImageJ software. Swallowing safety was scored on the Penetration-Aspiration Scale (PAS). Regression and receiver operating characteristic (ROC) analyses were performed to test our study aim. RESULTS:Twenty-four of 30 participants had some degree of vocal fold atrophy (BI >0). When controlling for age, disease duration did not significantly influence BI. BI was not predictive of any sensorimotor parameters of cough including measures of cough airflow, reflex cough threshold, or urge to cough. BI discriminated participants with near-normal (PAS 1-3) swallowing safety from participants with impaired (PAS 4-8) swallowing safety (P = .01, sensitivity: 87.0%, specificity: 71.4%, cutoff value BI >4.6). CONCLUSION:Vocal fold atrophy is a potential factor contributing to poor swallowing safety in PD. BI was not associated with cough function in this PD cohort, contrary to prior studies that have shown improved cough measures after vocal fold augmentation. Vocal fold atrophy in PD remains an important area of study as a targetable intervention for patients with airway protective dysfunction. Future studies should include measures of glottic closure during vocal fold adduction. LEVEL OF EVIDENCE:Level 3 Laryngoscope, 130:303-308, 2020. 10.1002/lary.28158
    Treatment of Dysphagia in Parkinson's Disease: A Systematic Review. López-Liria Remedios,Parra-Egeda Jennifer,Vega-Ramírez Francisco A,Aguilar-Parra José Manuel,Trigueros-Ramos Rubén,Morales-Gázquez María José,Rocamora-Pérez Patricia International journal of environmental research and public health The incidence of oropharyngeal dysphagia in Parkinson's disease (PD) is very high. It is necessary to search for effective therapies that could prevent pneumonia. Previous results should be interpreted cautiously as there is a lack of evidence to support the use of compensatory or rehabilitative approaches to dysphagia. We reviewed the scientific literature to describe the treatments of dysphagia in PD. A systematic review was performed in PubMed, Scopus, Elsevier, and Medline according to PRISMA standards in 2018. The articles that did not mention dysphagia secondary to PD or used surgical treatment were excluded. Eleven articles met the criteria with information from 402 patients. The review relates to different protocols, such as training in expiratory muscle strength, postural techniques, oral motor exercises, video-assisted swallowing therapy, surface electrical stimulation, thermal stimulation, touch, compensatory interventions, training regime for swallowing, neuromuscular electrical stimulation, Lee Silverman voice treatment, swallow maneuver, airway protection, and postural compensation maneuvers. This review identifies the rationing interventions in each trial, if they are efficient and equitable. Several rehabilitative therapies have been successful. An improvement was seen in the degenerative function (coordination, speed, and volume), quality of life, and social relationships of people with PD. Further investigations concerning the clinical applicability of these therapies based on well-designed randomized controlled studies are needed. Larger patient populations need to be recruited to evaluate the effectiveness, long-term effects, and new treatment techniques. 10.3390/ijerph17114104
    Effect of cognitive and motor dual-task on oropharyngeal swallowing in Parkinson's disease. Labeit Bendix,Claus Inga,Muhle Paul,Regner Liesa,Suntrup-Krueger Sonja,Dziewas Rainer,Warnecke Tobias European journal of neurology BACKGROUND:Dysphagia frequently occurs in patients with Parkinson's disease (PD) and is associated with severe complications. However, the underlying pathology is poorly understood at present. This study investigated the effect of cognitive and motor dual-task interference on oropharyngeal swallowing in PD. METHODS:Thirty PD patients (23 men, mean age 65.90 ± 9.32 years, mean Hoehn and Yahr stage 2.62 ± 0.81, mean UPDRS 18.00 ± 7.18) were examined using flexible endoscopic evaluation of swallowing (FEES). FEES was performed during three paradigms: at baseline without interference, during a cognitive dual-task, and during a motor dual-task. Oropharyngeal swallowing function was rated using a score which was validated to detect changes in PD related dysphagia. The three paradigms were compared using a two-way-repetitive-measures-ANOVA and a post-hoc-analysis. RESULTS:Mean swallowing score in baseline FEES was 10.67 ± 5.89. It significantly increased (worsened) to 15.97 ± 7.62 (p < 0.001) in the motor dual-task and to 14.55 ± 7.49 (p < 0.001) in the cognitive dual-task. Premature bolus spillage and pharyngeal residue both significantly increased during both of the dual-task conditions whereas penetration/aspiration events did not change. CONCLUSION:Oropharyngeal swallowing in patients with PD is not purely reflexive but requires mental capacity. Additional allocation of attentional resources in the central control of swallowing seems to be an effective compensatory mechanism in PD-related dysphagia: The proposed dual-task protocol may be useful to challenge swallowing functional reserve. Conversely, as a therapeutic strategy, it could be beneficial to focus attention on swallowing and to avoid dual-task situations. 10.1111/ene.14603
    Evaluation of the pharynx and upper esophageal sphincter motility using high-resolution pharyngeal manometry for Parkinson's disease. Taira Kenkichiro,Fujiwara Kazunori,Fukuhara Takahiro,Koyama Satoshi,Morisaki Tsuyoshi,Takeuchi Hiromi Clinical neurology and neurosurgery Parkinson's disease (PD) is associated with a high incidence of dysphagia. Aspiration pneumonia due to dysphagia is a major cause of death in patients with PD, and therefore accurately evaluating dysphagia should help improve prognosis. It has been reported that the severity of dysphagia does not always correlate with the Hoehn and Yahr (H&Y) stage for classifying PD severity. However, no reports have quantitatively evaluated the relationship between severity of dysphagia and H&Y stage. High-resolution pharyngeal manometry (HRPM) is a quantitative method that can be used to measure swallowing pressure from the velopharynx to the entry of the upper esophageal sphincter (UES). We used HRPM to measure swallowing pressure in 51 patients with PD. As PD progresses, atrophy and degeneration of the pharyngeal muscles become more pronounced, which contributes to dysphagia. However, thus far there is no quantitative clinical evidence for this pathological change. To evaluate the relationship between severity of underlying PD and dysphagia, patients were categorized by H&Y stage, as follows: stage II in four patients, stage III in 23, stage IV in 14, and stage V in 10. In patients with H&Y stages II, III, IV, and V, the respective velopharyngeal pressures were 179.8 ± 32.5, 157.6 ± 62.2, 172.2 ± 48.9, and 107.4 ± 44.0 mmHg, the mesopharyngeal pressures were 126.8 ± 53.2, 121.6.1 ± 50.4, 142.1 ± 57.8, and 61.4 ± 19.6 mmHg, the residual UES pressure were -8.0 ± 10.8, 10.3 ± 16.1, 16.5 ± 37.9, and 11.2 ± 16.2 mmHg, and the resting UES pressure were 49.5 ± 30.0, 15.8 ± 25.7, 1.85 ± 14.1, and -1.2 ± 12.2 mmHg. Patients with severe PD demonstrated significantly decreased velopharyngeal and oropharyngeal pressures, along with incomplete UES opening and contraction. HRPM can detect subtle abnormalities by quantifying swallowing pressure in patients with PD. Evaluating swallowing pressure with HRPM provides insights into neuromuscular dysfunction that causes abnormal pressure generation during pharyngeal swallowing in patients with PD. 10.1016/j.clineuro.2020.106447
    Predictors of Penetration-Aspiration in Parkinson's Disease Patients With Dysphagia: A Retrospective Analysis. The Annals of otology, rhinology, and laryngology OBJECTIVE:Penetration-aspiration is considered the most severe sign of dysphagia, with aspiration pneumonia as one of its consequences. More than half of Parkinson's disease (PD) patients suffer from dysphagia, and aspiration pneumonia is among the primary causes of mortality in PD patients. However, the identification of predictors of penetration-aspiration in PD patients remains an understudied topic. The purpose of this study was to identify predictors of penetration-aspiration in patients with PD. METHODS:The data of 89 PD patients with dysphagia who underwent routinely conducted videofluoroscopic studies of swallowing (VFSS) were included in this retrospective study. The occurrence of penetration-aspiration was defined as scores ≥3 on the Penetration-Aspiration Scale (PAS). Four commonly reported signs of dysphagia in PD patients were evaluated as possible predictors. Furthermore, the relationships between the occurrence of penetration-aspiration and liquid bolus volume as well as clinical severity of PD (modified Hoehn and Yahr scale) were examined. RESULTS:Logistic regression showed that a delayed initiation of the pharyngeal swallow (odds ratio [OR] = 7.47, P = .008) and a reduced hyolaryngeal excursion (OR = 5.13, P = .012) were predictors of penetration-aspiration. Moreover, there was a strong, positive correlation between increasing liquid bolus volume and penetration-aspiration (γ = 0.71, P < .001). No correlation was found between severity of PD and penetration-aspiration (γ = 0.077, P = .783). CONCLUSION:Results of the present study allow for a better understanding of penetration-aspiration risk in PD patients. They are useful for treatment planning in order to improve safe oral intake and adequate nutrition. 10.1177/0003489419841398
    Effectiveness of pharmacologic treatment for dysphagia in Parkinson's disease: a narrative review. Chang Min Cheol,Park Jin-Sung,Lee Byung Joo,Park Donghwi Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology BACKGROUND:The effectiveness of pharmacological treatment on dysphagia in Parkinson's disease (PD) is debatable. We reviewed the literature for analyzing the effect of pharmacological treatment on the improvement of dysphagia in PD patients. METHODS:We searched the PubMed database for papers published before June 21, 2020, that evaluated the effect of pharmacologic treatments for improving dysphagia in patients with PD. The following inclusion criteria were applied for the selection of articles: 1) studies performed on patients with dysphagia due to PD, 2) studies where pharmacologic treatment was applied for improvement of dysphagia, and 3) those where follow-up evaluation was performed after the treatment. RESULTS:The primary literature search yielded 415 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included nine studies in this review. In five previous studies, the positive effects of dopaminergic drugs on dysphagia were reported, whereas two showed no significant positive results. The remaining two studies showed equivocal results. CONCLUSION:We found that dopaminergic drugs have some potential to improve dysphagia in patients with PD. However, studies with high-quality evidence are lacking. For the clear elucidation of the effect of dopaminergic drugs on dysphagia in patients with PD, randomized controlled trials with large cohorts and detailed analyses should be conducted in the future. 10.1007/s10072-020-04865-w
    [Acupuncture adjuvant treatment for dysphagia in patients with Parkinson's disease: a randomized controlled trial]. Wu Ming-Xia,Wang Liu-Gen,Li He-Ping,Zeng Xi Zhongguo zhen jiu = Chinese acupuncture & moxibustion OBJECTIVE:To observe the effect of acupuncture on swallowing function and nutritional status of patients with Parkinson's disease (PD) dysphagia. METHODS:A total of 56 patients with PD dysphagia were randomly divided into an observation group and a control group, 28 cases in each one. Both groups were given conventional treatment and swallowing function rehabilitation training.On the basis, the observation group was treated with acupuncture (filiform needling and tongue picking acupuncture). The acupoints of filiform needling were Lianquan (CV 23), Shanglianquan (Extra), Yifeng (TE 17), etc.; and the tongue picking acupuncture was applied at Jinjin (EX-HN 12), Yuye (EX-HN 13) and posterior pharyngeal wall. Rehabilitation training and acupuncture were performed once a day for 5 consecutive days a week, 2 weeks as a course of treatment, 3 courses in total. The swallowing function [oral transit time (OTT), swallowing response time (SRT), pharyngeal transit time (PTT), laryngeal closure duration (LCD)] and nutritional indexes [body mass index (BMI), serum albumin (ALB), serum prealbumin (PA), hemoglobin (Hb)] in the two groups were evaluated before and after treatment, and the clinical effects were compared. RESULTS:After treatment, the paste and liquid OTT, SRT, PTT, LCD in the two groups were shorter than those before treatment (<0.05), and the observation group was shorter than the control group (<0.05). After treatment, the nutritional indexes (BMI, ALB, PA, Hb) in the two groups were higher than those before treatment (<0.05), and the observation group was higher than the control group (<0.05). The total effective rate of the observation group was 92.9% (26/28), which was better than 67.9% (19/28) of the control group (<0.05). CONCLUSION:Acupuncture-assisted rehabilitation training can improve the swallowing function and nutritional status in patients with Parkinson's disease swallowing disorders. 10.13703/j.0255-2930.20200724-0002
    Predictive clinical factors for penetration and aspiration in Parkinson's disease. Nienstedt Julie Cläre,Bihler Moritz,Niessen Almut,Plaetke Rosemarie,Pötter-Nerger Monika,Gerloff Christian,Buhmann Carsten,Pflug Christina Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society BACKGROUND:Do the current swallow-specific subquestions of neurological diagnostic tools reflect the objective swallowing function in Parkinson's disease (PD) patients or are clinical factors superior to predict critical aspiration? METHODS:In a cross-sectional, observational study a total of 119 Parkinson outpatients were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES). Self-reported dysphagia by subquestions of the MDS-UPDRS and NMS questionnaire and history of subjective aspiration signs were collected. KEY RESULTS:Nearly, all PD patients showed deglutition abnormalities in FEES (113/119) while only 12%-27% of them reported swallowing problems in the swallow-specific subquestions of neurological standard diagnostic tools (MDS-UPDRS and NMS-Quest), and the answers were heterogeneous and poorly reproducible. With a sensitivity of up to a maximum of 50%, self-reported dysphagia is therefore no reliable tool for identifying dysphagia in PD. While most clinical parameters were linked to dysphagia to some extent, logistic regression analysis revealed high age (Odds Ratio (OR) 1.1 in years, 95% CI 1.03-1.18, P < 0.01), gender (OR 0.3 for females, 95% CI 0.08-0.97, P = 0.04), and affirmed subjective aspiration signs (OR 8.6, 95% CI 3.05-26.52, P < 0.001) as the most significant predictors for critical dysphagia. CONCLUSIONS AND INFERENCES:Self-perception of swallowing is no reliable tool for identifying dysphagia and questionnaires are insufficient for detecting previous aspiration. Consequent and specific asking for previous subjective aspiration signs is the single most important measure for identifying PD patients at risk for critical aspiration. 10.1111/nmo.13524
    Rasagiline monotherapy improves swallowing in patients with Parkinson's disease. Hirano Makito,Isono Chiharu,Samukawa Makoto,Fukuda Kanji,Kusunoki Susumu Parkinsonism & related disorders 10.1016/j.parkreldis.2020.07.010
    Is drooling secondary to a swallowing disorder in patients with Parkinson's disease? Nóbrega Ana Caline,Rodrigues Bernardo,Torres Ana Catarina,Scarpel Renata D'Arc,Neves Carolina Alves,Melo Ailton Parkinsonism & related disorders Drooling is a common manifestation in Parkinson's disease (PD). It causes psychosocial difficulties and can result in aspiration and chest infection. Previous studies point to an association between swallowing problems and sialorrhea. The aim of this study was to determine if drooling is associated with dysphagia in PD patients. Sixteen PD patients with diurnal drooling were assessed using a modified barium swallowing with videofluoroscopy, and a drooling score. Changes in the oral stage of swallowing were seen in 100% of the patients; and in the pharyngeal stage, in 94% of the patients. The results showed a correlation between the drooling scale score and the level of dysphagia (-0.426; p<0.05). Patients with the worst dysphagia had the worst drooling. 10.1016/j.parkreldis.2007.08.003
    Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study. Miles Anna,Jardine Marie,Johnston Felicity,de Lisle Martin,Friary Philippa,Allen Jacqui Journal of the neurological sciences PURPOSE:Lee Silverman Voice Treatment (LSVT LOUD®) is an effective therapy for phonation in Parkinson's Disease (PD) but little is known about any additional spread of effects to swallowing and cough function. This pilot study examined the effect of LSVT LOUD on pharyngeal swallowing parameters and reflexive cough strength. METHODS:Twenty participants (14 men, 6 women; mean 68years, SD3.5) with PD referred for LSVT LOUD with complaints of voice deterioration were recruited. Mean duration of PD was 6yrs., SD 3. Self-reported Eating Assessment Tool-10 scores ranging from 0 to 25 (normal<3). Prior to LSVT LOUD, 1-week post- and 6-months post-treatment, participants undertook a videofluoroscopic study of swallowing and aerodynamic measures of involuntary cough. RESULTS:All participants completed the LSVT LOUD programme; 3 participants were lost to follow-up at 6-months. All participants made significant gains in average sound pressure level (dB SPL). Aspiration was not observed. Pharyngeal residue (p<0.05) and pharyngeal area at rest reduced (p<0.01) while maximal opening of pharyngoesophageal segment (PES) (p<0.05) and PES opening duration (p<0.05) significantly increased. There was a significant improvement in involuntary cough peak expiratory flow rate and peak expiratory flow rise time. All changes were maintained at 6-months. CONCLUSION:LSVT LOUD demonstrates additional spread effects on pharyngoesophageal deglutitive function and involuntary cough effectiveness in people with mild PD referred with voice complaints. Consequently, LSVT LOUD has potential to provide additional benefits for swallowing safety and efficiency in this patient group. 10.1016/j.jns.2017.11.015
    Changes in Timing of Swallow Events in Parkinson's Disease. Schiffer Breanne L,Kendall Katherine The Annals of otology, rhinology, and laryngology OBJECTIVES::The prevalence of Parkinson's disease (PD) increases as the population ages. Dysphagia and subsequent aspiration pneumonia are common causes of morbidity and mortality in those with PD. To maximize the benefit of swallowing therapy, protocol design should be based on an understanding of the physiologic swallowing deficits present in the PD population. The aim of this study was to compare the timing of swallow events in a cohort of patients with PD with that in normal age-matched control subjects to characterize variations in the coordination of structural displacement and bolus movement that may contribute to dysphagia. METHODS::This retrospective study included 68 adults with diagnoses of PD. Liquid bolus swallows during modified barium swallow studies were analyzed and compared with those from an age- and sex-matched cohort of 48 adults without PD. RESULTS::Patients with PD were significantly slower in initiating and completing airway closure. Hyoid elevation was prolonged in this patient population. CONCLUSIONS::Patients with PD demonstrate slower initiation of airway closure and a delay in relaxation of hyoid elevation during swallow. Delays increased with larger boluses. These findings may be related to impaired pharyngeal sensation and increased muscular rigidity. The results of this study will be helpful in guiding swallow therapy for patients with PD. 10.1177/0003489418806918
    Drooling in Parkinson's Disease: Evidence of a Role for Divided Attention. Reynolds Hannah,Miller Nick,Walker Richard Dysphagia Drooling is a frequently reported symptom in Parkinson's Disease (PD) with significant psychosocial impact and negative health consequences including silent aspiration of saliva with the associated risk of respiratory infections. It is suggested that in PD drooling is associated with inefficient oropharyngeal swallowing which reduces the effective clearance of saliva rather than hyper-salivation. This is compounded by unintended mouth opening and flexed posture increasing anterior loss of saliva. It is reported to occur most frequently during cognitively distracting concurrent tasks suggesting an impact from divided attention in a dual-task situation. However, this supposition has not been systematically examined. This study assessed whether frequency of saliva swallows reduced, and drooling severity and frequency increased, when people with PD engaged in a cognitively distracting task. 18 patients with idiopathic PD reporting daytime drooling on the Unified Parkinson's Disease Rating Scale (UPDRS) were recruited. They completed the Radboud Oral Motor Inventory for PD saliva questionnaire and the Montreal Cognitive Assessment. UPDRS drooling score, disease stage, duration, gender, and age were recorded. Swallow frequency and drooling severity and frequency were measured at rest and during a distracting computer-based language task. There was no significant difference between drooling severity at rest and during distraction (Wilcoxon signed rank test z = - 1.724, p = 0.085). There was a significant difference between at rest and distraction conditions for both drooling frequency (Wilcoxon signed rank test z = - 2.041, p = 0.041) and swallow frequency (Wilcoxon signed rank test z = - 3.054, p = 0.002). Participants swallowed less frequently and drooled more often during the distraction task. The frequency of saliva swallows and drooling are affected by divided attention in a dual-task paradigm. Further studies are needed to explore the exact role of attention in saliva management and the clinical applications in assessment and treatment. 10.1007/s00455-018-9906-7
    Concordance and discriminatory power of cough measurement devices for individuals with Parkinson disease. Silverman Erin P,Carnaby-Mann Giselle,Pitts Teresa,Davenport Paul,Okun Michael S,Sapienza Christine Chest BACKGROUND:Dysphagia and aspiration pneumonia are two causes of morbidity in Parkinson disease (PD). In PD, impaired airway clearance can lead to penetration of foreign material, resulting in a high prevalence of aspiration pneumonia and death. This study examines three different devices for measurement of peak airflow during voluntary cough in healthy control subjects and those with PD. Two simple and low-cost devices for measuring peak cough airflow were compared with the "gold standard" pneumotachograph. METHODS:Thirty-five healthy control subjects and 35 individuals with PD produced voluntary cough at three perceived strengths (weak, moderate, and strong cough) for each of the three devices. RESULTS:A significant difference in mean peak cough airflow was demonstrated for disease (F[1,56] = 4.0, P &lt; .05) and sex (F[1,56] = 9.59, P &lt; .003) across devices. The digital and analog meters were comparable to the gold standard demonstrating no significant difference (statistical) by device (digital vs analog) in receiver operating characteristic curve analysis. Both devices were discriminative of the presence of PD. CONCLUSIONS:The analog and digital peak airflow meters are suitable alternatives to the gold standard pneumotachograph due to their low cost, portability, ease of use, and high sensitivity relative to normative peak cough airflows. Voluntary cough airflow measures may serve as a noninvasive means of screening for aspiration risk in target populations. Additionally, quantification of cough strength through use of predetermined limens for weak, moderate, and strong cough may assist clinicians in better describing and tracking cough strength as a contributing factor to aspiration risk. 10.1378/chest.13-0596
    Is the Munich dysphagia Test-Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Buhmann Carsten,Flügel Till,Bihler Moritz,Gerloff Christian,Niessen Almut,Hidding Ute,Nienstedt Julie Cläre,Pflug Christina Parkinsonism & related disorders BACKGROUND:Dysphagia is common in Parkinson's disease (PD) and leads to pneumonia, malnutrition, and reduced quality of life. For detecting dysphagia-exposed PD patients, the Munich dysphagia test-Parkinson's disease (MDT-PD) is a patient self-reported tool that has been developed specifically for PD patients. The MDT-PD is available in both German and English. This study aimed to ascertain whether the MDT-PD can detect aspiration in PD patients and, therefore, serve as a suitable screening tool. METHODS:In a controlled, cross-sectional, observational study, a total of 119 PD outpatients were examined clinically and were evaluated by the MDT-PD and the one swallowing question (NMS-3) from the nonmotor symptom questionnaire for Parkinson's disease (NMSQuest). The results of the MDT-PD and the NMS-3 were compared to the penetration-aspiration scale (PAS) rating defined by flexible endoscopic evaluation of swallowing (FEES). KEY RESULTS:Half of the patients with aspiration as determined using FEES were not detected by the MDT-PD and NMS-3 self-reported tools. The proportion of false positive patients was high with both tools. The sensitivity of the MDT-PD to detect patients who are at risk for aspiration is insufficient (0.37) and not superior to applying the dysphagia screening question from the NMSQuest (0.5). CONCLUSION:This study reveals that the MDT-PD is not suitable for detecting aspiration in PD patients and, therefore, cannot be considered as a screening tool for aspiration. However, at present, there is no alternative validated screening tool that can reliably detect aspiration in PD patients. A readjustment of the MDT-PD is urgently needed. 10.1016/j.parkreldis.2018.10.031
    Dysphagia in Parkinson's Disease Improves with Vocal Augmentation. Howell R J,Webster H,Kissela E,Gustin R,Kaval F,Klaben B,Khosla S Dysphagia While voice-related disorders in Parkinson's disease (PD) are commonly discussed in the literature, dysphagia in PD is less widely published. Vocal fold augmentation, including injection laryngoplasty (IL), is a well-established treatment for glottal insufficiency (Cates et al. in Otolaryngol Head Neck Surg 155(3):454-457, 2016). This study aimed to observe the effects of IL in PD patients with vocal bowing, with or without therapy, on glottic closure and patient-reported dysphagia outcomes. The study design was based on retrospectively collected database and cohort-case series. PD patients selected for retrospective review over a 2-year period were referred and evaluated in the Voice, Swallowing, and Airway multidisciplinary clinic by speech language pathologist and laryngologist, and were undergoing IL. Charts were reviewed for age, gender, Body Mass Index (BMI), onset of PD, and Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part 3 (MDS-UPDRS) scoring. We compared pre/postoperatively (> 1 < 3 months) using validated patient-reported outcome tools: Reflux Symptom Index (RSI), Glottal Function Index (GFI), Eating Assessment Tool-10 (EAT), and stroboscopic examinations. The study included 14 patients undergoing 22 IL or 1.6 IL/patient: mean age 70 years (63-80), 100% male, and BMI 25.9 ± 4.3 (mean ± SD). MDS-UPDRS scoring 33 ± 20 (moderate severity), with time between PD diagnosis and IL 8 ± 10 years. All patients had pre- and post-stroboscopic examinations; however, only 4:14 underwent formal swallowing evaluation. Overall, 14 IL patients improved on patient-reported measures (ΔRSI = 4; ΔGFI = 3; ΔEAT = 4). Based on the findings of the study, we conclude that PD is a progressive neurodegenerative condition with dysphagia. The presented pilot data suggest that IL may be considered as a beneficial adjunct for PD patients with glottal insufficiency. LEVEL OF EVIDENCE: 4. 10.1007/s00455-019-09982-z
    Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease. Simons Janine A,Fietzek Urban M,Waldmann Annika,Warnecke Tobias,Schuster Tibor,Ceballos-Baumann Andrés O Parkinsonism & related disorders BACKGROUND:Dysphagia in patients with Parkinson's disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD. METHODS:The two-phased project comprised the questionnaire, diagnostic scales construction (N = 105), and a validation study (N = 82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration. RESULTS:The Munich Dysphagia Test - Parkinson's disease (MDT-PD) consists of 26 items that show high internal consistency (α = 0.91). For the validation study, 82 patients, aged 70.9 ± 8.7 (mean ± SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r = 0.70, p < 0.001). The MDT-PD sum score classified not noticeable dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively. CONCLUSIONS:MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients. 10.1016/j.parkreldis.2014.06.008
    A new swallowing supplement for dysphagia in patients with Parkinson's disease. Oh Eungseok,Jee Sungju,Kim Beom Keun,Lee Jung Seon,Cho Kanghee,Ahn Soyoung Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology Dysphagia associated with Parkinson's disease (PD) affects the mortality and quality of life of patients with PD. Avoiding aspiration and maintaining swallowing ability are among the concerns regarding PD care. Therefore, we developed a swallowing supplement for easier swallowing and tolerability in patients with PD. Thirty patients with PD and 50 healthy controls were enrolled and their swallowing function measured using the videofluoroscopic swallowing study (VFSS) and several dysphagia scales. The Unified Parkinson's Disease Rating Scale motor scores, Hoehn and Yahr stage, and levodopa doses were evaluated in patients with PD. The VFSS and survey were used to assess the viscosity, color, taste, nutrition, safety, and tolerability of the swallowing supplement. The MMSE score, serum albumin, and hemoglobin levels, and oral conditions were worse in the PD group than in the control group. Compared with controls, patients with PD had significantly lower total and sub-item scores of the swallowing quality of life (swal-QoL). Using commercialized yogurt, the pharyngeal delay time (PDT) and the modified penetration aspiration scale were higher in the PD group than in the control group. The swallowing supplement significantly shortened the PDT and pharyngeal transit time (PTT). Moreover, compared with commercialized yogurt, it improved pharyngeal wall coating, PTT, and aspiration in the videofluoroscopic dysphagia subscales. The survey scores were above average to good in the "easy swallowing" and "pharyngeal residual sense" items and tolerable in the remaining 6 preference items. This swallowing supplement could prevent aspiration and dysphagia complications in patients with PD. 10.1007/s10072-020-04730-w
    Swallowing Assessment in Parkinson's Disease: Patient and Investigator Reported Outcome Measures are not Aligned. van Hooren M R A,Vos R,Florie M G M H,Pilz W,Kremer B,Baijens L W J Dysphagia This study determines the relationship between patient and investigator reported outcome measures (PROMs versus IROMs) on oropharyngeal dysphagia (OD) in Parkinson's disease (PD). The PROMs used are the MD Anderson Dysphagia Inventory (MDADI) and the Dysphagia Severity Scale (DSS). The IROMs used are fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy of swallowing (VFS). Ninety dysphagic PD patients were included. Multilayer perceptron (MLP) neural network analysis was used to investigate the relationship between PROMs and IROMs on OD in PD. MLP neural network analysis showed a moderate agreement between PROMs and IROMs, with an area under the curve between 0.6 and 0.7. Two-step cluster analysis revealed several clusters of patients with similar scores on FEES and/or VFS variables, but with significant different scores on MDADI and DSS variables. This study highlights that there are PD patients with similar FEES and/or VFS findings that cannot be lumped together under the same pathophysiological umbrella due to their differences in PROMs. Since the exact origin of these differences is not fully understood, it seems appropriate for the time being to take into account the different dimensions of OD during the swallowing assessment so that they can be included in a patient-tailored treatment plan. 10.1007/s00455-020-10201-3
    Response to: The need of reliable warning signs for dysphagia in Parkinson's disease: an often-overlooked issue. Patel Bhavana,Legacy Joseph,Okun Michael S,Wheeler-Hegland Karen,Herndon Nicole E Expert review of gastroenterology & hepatology 10.1080/17474124.2021.1842195
    [Problem solving care models for Parkinson's disease]. Csóka Mária,Molnár Sándorné,Kellős Éva,Domján Gyula Orvosi hetilap INTRODUCTION:Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. AIM:The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. METHOD:Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models. RESULTS:The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. CONCLUSIONS:Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system. 10.1556/650.2016.30479
    Esophageal dysfunction in different stages of Parkinson's disease. Suttrup I,Suttrup J,Suntrup-Krueger S,Siemer M-L,Bauer J,Hamacher C,Oelenberg S,Domagk D,Dziewas R,Warnecke T Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society BACKGROUND:Dysphagia is a clinically relevant symptom in patients with Parkinson's disease (PD) leading to pronounced reduction in quality of life and other severe complications. Parkinson's disease-related dysphagia may affect the oral and pharyngeal, as well as the esophageal phase of swallowing. METHODS:To examine the nature and extend of esophageal dysphagia in different stages of PD and their relation to oropharyngeal dysfunction, we examined 65 PD patients (mean age 66.3±9.7 years, mean disease duration 7.9±5.8 years, mean Hoehn & Yahr [H&Y] stage 2.89±0.91) and divided into three groups (early [H&Y I+II; n=21], intermediate [H&Y III; n=25], and advanced stadium [H&Y IV+V; n=19]), using esophageal high-resolution manometry (HRM) to detect esophageal motor disorders. Oropharyngeal impairment was assessed using fiberoptic endoscopic evaluation of swallowing. KEY RESULTS:Major esophageal motor disorders were detected in nearly one third of the PD patients. Minor impairment of the esophageal body was present in 95% of participants and throughout all disease stages with pathological findings especially in peristalsis and intrabolus pressure (IBP). The IBP was found to significantly increase in the advanced stadium. Although dysfunction of the upper and lower esophageal sphincters was observed in individual patients, alterations in these esophageal segments revealed no statistical significance compared with normative data. No clear association was found between the occurrence of oropharyngeal dysphagia and esophageal impairment. CONCLUSIONS & INFERENCES:Esophageal body impairment in PD is a frequent phenomenon during all disease stages, which possibly reflects α-synucleinopathy in the enteric nervous system. 10.1111/nmo.12915
    Non-invasive assessment determine the swallowing and respiration dysfunction in early Parkinson's disease. Wang Chin-Man,Shieh Wann-Yun,Weng Yi-Hsin,Hsu Yi-Hsuan,Wu Yih-Ru Parkinsonism & related disorders INTRODUCTION:Dysphagia is common among patients with Parkinson's disease. Swallowing and its coordination with respiration is extremely important to achieve safety swallowing. Different tools have been used to assess this coordination, however the results have been inconsistent. We aimed to investigate this coordination in patients with Parkinson's disease using a non-invasive method. METHODS:Signals of submental muscle activity, thyroid cartilage excursion, and nasal airflow during swallowing were recorded simultaneously. Five different water boluses were swallowed three times, and the data were recorded and analyzed. RESULTS:Thirty-seven controls and 42 patients with early-stage Parkinson's disease were included. The rates of non-expiratory/expiratory pre- and post-swallowing respiratory phase patterns were higher in the patients than in the controls (P < 0.001). The rates of piecemeal deglutition when swallowing 10-ml and 20-ml water boluses and overall were also significantly higher in the patients (all P < 0.001). There were differences in oropharyngeal swallowing parameters between the patients and controls, including a pharyngeal phase delay with longer total excursion duration and excursion time in the patients swallowing small water boluses (1 ml, 3 ml and 5 ml), but no difference in the length of swallowing respiratory pause. CONCLUSION:Oropharyngeal swallowing and its coordination with respiration are affected in patients with early-stage Parkinson's disease, and safety compensation mechanisms were used more than efficiency during swallowing. The results of this study may serve as a baseline for further research into new treatment regimens and to improve the management of swallowing in patients with Parkinson's disease. 10.1016/j.parkreldis.2017.05.024
    Drooling is no early sign of dysphagia in Parkinson's disease. Nienstedt J C,Buhmann C,Bihler M,Niessen A,Plaetke R,Gerloff C,Pflug C Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society BACKGROUND:Dysphagia is frequent and clinically highly relevant in Parkinson's disease (PD). For a rational dysphagia screening predictors are required. Previous investigations suggested that drooling correlates with dysphagia and may serve as its early sign. The aim of this study was to clarify the interrelationship of drooling and dysphagia. METHODS:In a controlled, cross-sectional, observational study, a total of 119 Parkinson outpatients and 32 controls were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES). Drooling, dysphagia including retained pharyngeal secretions, and cognitive function were assessed by established evaluation scales. KEY RESULTS:Fifty percent of all PD patients but only 9% of controls had drooling (P < .001). Drooling and dysphagia were related in PD (P = .027) but the data do not support to view drooling as a hallmark symptom for critical dysphagia. Thirty-nine percent of the patients with critical aspiration had no drooling. In contrast, 41% of the patients with severe drooling had no clinically relevant dysphagia in FEES. The oral, but not the pharyngeal secretion management was impaired in PD patients and there was no clear association between drooling and pharyngeal secretion accumulation. Cognitive impaired patients had significantly more drooling (P = .005). CONCLUSIONS & INFERENCES:Although frequent in PD, drooling and dysphagia are only weakly related and drooling cannot be viewed as an early sign of dysphagia. Our data further suggest that the underlying cause of drooling is located in the voluntary oral phase, which is negatively influenced by cognitive deficits. 10.1111/nmo.13259
    Quality of life and swallowing questionnaire for individuals with Parkinson's disease: development and validation. Diniz Juliana Garcia,da Silva Alfredo Carlos,Nóbrega Ana Caline International journal of language & communication disorders BACKGROUND:Individuals with Parkinson's disease (PD) may exhibit some degree of change in swallowing dynamics during the course of the disease. These changes can affect their physical, functional and emotional quality of life. AIMS:To develop a quality of life and swallowing questionnaire for individuals with PD. METHODS & PROCEDURES:The first version of the questionnaire comprised 29 items taken from the accounts of 50 patients treated over a 2-month period at Sarah Hospital in Salvador, Bahia, Brazil. A committee of 10 experts in the field analyzed the content and reduced the questionnaire to 28 questions. The questionnaire was then administered to 140 PD patients and 47 healthy individuals. A factor analysis of the items guided the drafting of the final questionnaire, which consisted of 19 items grouped into four factors, encompassing physical, functional and emotional aspects. A test-retest assessment was conducted with 44 individuals with PD. OUTCOMES & RESULTS:The internal consistency, estimated by the mean of Cronbach's alpha coefficient, varied between 0.71 (domain 3) and 0.94 (domain 1) in the test and between 0.69 (domain 3) and 0.95 (domain 1) in the retest. The correlation coefficient in the test/retest comparison was high and significant, demonstrating that the measurement was stable. A significant difference was observed between the PD group and the comparison group. CONCLUSIONS & IMPLICATIONS:The questionnaire developed is a valid, statistically appropriate and clinically effective self-administered instrument for individuals with PD. 10.1111/1460-6984.12395
    Lingual Pressure Dysfunction Contributes to Reduced Swallowing-Related Quality of Life in Parkinson's Disease. Pitts Laura L,Kanadet Rene M,Hamilton Valerie K,Crimmins Sarah K,Cherney Leora R Journal of speech, language, and hearing research : JSLHR Purpose Dysphagia in Parkinson's disease (PD) is a major cause of depression and reduced quality of life (QOL). PD-related dysphagia often involves lingual dysfunction and weak pressure generation. The relation of disordered lingual pressure generation to swallowing-related QOL in persons with PD remains unknown. Method Twenty-four persons with idiopathic PD completed the Swallowing Quality of Life (SWAL-QOL) questionnaire and an evaluation of anterior and posterior tongue strength. Peak pressures were compared to age- and sex-matched controls. The magnitude of and latency to peak pressure were explored in relation to SWAL-QOL scores. Results Persons with PD exhibited significant anterior (p = .019) but not posterior (p = .081) lingual weakness compared to controls. Persons with PD and reduced anterior tongue strength (< 42 kPa) reported lower SWAL-QOL total (p = .043), extended eating durations (p = .025), and a reduced desire to eat (p = .020). Prolonged latency to peak anterior pressure in PD inversely correlated with SWAL-QOL total (r = -.750, p < .001) and served as a significant, independent predictor of 67% of the variance in SWAL-QOL total when controlling for age, sex, and disease stage. Conclusion Overall, SWAL-QOL scores declined in the presence of lingual pressure dysfunction. Lingual weakness and prolonged pressure building patterns secondary to PD, especially of the anterior tongue, may represent clinically relevant disruptions to mealtime behaviors that undermine swallowing-related QOL. These preliminary findings support further investigation of lingual pressure patterns in PD to help identify debilitating dysphagia and develop treatment strategies. 10.1044/2019_JSLHR-S-18-0366
    Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status. Ardenghi Luciana Grolli,Signorini Alana Verza,Maahs Gerson Schulz,Selaimen Fabio,Deutsch Konrado Massing,Dornelles Silvia,Rieder Carlos Roberto de Mello International archives of otorhinolaryngology  Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously.  The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES).  A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS).  The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL:  ≤ 0.001; 5 mL:  ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found.  These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients. 10.1055/s-0039-3402440
    The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson's disease. Schlickewei Ole,Nienstedt Julie Cläre,Frank Ulrike,Fründt Odette,Pötter-Nerger Monika,Gerloff Christian,Buhmann Carsten,Müller Frank,Lezius Susanne,Koseki Jana-Christiane,Pflug Christina European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery PURPOSE:Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. METHODS:In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. RESULTS:PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of ≥ 6 presented a sensitivity of 58% and specificity of 82%. CONCLUSIONS:The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications. 10.1007/s00405-020-06377-x
    Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture. Baert Florence,Vlaemynck Geertrui,Beeckman Anne-Sophie,Van Weyenberg Stephanie,Matthys Christophe Journal of food science Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages. 10.1111/1750-3841.15595
    Self-Perception of Voice and Swallowing Handicap in Parkinson's Disease. Silbergleit Alice K,Schultz Lonni,Hamilton Kendra,LeWitt Peter A,Sidiropoulos Christos Journal of Parkinson's disease BACKGROUND:Hypokinetic dysarthria and dysphagia are known features of Parkinson's disease; however, self-perception of their handicapping effects on emotional, physical, and functional aspects of quality of life over disease duration is less understood. OBJECTIVE:1) Based upon patient self-perception, to determine the relationship of the handicapping effects of dysphagia and dysphonia with time since diagnosis in individuals with Parkinson's disease; 2)To determine if there is a relationship between voice and swallowing handicap throughout the course of Parkinson's disease. METHOD:277 subjects completed the Dysphagia Handicap Index and the Voice Handicap Index. Subjects were divided into three groups based on disease duration: 0-4 years, 5-9 years, and 10 + years. RESULTS:Subjects in the longer duration group identified significantly greater perceptions of voice and swallowing handicap compared to the shorter duration groups. There was a significant positive correlation between the DHI and VHI. CONCLUSION:Self-perception of swallowing and voice handicap in Parkinson's disease are associated with later stages of disease and progress in a linear fashion. Self-perception of voice and swallowing handicap parallel each other throughout disease progression in Parkinson's disease. Individuals may be able to compensate for changes in voice and swallowing early while sensory perceptual feedback is intact. Results support early targeted questioning of patient self-perception of voice and swallowing handicap as identification of one problem indicates awareness of the other, thus creating an opportunity for early treatment and maintenance of swallowing and communication quality of life for as long as possible. 10.3233/JPD-212621
    Falls risk is predictive of dysphagia in Parkinson's disease. Kobylecki Christopher,Shiderova Irena,Boca Mihaela,Michou Emilia Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology OBJECTIVE:Evaluate the relationship between falls, freezing of gait, and swallowing disturbance in Parkinson's disease (PD). BACKGROUND:Dysphagia is a common symptom in PD, and is often thought of as an axial feature along with falls and gait disturbance. It is of interest to examine the relationship between these symptoms in PD, given the possibility of shared pathophysiology due to non-dopaminergic and extranigral dysfunction. METHODS:We recruited 29 consecutive non-demented patients with idiopathic PD and at least one clinically determined impairment in swallowing, falls, or freezing of gait. Swallow dysfunction was assessed using the Swallowing Disturbance Questionnaire (SDQ). The Falls Efficacy Scale and Freezing-of-gait questionnaire were recorded. Correlation analysis and multiple regression were used to determine the relationship between swallow and gait disturbance. RESULTS:Total SDQ score correlated strongly with the falls efficacy scale (Spearman's rho = 0.594; P = 0.001), but not with the freezing-of-gait score. Linear regression controlling for other factors associated with dysphagia identified falls efficacy score as a significant predictor of swallow dysfunction. CONCLUSIONS:The severity of dysphagia in PD is closely related to severity of falls, but not gait freezing. This may be helpful to more precisely determine the anatomical substrate of levodopa-resistant axial symptoms in PD and provide clues to further management. 10.1007/s10072-021-05700-6
    Swallowing disorders in Parkinson's disease. Mamolar Andrés Sandra,Santamarina Rabanal María Liliana,Granda Membiela Carla María,Fernández Gutiérrez María José,Sirgo Rodríguez Paloma,Álvarez Marcos César Acta otorrinolaringologica espanola INTRODUCTION:Parkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias. The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease. SUBJECTS AND METHODS:The initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fiberoptic endoscopic evaluation of swallowing. RESULTS:Disorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO (5.3%), relating to the diagnosis of respiratory pathology in the previous year. CONCLUSION:The SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias. 10.1016/j.otorri.2016.02.001
    Swallowing Dysfunctions in Parkinson's Disease. Simons Janine A International review of neurobiology Dysphagia is a very frequent and highly relevant symptom in Parkinson's disease (PD) for quality of life, morbidity, and remaining lifetime, which is unfortunately widely underdiagnosed and underestimated regarding patients' centered care. Especially in early stages, the causal association between disease and swallowing disabilities remains unnoticed, which may be accounted for by the inability of caregivers and physicians to detect subtle swallowing problems and by the low self-awareness among PD patients. In order to prevent patients from serious negative consequences for health issues (e.g., aspiration pneumonia or malnutrition) as well as for negative impact on their quality of life, it is on the highest importance of managing dysphagia timely and working closely together in a multidisciplinary team, who all are involved in the patients' care system. This chapter includes background information on epidemiology, pathophysiology, and symptomatology of swallowing disorders in PD. This is followed by a summary of the clinical course and health treats, adequate diagnostic procedures for early identification of dysphagia as well as effective treatment strategies. The conclusion provides recommendations for clinical practice routine. 10.1016/bs.irn.2017.05.026
    Effect of an impaired oral stage on swallowing in patients with Parkinson's disease. Wakasugi Y,Yamamoto T,Oda C,Murata M,Tohara H,Minakuchi S Journal of oral rehabilitation We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because patients with PD frequently exhibit an impaired oral stage of swallowing and the tongue movement affects oral and pharyngeal stage. In total, 201 patients with PD (106 men, 95 women; mean age 70·6 ± 8·0 years; median Hoehn-Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography, and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70·3 ± 7·8 years) with an OTT + 2 standard deviation (0·89 + 2 × 0·46) of 1·81 s, the patients with PD were divided into 167 patients with an OTT < 1·81 s and 34 patients with an OTT ≥ 1·81 s. Swallowing function was compared between the groups and assessed using logistic regression analysis. The following factors were significantly associated with oral stage impairment in both groups: tongue-to-palate contact, tongue root-to-posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration and onset of swallowing reflex. Logistic regression analysis showed that tongue root-to-posterior pharyngeal wall contact, onset of swallowing reflex and aspiration were independent factors. PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD. 10.1111/joor.12536
    The Modified Barium Swallow Impairment Profile as a Predictor of Clinical Outcomes of Admission for Pneumonia or Choking in Dysphagic Patients with Parkinson's Disease. Kooi Amanda Hui-Juan,Boo Jasmine Pei-Ling,Ng Samuel Yong-Ern,Acharyya Sanchalika,Goh Kwang-Hwee,Tay Kay-Yaw,Au Wing-Lok,Tan Louis Chew-Seng Dysphagia Dysphagia increases risk of pneumonia in patients with Parkinson's disease (PD). However, no studies have investigated the association between objective measures of swallowing dysfunction and clinical outcomes. Therefore, we aimed to study the link between scores obtained on the modified barium swallow impairment scale profile (MBSImP) and hospital admissions for pneumonia and choking, in groups of patients with PD on different feeding modes. 157 patients who completed MBS studies were divided into three groups based on their feeding modes (oral, enteral, and rejected enteral feeding with oral feeding at own risk). Videos were analysed using the MBSImP. We evaluated the association of the oral, pharyngeal, and combined scores, with risk of admission for pneumonia and choking. Kaplan-Meier plots and log-rank tests were used to compare survival distributions among feeding groups. Cox regression models were generated to estimate hazard ratios (HRs) and 95% confidence intervals. Patients in the group that rejected enteral feeding scored the highest on the MBSImP, followed by enteral then oral feeding. Within the group that rejected enteral feeding, higher pharyngeal (HR = 3.73, p = 0.036) and combined scores (HR = 1.63, p = 0.034) significantly increased the risk of pneumonia and choking. In the enteral feeding group, higher oral subscores (HR = 2.16, p = 0.011) increased risk for the event, while higher pharyngeal (HR = 0.40, p = 0.004) subscores reduced risk for pneumonia and choking. This is the first study to analyse the association of MBSImP scores with clinical outcomes in PD patients. Patients who rejected enteral feeding had the highest risk for pneumonia and choking that could be predicted by their MBSImP scores. In the enteral feeding group, this risk was partially reversed. Compliance with feeding modes reduces the risk of pneumonia and choking. 10.1007/s00455-019-09986-9
    Predicting Airway Invasion Using Screening Tools and Laryngeal Kinematics in People with Parkinson's Disease: A Pilot Study. Dumican Matthew,Watts Christopher Journal of Parkinson's disease BACKGROUND:Dysphagia in Parkinson's disease (PD) is a common manifestation, particularly in advanced disease stages. However, the pathophysiology and time course of dysphagia progression remains unclear in non-advanced disease stages (e.g., Hoehn & Yahr stages I-III). Conflicting reports from investigations of the perception of dysphagia in people with PD further complicates our understanding of dysphagia in this population. OBJECTIVE:The objectives of this research were to evaluate the ability of screening tools to detect swallowing impairments and how laryngeal kinematics predict the occurrence of abnormal swallowing events. METHODS:14 individuals with non-advanced PD, no previous history of dysphagia diagnosis, and self-reported difficulty swallowing participated. The Swallow Disturbance Questionnaire (SDQ) and 3-oz water swallow test (WSST) were administered, along with a videoflouroscopic swallow study (VFSS). Laryngeal kinematics were represented by laryngeal vestibule closure reaction time (LVrt) and laryngeal vestibule closure duration (LVCd). The Penetration-Aspiration Scale (PAS) was used to quantify airway invasion. RESULTS:A logistic regression indicated a significant model of predicting airway invasion from our predictors (p = 0.003). LVrt and SDQ (p < 0.05) provided the largest impact (OR = 1.11; 1.17). The WSST showed no significance in predicting swallow impairment (p > 0.05). CONCLUSION:Decreased airway safety related to laryngeal kinematic function in PD may be manifesting at non-advanced disease stages to varied degrees. Our results support expectations of dysphagia manifestation in PD although screening practices may not adequately identify impairment. Future research should target specific laryngeal characteristics within this population to better understand the physiological cause of swallowing impairment and developof targeted interventions. 10.3233/JPD-202044
    Telerehabilitation for Communication and Swallowing Disorders in Parkinson's Disease. Theodoros Deborah Journal of Parkinson's disease Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). The negative impact of these disorders on the quality of life of the person with PD and their families cannot be underestimated. Despite a demand for speech-language pathology services to support people with PD, many barriers to services exist. Telerehabilitation provides an alternate and complementary approach to in-person therapy that is patient-centered, enables timely assessment and intervention, and facilitates continuity of care throughout the course of the disease. This review explores the telerehabilitation applications designed for the management of the communication and swallowing disorders in PD, addresses the benefits and challenges of telerehabilitation, identifies future research directions, and highlights the potential of new technologies to enhance the management of communication and swallowing disorders and quality of life for people with PD. 10.3233/JPD-202414
    Consensus on the treatment of dysphagia in Parkinson's disease. Schindler Antonio,Pizzorni Nicole,Cereda Emanuele,Cosentino Giuseppe,Avenali Micol,Montomoli Cristina,Abbruzzese Giovanni,Antonini Angelo,Barbiera Filippo,Benazzo Marco,Benarroch Eduardo,Bertino Giulia,Clavè Pere,Cortelli Pietro,Eleopra Roberto,Ferrari Chiara,Hamdy Shaheen,Huckabee Maggie-Lee,Lopiano Leonardo,Marchese-Ragona Rosario,Masiero Stefano,Michou Emilia,Occhini Antonio,Pacchetti Claudio,Pfeiffer Ronald F,Restivo Domenico A,Rondanelli Mariangela,Ruoppolo Giovanni,Sandrini Giorgio,Schapira Anthony,Stocchi Fabrizio,Tolosa Eduardo,Valentino Francesca,Zamboni Mauro,Zangaglia Roberta,Zappia Mario,Tassorelli Cristina,Alfonsi Enrico Journal of the neurological sciences BACKGROUND:Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. OBJECTIVE:To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. METHODS:A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS:The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. CONCLUSIONS:The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists. 10.1016/j.jns.2021.120008
    Early identification and treatment of communication and swallowing deficits in Parkinson disease. Ciucci Michelle R,Grant Laura M,Rajamanickam Eunice S Paul,Hilby Breanna L,Blue Katherine V,Jones Corinne A,Kelm-Nelson Cynthia A Seminars in speech and language Parkinson disease (PD) is a complex, progressive, neurodegenerative disorder that leads to a wide range of deficits including fine and gross sensorimotor impairment, autonomic dysfunction, mood disorders, and cognitive decline. Traditionally, the focus for diagnosis and treatment has been on sensorimotor impairment related to dopamine depletion. It is now widely recognized, however, that PD-related pathology affects multiple central nervous system neurotransmitters and pathways. Communication and swallowing functions can be impaired even in the early stages, significantly affecting health and quality of life. The purpose of this article is to review the literature on early intervention for communication and swallowing impairment in PD. Overarching themes were that (1) studies and interpretation of data from studies in early PD are limited; (2) best therapy practices have not been established, in part due to the heterogeneous nature of PD; and (3) as communication and swallowing problems are pervasive in PD, further treatment research is essential. 10.1055/s-0033-1358367
    Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Ding X,Gao J,Xie C,Xiong B,Wu S,Cen Z,Lou Y,Lou D,Xie F,Luo W European journal of clinical nutrition BACKGROUND/OBJECTIVES:Dysphagia is relatively common in patients with Parkinson disease (PD) and can have a negative impact on their quality of life; therefore, it is imperative that its prevalence in PD patients is studied. The aim of this study was to explore the prevalence and clinical correlation of dysphagia in Chinese PD patients. SUBJECTS/METHODS:We recruited 116 Chinese PD patients. A videofluoroscopic study of swallowing (VFSS) was used to identify dysphagia. Assessments, including water drinking test, relative motor symptoms, non-motor symptoms (NMS) and quality of life, were performed to analyze the risks of dysphagia. RESULTS:The prevalence of dysphagia was 87.1%. The comparison of demographic and clinical features between patients with and without dysphagia included sex, education level, disease course, Mini-mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Question 6, 7 of the Unified Parkinson Disease Rating Scale (UPDRS Part II), Hoehn-Yahr stage (H&Y), water drinking test, 39-item Parkinson Disease Questionnaire (PDQ-39) and Non-Motor Symptoms Quest (NMSQ). We found significant correlations between dysphagia and age. Using age, disease course, and H&Y stage as the independent variable in our regression analysis for assessing the risk factors of dysphagia in PD patients, age and H&Y stage displayed a strong correlation as the risk factors. The risk of dysphagia in elderly PD patients is 1.078 times greater than that of younger PD patients. Also, the risk of dysphagia in PD patients of a greater H&Y staging is 3.260 times greater than that of lower staging PD patients. CONCLUSIONS:Our results suggest that dysphagia is common in Chinese PD patients. Older patients or those in higher H&Y stages are more likely to experience dysphagia. There is no correlation between dysphagia and PD duration. 10.1038/ejcn.2017.100
    Effectiveness of Interventions for Dysphagia in Parkinson Disease: A Systematic Review. Gandhi Pooja,Steele Catriona M American journal of speech-language pathology PURPOSE:Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD. METHOD:Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures. RESULTS:Interventions were classified as follows: pharmacological ( = 11), neurostimulation ( = 8), and behavioral ( = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS ( = 17), FEES ( = 6), and EMG ( = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa. CONCLUSIONS:Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.17132162. 10.1044/2021_AJSLP-21-00145
    Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study. Pflug Christina,Bihler Moritz,Emich Katharina,Niessen Almut,Nienstedt Julie Cläre,Flügel Till,Koseki Jana-Christiane,Plaetke Rosemarie,Hidding Ute,Gerloff Christian,Buhmann Carsten Dysphagia To assess the prevalence of dysphagia and its typical findings in unselected "real-world" Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water, biscuit, and bread). Typical findings of dysphagia like penetration and aspiration, residues, and leakage were assessed. Dysphagia was common in Parkinson patients and occurred in all, even early, disease stages. Only 5% (6/119) of patients showed a completely unremarkable deglutition. Aspiration was seen in 25% (30/119) of patients and always related to water. Residues occurred in 93% (111/119), most commonly for bread. Leakage was much less frequent and was found in only 3-18%, depending on consistency. In a significant fraction of patients, objective dysphagia was not subjectively perceived. A total of 16% of asymptomatic patients suffered from critical aspiration. Significant swallowing deficiencies already occurred in early disease. Aspiration was found in 4 of 20 (20%) patients with disease duration of less than 2 years. Seven of 57 patients (12%) with Hoehn and Yahr stage 2 suffered from severe aspiration. Given the high frequency of critical aspiration in Parkinson disease, these patients should be evaluated early for dysphagia to avoid complications and recommend an adequate therapy. FEES is a simple, cost efficient, minimally invasive method that is ideally suited for this purpose. 10.1007/s00455-017-9831-1
    Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review. Theodoros Deborah,Aldridge Danielle,Hill Anne J,Russell Trevor International journal of language & communication disorders BACKGROUND:Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre-based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology-enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. AIMS:To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. METHODS & PROCEDURES:Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. MAIN CONTRIBUTION:A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD ). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive-communication and swallowing disorders. CONCLUSIONS & IMPLICATIONS:Research evidence supporting technology-enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology-enabled management pathway. Future research needs to address technology-enabled management of cognitive-communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD. 10.1111/1460-6984.12400
    Usefulness of a modified questionnaire as a screening tool for swallowing disorders in Parkinson disease: A pilot study. Radhakrishnan Sureshkumar,Menon Unnikrishnan K,Sundaram K R Neurology India AIMS:To determine the correlation between our questionnaire scores and two standard Parkinson's disease (PD) disability scores [Unified Parkinsons' Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y)], and to study the correlation between the various subgroups of our dysphagia screening questionnaire. SETTINGS AND DESIGN:This study was conducted at a movement disorder clinic in a tertiary care hospital in Kochi, Kerala. This was a cross-sectional observational study. MATERIALS AND METHODS:A questionnaire was developed comprising 11 items, keeping in mind the most relevant swallowing issues in PD patients. The questions were subdivided into four groups representing the different stages of swallowing. Reliability and validity studies were conducted for the questionnaire. Corresponding UPDRS and H and Y scores were documented on the same day. STATISTICAL ANALYSIS USED:Mean and standard deviation (SD) values of the scores in each group and the correlation between scores (Pearson correlation coefficient) were done. RESULTS:Responses were obtained from 106 PD patients (67 males, 39 females), with a mean age of 66.9 years (SD, 8.62). Our questionnaire score showed a high coefficient of variation (145%) compared to the UPDRS and H and Y scores. There was also moderate correlation between our questionnaire score and the two standard scores with a significant P value. Finally, the highest mean scores were for questions from group A and the least for questions from group D. CONCLUSIONS:The association between worsening motor symptoms and swallowing difficulties has been documented in this study. The oral stage of swallowing remains the most affected in PD, which can be recognized early using our questionnaire. 10.4103/0028-3886.253586
    Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders. Umemoto George,Furuya Hirokazu Internal medicine (Tokyo, Japan) Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition. 10.2169/internalmedicine.2373-18
    Predictors of Residue and Airway Invasion in Parkinson's Disease. Curtis James A,Molfenter Sonja,Troche Michelle S Dysphagia Dysphagia is a highly prevalent disorder in Parkinson's Disease (PD) characterized by changes in swallowing kinematics, residue, and airway invasion. These changes can lead to serious medical morbidities including malnutrition, aspiration pneumonia, and death. However, little is known about the most predictive causes of residue and airway invasion in this patient population. Therefore, the aims of this study were to (1) assess how disease severity affects residue, airway invasion, and swallowing kinematics in PD; and (2) determine which swallowing kinematic variables were most predictive of residue and airway invasion. A secondary analysis of forty videofluoroscopic swallow studies (VFSS) from individuals with early through mid-stage PD was performed. Airway invasion (Penetration-Aspiration Scale 'PAS'), residue (Bolus Clearance Ratio 'BCR'), and ten spatiotemporal swallowing kinematic variables were analyzed. Statistical analyses were used to determine if disease severity predicted residue, depth of airway invasion, and swallowing kinematics, and to examine which swallowing kinematic variables were most predictive of residue and the presence of airway invasion. Results revealed that residue and the presence of airway invasion were significantly predicted by swallowing kinematics. Specifically, airway invasion was primarily influenced by the extent and timing of airway closure, while residue was primarily influenced by pharyngeal constriction. However, disease severity did not significantly predict changes to swallowing kinematics, extent of residue, or depth of airway invasion during VFSS assessment. This study comprehensively examined the pathophysiology underlying dysphagia in people with early to mid-stage PD. The results of the present study indicate that disease severity alone does not predict swallowing changes in PD, and therefore may not be the best factor to identify risk for dysphagia in PD. However, the swallowing kinematics most predictive of residue and the presence of airway invasion were identified. These findings may help to guide the selection of more effective therapy approaches for improving swallowing safety and efficiency in people with early to mid-stage PD. 10.1007/s00455-019-10014-z
    Alteration of Brain Functional Connectivity in Parkinson's Disease Patients with Dysphagia. Gao Jixiang,Guan Xiaojun,Cen Zhidong,Chen You,Ding Xueping,Lou Yuting,Wu Sheng,Wang Bo,Ouyang Zhiyuan,Xuan Min,Gu Quanquan,Xu Xiaojun,Huang Peiyu,Zhang Minming,Luo Wei Dysphagia Dysphagia is a common non-primary symptom of patients with Parkinson's disease. The aim of this study is to investigate the underlying alterations of brain functional connectivity in Parkinson's disease patients with dysphagia by resting-state functional magnetic resonance imaging. We recruited 13 Parkinson's disease patients with dysphagia and ten patients without dysphagia, diagnosed by videofluoroscopic study of swallowing. Another 13 age and sex-matched healthy subjects were recruited. Eigenvector centrality mapping was computed to identify functional connectivity alterations among these groups. Parkinson's disease patients with dysphagia had significantly increased functional connectivity in the cerebellum, left premotor cortex, the supplementary motor area, the primary motor cortex, right temporal pole of superior temporal gyrus, inferior frontal gyrus, anterior cingulate cortex and insula, compared with patients without dysphagia. This study suggests that functional connectivity changes in swallowing-related cortexes might contribute to the occurrence of dysphagia in Parkinson's disease patients. 10.1007/s00455-019-10015-y
    Does the M.D. Anderson Dysphagia Inventory correlate with dysphagia-limit and the Unified Parkinson Disease Rating Scale in early-stage Parkinson's disease? Wang Chin-Man,Tsai Ting-Ta,Wang Szu-Heng,Wu Yih-Ru Journal of the Formosan Medical Association = Taiwan yi zhi BACKGROUND:Dysphagia is a common and critical condition that occurs in Parkinson's disease (PD), and it may appear in early stages. However, few reliable swallowing-related questionnaires are currently available. Therefore, finding efficient questionnaires for surveying dysphagia during the early stages of PD is necessary. PURPOSE:This prospective study aimed to identify the correlations between the M.D. Anderson Dysphagia Inventory (MDADI) with dysphagia limit (DL) and the Unified Parkinson Disease Rating Scale (UPDRS) in early-stage PD. METHODS:Forty-two patients with early-stage PD were recruited from a medical center. Data were collected for analysis of swallowing-related quality of life using the MDADI, symptom severity using the UPDRS, and DL using a noninvasive swallowing-respiration assessment system. RESULTS:Our results showed that the MDADI, including its composite and subscales, was not correlated with DL. The composite scores of the MDADI were moderately correlated with the total score of the UPDRS (r = -0.504; p < 0.05) as well as with the second and third sections of the UPDRS scores (r = -0.453 to -0.478; p < 0.05). These results indicated that the impaired MDADI score can predict symptom severity (UPDRS), especially in activities of daily life and motor function. CONCLUSION:The impaired MDADI for early-stage PD was determined, and decreased DL as a presentation of dysphagia could not be reflected by the MDADI. The MDADI may be used as a quick and convenient questionnaire for predicting the severity of early-stage PD, but not for the screening of early or subclinical dysphagia. 10.1016/j.jfma.2019.05.005
    A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration. Expert review of gastroenterology & hepatology INTRODUCTION:Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia. AREAS COVERED:This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD. EXPERT OPINION:A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options. 10.1080/17474124.2020.1769475
    Predictors of Pharyngeal Dysphagia in Patients with Parkinson's Disease. Claus Inga,Muhle Paul,Suttrup Judith,Labeit Bendix,Suntrup-Krueger Sonja,Dziewas Rainer,Warnecke Tobias Journal of Parkinson's disease BACKGROUND:Diagnosis of pharyngeal dysphagia in patients with Parkinson's disease is often difficult as reliable screening methods are lacking so far and clinical examination fails to adequately assess the pharyngeal phase of swallowing. OBJECTIVE:To identify clinical predictors indicating the presence of pharyngeal dysphagia in patients at risk. METHODS:We examined pharyngeal dysphagia in a large cohort of patients with Parkinson's disease (n = 200) divided in three clinical subtypes (tremor-dominant (TD), mainly bradykinetic (BK) and early postural instability and gait difficulty PIGD)) by using flexible endoscopic evaluation of swallowing. ANOVA-multivariance analysis and following t-tests as well as binary logistic regression analysis were performed to detect group differences and to identify clinical predictors for dysphagia. RESULTS:Statistically significant differences were found in the dysphagic group: age, male gender, disease duration, stage of the disease, Levodopa equivalent dose and higher scores on the Unified Parkinson's disease rating scale III and II, item 7. The PIGD subtype was affected more frequently than the TD and BK subtype. In a logistic regression model higher age (>63.5 years p < 0.05) and Levodopa equivalent dose (>475 mg, p < 0.01) were identified to be independent predictors for the presence of pharyngeal dysphagia. CONCLUSION:Particularly patients with an age > 63.5 years and a daily Levodopa equivalent dose >475 mg show an increased risk for pharyngeal dysphagia. These findings may partly be influenced by presbyphagia but are likely to represent disease progression. The PIGD subtype seems to be a risk factor due to more pronounced dyscoordination of oropharyngeal muscle movements. 10.3233/JPD-202081
    Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease. Claus Inga,Muhle Paul,Czechowski Judith,Ahring Sigrid,Labeit Bendix,Suntrup-Krueger Sonja,Wiendl Heinz,Dziewas Rainer,Warnecke Tobias Movement disorders : official journal of the Movement Disorder Society BACKGROUND:Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare. OBJECTIVE:The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing. METHODS:In this double-blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4-week expiratory muscle strength training. Twenty-five participants used a calibrated ("active") device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing-related cortical activation was measured in 22 participants (active:sham; 11:11) using whole-head magnetencephalography. RESULTS:The active group showed significant improvement in the flexible endoscopic evaluation of swallowing-based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination. CONCLUSIONS:Four-week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. 10.1002/mds.28552
    Drooling, Swallowing Difficulties and Health Related Quality of Life in Parkinson's Disease Patients. Arboleda-Montealegre Gladis Yohana,Cano-de-la-Cuerda Roberto,Fernández-de-Las-Peñas César,Sanchez-Camarero Carlos,Ortega-Santiago Ricardo International journal of environmental research and public health BACKGROUND:Parkinson's disease (PD) is the most common neurodegenerative disorder associated with motor and nonmotor symptoms. Drooling, one of the nonmotor symptoms, can be present in 70-80% of patients with PD. The aim of this paper is to study the characteristics of PD patients with drooling compared to those without in terms of age, gender, disease duration, stage of the disease, swallowing difficulties, and health-related quality of life; methods: a cross-sectional study was conducted. The sample was divided into two groups: PD with drooling ( = 32) and PD without drooling ( = 30). Age, gender, disease duration and Hoehn & Yahr (H & Y) stage, Sialorrhea Clinical Scale for Parkinson's Disease (SCS-PD), the 10-item Eating Assessment Tool (EAT-10), and the 39-item Parkinson's Disease Questionnaire (PDQ-39) were compared between groups; Results: 62 individuals with PD, 40 men and 22 women (mean age 73 ± 8 years), were included. Overall, 32 patients reported drooling, and 30 did not exhibit it. The ANCOVA found significant differences between groups for the EAT-10 score (0.83, 95% CI = 5.62-9.03; = 0.016) and SCS-PD score (1.48, 95% CI = 0.86-6.81; < 0.001). Analysis of the PDQ-39 scores revealed no significant differences between groups for the PDQ-39 total score ( > 0.057) and in all subscales. The inclusion of gender, age, disease duration, and H & Y as covariates did not influence the results (all > 0.05). CONCLUSIONS:drooling is related to swallowing difficulties assessed with EAT-10 but not with health-related quality of life assessed with PDQ-39 in PD patients with drooling compared to PD patients without it. Age, gender, duration of the disease, and the H & Y state of PD patients with and without drooling seem to be similar. 10.3390/ijerph18158138
    A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. Cosentino Giuseppe,Avenali Micol,Schindler Antonio,Pizzorni Nicole,Montomoli Cristina,Abbruzzese Giovanni,Antonini Angelo,Barbiera Filippo,Benazzo Marco,Benarroch Eduardo Elias,Bertino Giulia,Cereda Emanuele,Clavè Pere,Cortelli Pietro,Eleopra Roberto,Ferrari Chiara,Hamdy Shaheen,Huckabee Maggie-Lee,Lopiano Leonardo,Marchese Ragona Rosario,Masiero Stefano,Michou Emilia,Occhini Antonio,Pacchetti Claudio,Pfeiffer Ronald F,Restivo Domenico A,Rondanelli Mariangela,Ruoppolo Giovanni,Sandrini Giorgio,Schapira Anthony H V,Stocchi Fabrizio,Tolosa Eduardo,Valentino Francesca,Zamboni Mauro,Zangaglia Roberta,Zappia Mario,Tassorelli Cristina,Alfonsi Enrico Journal of neurology BACKGROUND:Parkinson's disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. OBJECTIVE:To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. METHODS:A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS:Eighty-five papers were used to inform the Panel's statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. CONCLUSIONS:The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD. 10.1007/s00415-021-10739-8