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Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease
Abstract
Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 +/- 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients.
... As described in greater detail below, the screening protocol included three different modes of assessment, each of which has been used previously as a screening tool in the PD population, namely a self-report dysphagia survey, a water swallow test, and a measure of voluntary cough strength. The survey measure used was the Swallow Disturbance Questionnaire (SDQ), a validated self-report tool specifically developed for the identification early dysphagia in individuals with PD [18]. In its original validation, the questionnaire was shown to be able to accurately detect symptoms of dysphagia in the PD population with a sensitivity and specificity of 81%. ...
... The participants in that study were individuals with idiopathic PD who had no comorbid conditions that could affect swallowing (including previous radiation or surgery to the head and neck, trauma, or other neurological conditions). A self-reported dysphagia measure, the SDQ [18], was completed by each participant prior to undergoing VFSS using a standardized protocol, as described in greater detail below. All participants were in the clinical "on" state with patients being asked to take their PD medications before the examination. ...
... The SDQ is a validated self-report tool for the identification of early dysphagia in individuals with PD [18]. The survey consists of 15 questions and asks the respondent to rate the frequency of each of item. ...
The Swallow Disturbance Questionnaire (SDQ) is a screening tool developed to identify patients with Parkinson’s Disease (PD) in need of objective swallowing evaluation. In a previous investigation, the SDQ did not predict abnormal airway protection on a videofluoroscopic swallowing study (VFSS). This investigation was undertaken to determine whether SDQ scores were more accurate when a global measure was used. The Dynamic Imaging Grade for Swallowing Toxicity (DIGEST) is a validated measure that provides a safety, efficiency, and total severity grade based on VFSS. A secondary analysis was performed using data from 20 patients with PD who had participated in a standardized VFSS protocol. The study sample was predominantly male (80%) with an average age of 71 years, and an average PD duration of 9 years. Using an established cut-off score, participants were subdivided into those with “normal” (n = 10) and “abnormal” SDQ scores (n = 10). Recordings were scored using the DIGEST protocol by two blinded raters who also rated overall dysphagia severity from the VFSS. There was good agreement between the two raters on the DIGEST and strong correlations between DIGEST scores and clinician perceptions of dysphagia severity. Higher SDQ scores were associated with poorer Efficiency on the DIGEST but not Safety or Total scores. Consistent with other PD studies, subjective perceptions of dysphagia were poorly predictive of objective findings on VFSS. There is little information about the validity of the DIGEST for rating neurogenic dysphagia. Our study provides preliminary support for the use of the DIGEST in the PD population.
... While some pwPD experience dysphagia symptoms and psychosocial sequelae, it has also been established that pwPD are not always aware of airway protective deficits, evidenced by discrepancies between patient report and objective findings from instrumental swallowing assessments (Gong et al., 2022;Kalf et al., 2012;Mamolar Andrés et al., 2017;Manor et al., 2007;Nienstedt et al., 2019). A meta-analysis revealed that only half of pwPD who demonstrated dysphagia on instrumental assessment reported dysphagia on questionnaires or during patient interview (Gong et al., 2022). ...
... A meta-analysis revealed that only half of pwPD who demonstrated dysphagia on instrumental assessment reported dysphagia on questionnaires or during patient interview (Gong et al., 2022). The discrepancy between objective findings and patient report has been attributed to reduced awareness of deficits, behavioral adaptations that may act as compensatory mechanisms, inadequate knowledge of symptoms, lack of overt signs of impairment, and/or reduced laryngeal sensation (Hammer et al., 2013;Manor et al., 2007). In fact, it has been documented that pwPD may experience reduced awareness of illness severity (Leritz et al., 2004;Seltzer et al., 2001) and underreport other disease symptoms such as visual, vestibular, and oculomotor disturbances (Berliner et al., 2020). ...
Purpose
Disordered airway protection, including both disordered swallowing (dysphagia) and disordered cough (dystussia), is highly prevalent among persons with Parkinson's disease (pwPD). A comprehensive understanding of the perspectives of pwPD as it relates to airway protection is currently lacking and is necessary to provide relevant, person-centered care. Therefore, this study used a parallel-convergent mixed methods design to quantitatively and qualitatively investigate pwPD's perspectives on airway protection.
Method
Thirteen pwPD were consecutively recruited from a cough training trial. Quantitative data (obtained from the Swallowing Quality of Life questionnaire [SWAL-QOL] and the modified Canadian Occupational Performance Measure [mCOPM]) and qualitative data (obtained from semistructured interviews) were integrated to define participant knowledge, perceived importance, perceived performance, and psychosocial implications of airway protective deficits.
Results
All participants reported basic knowledge about airway protection, which centered around four themes—physiology, the interconnectedness between bulbar functions, danger, and impaired airway protection as a consequence of PD. All participants believed that airway protection was important (median mCOPM score = 10), with three primary themes related to importance—survival, anticipated future decline, and maintaining oral intake. We identified a split between participants who perceived themselves to have “a swallowing problem” and those who did not, with three themes relating to perceived impairment—use of eating strategies, unpredictable and inconsistent symptom experience, and vigilance required to mitigate symptoms. Psychosocial ramifications centered on three key themes that aligned with three SWAL-QOL domains—overall burden, fear of future decline, and social embarrassment.
Conclusion
The integration of quantitative and qualitative data in this study highlights the importance of considering unique patient perspectives to develop personalized and relevant management plans for each unique pwPD that integrate objective and clinical findings with patient priorities and needs.
Supplemental Material
https://doi.org/10.23641/asha.28489280
... Esophageal dysphagia and oropharyngeal dysphagia manifest differently, as well as dysphagia resulting from neurological conditions such as Parkinson's disease or dysphagia in head and neck cancer survivors. Disease-specific dysphagia PROMs have been developed, and their application to the appropriate population is of great importance if the PROM is to accurately capture and reflect the patient's functional health status or quality of life (Chen et al., 2001;Manor et al., 2007;Silbergleit et al., 2012;Taft et al., 2016). These challenges with PROMs in the field of dysphagia emphasize the importance of the rigor required in PROM development for the population of patients with swallowing difficulties and the transparency necessary for proper evaluation of PROM inclusion in clinical studies in this population. ...
... There are PROMs devoted to evaluation of different types of dysphagia. For example, the M.D. Anderson Dysphagia Inventory was developed for patients with head and neck cancer (Chen et al., 2001), and the Swallowing Disturbance Questionnaire was validated for use with patients with Parkinson's disease (Manor et al., 2007). There are PROMs devoted strictly to esophageal dysphagia (Taft et al., 2016) and general swallowing PROMs such as the Eating Assessment Tool-10 (Belafsky et al., 2008) or the Dysphagia Handicap Index (Silbergleit et al., 2012). ...
Purpose
Patient-reported outcome measures (PROMs) are an important tool both in clinical practice and research involving patients with swallowing disorders. There are several challenges to be overcome and methodological details to be adequately reported to ensure rigor and transparency in studies utilizing PROMs in dysphagia research. For this reason, the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool developed to ensure rigor and transparency in dysphagia research, has devoted a domain to PROMs. The aim of this current article, as part of a larger forum of articles, is to present the PROM section of FRONTIERS and describe its development.
Method
A literature review was carried out on PROMs in the field of dysphagia by three members of the FRONTIERS collaborative to identify items that were necessary for the rigorous application and transparent reporting of PROMs utilized in research of swallowing disorders in human subjects. Framework items were then subjected to an iterative process of feedback and consensus among the three members of the working group as well as all members of the FRONTIERS collaborative. Items were flagged for review and revised as needed until consensus was achieved on the final list. The final item list was compared to existing critical appraisal tools for PROMs.
Results
The final checklist for the PROMs domain included 20 “Yes/No” questions that can be broadly divided into three categories: (a) development and validation, (b) patient population, and (c) PROM administration method. Each item is presented with a rationale for its inclusion.
Conclusions
The use of the FRONTIERS Framework will serve researchers and those appraising quality of research involving PROMs. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.
... Another reason that can be considered for this difference is the greater accuracy of the objective evaluations tools such as Videofluoroscopic swallowing study (VFSS), FEES, and Electromyography (EMG) techniques that show accurate and complete results compared to subjective evaluation tools including interviews and selfreports (52). Also, it is possible that the patients with dysphagia are unaware of their problem (53). The Unified Parkinson's Disease Rating Scale (UPDRS) as a subjective evaluation tool and VFSS as a gold standard for diagnosing swallowing disorders are commonly used in Parkinson's patients (21). ...
... Therefore, it is necessary to identify dysphagia in these phases and it is better to consider these two phases in estimating the pooled prevalence of dysphagia in PD. The limitations of our study are as follows: 1) Lack of a fixed method for diagnosing the subjective and objective evaluation tools, 2) Lack of control groups in most of the included studies, 3) Lack of follow-up period in the published studies, 4) The self-reported questionnaires as a subjective evaluation tool were used in some studies, however, some PD patients were unaware of their dysphagia and did not report it unless they were asked (5,53). Lack of evaluation of the severity and stages of PD, but the duration of the PD was considered as an alternative factor. ...
Background: There is still disagreement about the prevalence and incidence of dysphagia in Parkinson’s Disease (PD). Since the prevalence of dysphagia has been reported very differently in the related literature, it is imperative to estimate pooled prevalence in PD patients. Thus, we conducted a systematic review and meta-analysis to estimate the pooled prevalence of dysphagia in PD overall and separately for each assessment method (subjective and objective). Methods: These databases were searched: ScopusPubMed Web of Science ,and Google Scholar, January 1990 to October 2021. A random-effects model was used to pool the prevalence rates reported in the included studies by the Comprehensive Meta-Analysis (CMA( software .All designs of the studies were included. Results :Thirty-nine articles entered the current meta-analysis. The global estimation of the overall prevalence of dysphagia in PD patients was 50.4% )95%CI:42.2-58.6) in all the 39 studies, which proved statistically heterogeneous (p<0.001). Moreover, the pooled prevalence by the subjective (30 studies) and objective (19 studies) methods of assessment were estimated to be 39.5 and 68.8%, respectively. There was also a significant relationship between the prevalence of dysphagia and age of Parkinson’s patients )r=0.44, p=0.011) and also between the prevalence of dysphagia and the duration of PD (r=0.55, p=0.006). Conclusion: Based on the results, one in two patients with PD has dysphagia. This is proven that dysphagia is common in PD. The prevalence of objective dysphagia and subjective dysphasia were very different. It suggests that all Parkinson’s patients should be evaluated for swallowing disorders regularly with objective tools.
... 5 Schlickewei et al., 6 in a study using the EAT-10 questionnaire with 50 patients, did not find a correlation with aspiration/penetration scores, indicating that the EAT-10 failed to identify 38% of penetration/aspiration cases during FESS. In another study, 95% of 119 PD patients did not report swallowing problems but exhibited signs of penetration/aspiration during FEES. 3 Although the use of questionnaires for screening dysphagia risk in patients with PD has been widely discussed, 3,[6][7][8][9] there are controversies regarding these instruments because patients with PD often do not report changes in swallowing physiology, 3,5,6,8,10 which can lead to a delayed diagnosis of dysphagia. 11 This delay can worsen symptoms and lead to clinical complications, often resulting in hospitalization for bronchoaspiration pneumonia. ...
... These results differ from the literature, which suggests that the SDQ-PD is a questionnaire capable of identifying dysphagia risk in the PD population with good sensitivity (80.5%) and specificity (81.3%). 7 In contrast, we revealed a sensitivity of 28.57% and specificity of 68.18% in a very similar sample to the study conducted by Manor et al. 7 However, it is important to note that Manor et al. 7 used FEES as the standard evaluation and did not use a scale to assess the presence of penetration/aspiration. It is essential to highlight that the presence of penetration/aspiration during swallowing without residue (PAS 2, 4, and 6) was not identified by FEES; however, VFSS provided greater accuracy in detecting these occurrences. ...
Background The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications.
Objective To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD.
Methods Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy.
Results EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%.
Conclusion The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.
... As detected by FEES, the main difficulty of Poststroke patient was in the pharyngeal phase confirmed by the presence of pharyngeal mobility problem leading to both residue especially in the pyriform fossae and penetration while for the vocal fold immobilization, the main breakdown was the insufficiency of airway protection due to glottic closure problem. This is in agreement with a study of Cabib et al [43] who found that chronic Post-Stroke oropharyngeal dysphagia was associated with stroke severity. In their study, they found that impaired conduction and cortical integration of pharyngeal sensory inputs at the stroke site were key features of Post-Stroke oropharyngeal dysphagia. ...
... The Cronbach's alpha of the current study was (0.768) which was slightly lower than the original English version of the questionnaire which was (0.89). This may be attributed to the fact that the original English version by Manor et al [43] was performed on only one type of patients who were diagnosed with Parkinson's disease showing dysphagia while the current study had different and multiple etiologies of dysphagia. When Cohen & Manor [23] performed their questionnaire on various etiologies of the dysphagia, the Cronbach's alpha was (0.8). ...
... Despite dysphagia affecting about 4 out of 5 patients with Parkinson's disease, it is often underreported by these patients [20,40]. For this reason, multiple questionnaires have been validated with the goal of earlier detection of dysphagia in patients with Parkinson's disease, including the Swallowing Disturbance Questionnaire (SDQ), Munich Dysphagia Test -Parkinson's Disease (MDT-PD), and DYPARK questionnaire [41][42][43]. ...
... For this reason, identifying Parkinson's as the etiology becomes critical in management. For patients with Parkinson's, validated questionnaires have been developed to diagnose dysphagia, such as the SDQ and MDT-PD [41,42,92]. On the other hand, for patients with dysphagia, it is often difficult to identify Parkinson's disease in the early, premotor stage of disease given the lack of reliable diagnostic tools [93], even though esophageal manometry is abnormal in 40-60% of these patients [94]. ...
Purpose of review:
While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence.
Recent findings:
In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
... Right after the initial FEES, participants completed several questionnaires, including the Eating Assessment Tool-10 (EAT-10), Reflux Symptom Index (RSI), Voice Handicap Index (VHI-10) and Swallowing Disturbance Questionnaire (SDQ) and underwent the Unified Parkinson's Rating Scale (UPDRS) by a neurologist. [26][27][28][29][30] The RSI was included as it evaluates laryngeal symptoms commonly associated with swallowing disorders. After the initial FEES assessment, if the participants were deemed eligible for study participation, a speech-language pathologist (SLP) not involved in the swallowing evaluation provided instruction on the proper use of the ETM. ...
To evaluate the impact of the elevation training mask (ETM) on swallowing safety and swallowing efficiency in patients with Parkinson’s disease (PWP) when used as a respiratory muscle strengthening tool. Study Design. Prospective cohort study. Setting. Tertiary university-affiliated medical center. Thirteen PWP underwent Fiberoptic Endoscopic Evaluation of Swallowing and spirometry assessments both before and after a 4-week ETM use, which included incrementally increasing resistance each week. Measurements taken included EAT-10, swallowing disturbances questionnaire (SDQ), Penetration Aspiration Score (PAS), Yale Pharyngeal Residue Severity Rating Scale, and Peak Expiratory Flow (PEF). Disease severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS). Eleven out of 13 male participants (median age 70 years, UPDRS 33, disease duration 8.5 years) completed the 4-week protocol (84.6% completion rate). Vallecular residue significantly decreased for solids (median from 3.0 [IQR: 2.0–3.0] to 2.0 [IQR: 1.0–2.0], p = 0.028) and semi-solids (from 3.0 [IQR: 2.0–4.0] to 2.0 [IQR: 1.0–3.0], p = 0.025), with a non-significant improvement for liquids (from 2.0 [IQR: 2.0–2.0] to 2.0 [IQR: 1.0–2.0], p = 0.19). Patient-reported outcomes (EAT-10, SDQ, VHI-10, RSI) and PEF showed non-significant trends toward improvement. A 4-week use of ETM, serving as a form of respiratory muscle strengthening, demonstrated specific improvements in vallecular residue for semi-solid and solid consistencies in PWP with dysphagia. While other swallowing and respiratory measures showed positive trends, these changes did not reach statistical significance. Further research with a larger cohort is needed to evaluate ETM’s role in swallowing rehabilitation.
... Direct questioning, such as in the SDQ and SDQ-J [5,22], is a feasible and well-validated approach established as an aspiration predictor in PD (sensitivity 0.78, specificity 0.85) [5]. However, given the reliability concerns of subjective assessments, objective measures are needed as predictors. ...
... verified the reliability and validity of the K-MDADI and found that it is also a reliable tool for evaluating dysphagia's effects on quality of life in patients with head and neck cancer.4. Korean version of the Swallowing Disturbance Questionnaire (K-SDQ)Manor et al. (2007) developed the self-reported SDQ to assess dysphagia symptoms and compared those findings to objective swallowing evaluations for patients with Parkinson's disease (PD). The SDQ includes a 15-item questionnaire on common swallowing disturbance in the oral (five items) and pharyngeal (10 items) phases of swallowing. ...
Patient-reported outcome measures (PROMs) have been studied for their application in the evaluation of patient experiences of dysphagia and swallowing-related quality of life in Korea. However, there has not been sufficient attention to these measures. This scoping review was to overview the latest evidence on swallowing-related PROMs and those measurement properties. We also performed a quality assessment for the cross-cultural adaptation of the PROMs if those were adapted in Korea. We reviewed articles published in English and Korean from their beginning through December 2023 using three electronic databases: PubMed, Embase, and Web of Science. Because this review included both the translated versions of and Korean-developed questionnaires, the cross-cultural adaptation and measurement properties of PROMs were investigated for quality assessment. We evaluated nine studies with eight PROMs in total. The cross-cultural adaptation of PROMs generally demonstrated poor quality, in terms of a lack of evidence on the translational process to adequately adapt the questionnaire items to different socio-cultural contexts. The Korean-developed questionnaires also showed poor quality of the measurement properties. This
may be due to the questionnaires' early developmental stage at present. This scoping review was the first to outline the current evidence on swallowing-related PROMs in Korea. Further studies
are necessary to ensure the high methodological quality of the questionnaires for dysphagia diagnosis and intervention.
... The correction for the imperfection required the establishment of the imperfect gold standard sensitivity and specificity from previous studies or a test group 28,29,33,34 . Previous studies show that FEES has approximately 80-87% sensitivity and 81-100% specificity in detecting dysphagia 28,29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44] . We are correcting based on these levels. ...
Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to evaluate the effectiveness of the Arabic version of the EAT-10 screening instrument (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients. Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 instrument to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93 to 97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI 0.91, 1.56, p-value = 0.21), indicating statistical insignificance. In conclusion, A-EAT-10 is an excellent option for dysphagia evaluation, offering non-invasive, straightforward, and cost-effective advantages compared to FEES. Its utility extends to predicting the need for PEG tube insertion at initial patient visits, making it a valuable tool for informed treatment decisions. Notably, A-EAT-10 demonstrates a diminishing correlation with FEES over time.
... Possible interventions of dysphagia of patients with Parkinson's can cause dietary adjustments, oropharyngeal exercises, speech pathology, and, in some instances, the use of enteral feeding tubes where regular assessment and monitoring of swallowing function in people with Parkinson's disease by healthcare practitioners can show as a basic to remove problems and enhance quality of life [22]. [23], [24], [25], [26], [27], [28], [29], [30] ...
Dysphagia is one of the indicators that most negatively affects the general health associated with patients who suffered of Parkinson's disease, which impairs their ability to eat foods in a
healthy manner. This study was interesting to assess and analyze health outcomes related to dysphagia for patients with idiopathic Parkinson's disease (IPD). A cross-sectional study was undertaken in several hospitals in Iraq over a span of two years, including during February 3, 2022, until November 26, 2023. The study focused on patients diagnosed with Parkinson's disease who furthermore have dysphagia. The study included an overall of 106 samples, having ages spanning between 50 to 70 years. In addition, this study has effectively established categorizations and assessments for the aim of classifying the degree of severity related to Parkinson's disease, as well as assessing the complexity and intensity of dysphagia among people diagnosed with Parkinson's disease. The results recorded patients with Parkinson's as the most common category at 36.79%; males were higher at 66.98% than females at 33.02%; BMIs were <23.0 at 28.30%; and 24-26 at 37.74%. 36, accounting for 33.96%, 10.38% for smoking patients, and 89.62% for non-smoking patients. The most noticeable symptoms or indicators were tremors, which included 34 patients; Bradykinesia, which included 45 patients, is considered the most common among patients. The most common classification of Parkinson's disease severity in people was behavior, with a score of 69; activities of daily living, with a
score of 104; complications of the disease, with a score of 98; and motor examination, with a score of 86. Our results recorded data on the grades and grades of dysphagia associated with Parkinson's disease, where oral motility was normal grade 3, severe grade 1, swallowing reflex involved grade 2, and delay was 1. Dysphagia has a significant influence on the overall well-being of those afflicted by Parkinson's disease, resulting in exerting a negative impact on their daily activities.
... A battery of neuropsychological assessments was performed by a qualified neurologist on the day the VFSS was conducted, including (1) H&Y stage to evaluate the severity of motor symptoms; (2) question 6 of the unified Parkinson's Disease Rating Scale II to evaluate drooling; (3) Mini-Mental State Examination (MMSE) to evaluate cognitive function; (4) Hamilton Anxiety Scale (HAMA) [14]; (5) Hamilton Depression Scale (HAMD) [14]; (6) the Chinese version of the Swallowing Disturbance Questionnaire (SDQ-C), which is a 15-item self-reported questionnaire with five items related to the oral phase of swallowing and 10 items related to the pharyngeal phase [17]; and (7) the five-level Kubota Water Swallowing Test (KWST) [14]. ...
Airway invasion is common in patients with Parkinson’s disease (PD) and can cause serious complications. However, a PD-related dysphagic pattern has not been clearly elucidated. In this study, 53 patients with early to moderate PD were enrolled to undergo a videofluoroscopic study of swallowing evaluation (VFSS) and a battery of neuropsychological assessments. A set of VFSS variables (three visuoperceptual, nine temporal, and six spatial) were measured. The main effects of bolus viscosity and volume on airway invasion were calculated. Statistical analyses were performed to determine key kinematic factors of airway invasion for swallowing each bolus type. Airway invasion frequency was significantly higher for liquid boluses (liquid vs. pudding P < 0.001; liquid vs. honey P = 0.006). Laryngeal vestibule closure reaction time (LVCrt) was the key kinematic factor of airway invasion for 3 ml liquid swallow (P = 0.040), anterior displacement of hyoid bone was the key kinematic factor for both 5 ml and 10 ml liquid swallows (P = 0.010, 0.034, respectively). Male sex and advanced Hoehn and Yahr stage were significantly related to reduced anterior displacement of hyoid bone. These results reveal the dysphagic pattern related to PD, demonstrating that prolonged LVCrt and reduced anterior displacement of hyoid bone are two crucial kinematic factors contributing to airway invasion during the liquid swallow. In addition, hyoid bone dysfunction was correlated with disease severity and male sex. Our findings warrant further investigation of the pathophysiological mechanism of dysphagia in PD and would guide clinical intervention.
... [32] This imperfection means that a straightforward comparison will lead to certain biases in the results. [ [32,47] We are correcting based on these levels. There is no established sensitivity-speci city regarding our search for HNC patients. ...
Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to validate the Arabic version of the EAT-10 questionnaire (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients.Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 questionnaire to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93–97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI: 0.91, 1.56, p-value = 0.21), indicating statistical insignificance.
In conclusion, A-EAT-10 exhibits excellent properties, making it a non-invasive, simple, and cost-effective alternative to FEES in dysphagia evaluation, and it can assist in predicting whether a patient requires PEG tube insertion before treatment initiation at first visits.
... All participants are requested to complete the Swallowing Disturbance Questionnaire (SDQ) self-reporting questionnaire [16,17]. SDQ consists of 15 questions on swallowing disturbances, 5 questions are related to the oral phase of swallowing, and 10 questions are related to the pharyngeal phase. ...
Background
Oculo-pharyngeal muscular dystrophy (OPMD) is a rare disease, caused by trinucleotide repeat expansion in the PABPN1 gene, inherited in an autosomal dominant (AD) manner. Its main features are eyelid ptosis and dysphagia, which manifest at the end of the fifth decade of life. Other symptoms include proximal muscle weakness and bulbar muscle weakness. Although OPMD is prevalent worldwide, a higher prevalence has been reported in the Jewish population from Bukhara. Currently, no specific drugs are available for OPMD.
Objective
Our National Israeli Registry for Oculo-Pharyngeal Muscular Dystrophy (IsrO-PMD) study aims to provide a framework for the assessment and documentation of the natural history of the diseases as we as a multi-disciplinary management of patients with OPMD. The IsrO-PMD may be the cornerstone of future clinical trials for novel therapies for OPMD.
Methods
The IsrO-PMD is a national prospective registry that involves non-interventional data collection based on the Global Rare Diseases Patient Registry (GRDPR) and data repository standard. Inclusion criteria are clinical diagnosis of OPMD and positive genetic testing. Patients who meet inclusion criteria will be examined using a series of multi-disciplinary investigations and questionnaires including periodic follow-up examinations. Specific attention is given to comprehensive neurological, swallowing, and ophthalmological evaluations.
Discussion
The establishment of this national registry will enhance our understanding of the natural history of OPMD, establish quality care benchmarks, and develop treatment strategies in addressing the multi-system pathophysiology of the disease and associated comorbidities. Our registry provides a foundation for the use of new cutting-edge treatments as they become available.
... The Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) [15] was administered to the patients by skilled nurses. Both the patients and controls completed the Scent Survey for Screening (SSS) to examine olfactory dysfunction [16], and the Swallowing Disturbance Questionnaire (SDQ) to assess swallowing ability [17]. Constipation was assessed according to the ROME III criteria [18]. ...
Background:
The prevalence of Parkinson's disease (PD) has increased steadily with the increase of the elderly population. PD may influence dietary intake and quality, and the gut microbiome composition. The present study examined differences in dietary intake and quality between PD patients and controls according to sex. In addition, we assessed the gut microbiome composition.
Methods:
This cross-sectional study was conducted at A Medical Center, Seoul, South Korea. PD severity, swallowing function, olfactory function, and constipation status were examined by a skilled nurse. Dietary data were collected through a semi-quantitative food frequency questionnaire. Stool samples were subjected to microbiome analysis. To examine dietary quality, the Dietary Quality Index-International (DQI-I), Healthy Eating Index (HEI), Index of Nutritional Quality (INQ), Dietary Diversity Score (DDS), and Mediterranean Diet Score (MDS) were used. An independent t-test was used to determine differences between patients and controls. A chi-square test was used to examine frequency differences.
Results:
Dietary intake did not differ between the PD patient and control groups. Regarding dietary quality, the patients consumed more saturated fat compared to controls. Overall, the dietary differences between the groups were minor. The composition of the gut microbiome differed between PD patients and controls. Lactobacillus and Bifidobacterium genus were most abundant in PD patients. Prevotella VZCB and other Faecalibacterium were most abundant in controls.
Conclusions:
Our results indicated that PD patients may experience gut microbiome change even in the early stage, while nutritional needs can be met when a balanced diet including various food groups are consumed.
... Only one question requires 'yes' or 'no' as an answer. The cut-off value is 11, and values equal to or higher than the cut-off indicate a risk of dysphagia in patients with PD. 19 ...
Background:
Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration.
Objective:
To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group.
Methods:
Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol.
Results:
Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC.
Conclusion:
PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.
... The SDQ is a self-report questionnaire used to detect swallowing problems in patients with PD [29]. In addition, it has been reported to be a sensitive and accurate tool for identifying dysphagia arising from various etiologies [30]. ...
Objective:
To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism.
Methods:
One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections.
Results:
Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV-V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson's disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p<0.05). Regarding clinical characteristics, higher H&Y stage (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.226-8.216; p=0.017) and diagnosis of IPD (OR, 0.280, 95% CI, 0.111-0.706; p=0.007) were significantly related to respiratory infections in the multivariate analysis. Among VFSS findings, pyriform sinus residue (OR, 14.615; 95% CI, 2.257-94.623; p=0.005) and premature bolus loss (OR, 5.151; 95% CI, 1.047-25.338; p=0.044) were also significantly associated with respiratory infection.
Conclusion:
This study suggests that disease severity, diagnosis, pyriform sinus residue, and premature bolus loss observed in VFSS are associated with respiratory infection in patients with parkinsonism.
... However, the effect of dopaminergic drugs, especially levodopa, on swallowing function and their role in the treatment of dysphagia is controversial [8][9][10]. Some studies showed significant improvement in dysphagia after using dopaminergic drugs in some patients with PD [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. ...
Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia.
Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients.
Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05.
Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011).
Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men.
... 17 A recent meta-analysis identified a total of 34 dysphagia-related PROs scale studies, 15 mostly conceived for specific conditions such as achalasia or Parkinson's disease. [18][19][20][21] Among the available scales for general dysphagia, PROMIS Gastrointestinal (PROMIS GI) Disrupted Swallowing is a robust instrument when evaluating all the different domains (conceptual model, content validity, reliability, construct validity, scoring and interpretation, and burden and presentation). 15 It was validated in the North American population, it is easy to use, and it was developed with the goal of evaluating the impact caused by dysphagia in an individual patient, regardless of etiology or type of dysphagia. ...
Introduction:
Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient's personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population.
Material and methods:
Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity.
Results:
The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach's α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity.
Conclusion:
The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.
... The type of screening and non-instrumental clinical swallowing assessment tools used by respondents are shown in Supplementary Table 2. The most frequently used screening [52], Dysphagia-Specific Screening Tool [53], and Swallowing Disturbance Questionnaire [54]. ...
Purpose:
To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries.
Methods:
A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing.
Results:
Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident.
Conclusions:
Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended.
... The scores of SDQ and DHI were selected as the outcomes of this study to evaluate swallowing status. DHI is a self-report questionnaire designed to measure the negative impact of dysphagia on the quality of life and can be a useful tool for screening and treatment planning patients with dysphagia (26). DHI consists of 25 items and has 9 questions in the functional subscale, 9 questions in the physical subscale, and 7 questions in the emotional subscale. ...
Background: Swallowing difficulties or dysphagia is the main cause of aspiration pneumonia and death in patients with Parkinson's disease (PD). Although dysphasia occurs in 90% of patients with PD, there is insufficient evidence to support the effectiveness of behavioral speech therapy in this disease. Objectives: This study aimed to investigate the effect of a new telerehabilitation program that was a combination of speech and music therapy on dysphagia in patients with PD. Methods: This study was a 3-arm randomized controlled trial (RCT). Thirty-three subjects with PD (mean age, 58.88 years; 25 men and 8 women with complaints of swallowing problems) were randomly assigned to the combination therapy (including breathing, speech, voice, and singing exercises), conventional speech therapy, and music therapy groups. Each patient participated in 12 telerehabilitation sessions over 4 weeks. Swallowing Disturbance Questionnaire (SDQ) and Dysphagia Handicap Index (DHI), as the outcomes of this study, were evaluated 1 week before the first intervention session, 1 week after the last intervention session, and 3 months after the last evaluation. Results: The results showed a significant improvement in SDQ and all sub-tests (functional, physical, and emotional), as well as the total score of DHI in the combination therapy and conventional speech therapy groups after treatment (P < 0.05). Also, the music therapy group had a significant improvement in the SDQ score, emotional sub-test, and the total score of DHI (P < 0.05). The combination therapy group demonstrated a significant outperform in the SDQ score compared to the other 2 groups, as well as in all sub-tests and the total score of DHI compared to the music therapy group (P < 0.05). The combination therapy group also showed more improvement in all sub-tests, as well as the total score of DHI, compared to the music therapy group (P < 0.05). The results also indicated that the speech therapy group had a more significant effect on the physical sub-test of DHI compared to the music therapy group (P < 0.05). Conclusions: Although swallowing function improved in all 3 groups, this improvement was more in the combination therapy group than in the other groups. Therefore, it can be concluded that combination therapy has the potential to provide additional benefits for swallowing efficiency in this patient group. The results also suggest that the telerehabilitation method is feasible to deliver intensive therapy to individuals with PD to improve swallowing functions.
... V praxi sa na detekciu dysfágie používajú štandardné skríningové nástroje, ako je Swallowing distrubance questionnaire (SDQ) (21) , Huntington's Disease Dysphagia Scale (22) , alebo GUSS (Gugging Swallowing Screen) test, používaný u nás často v súvislosti so skríningom dysfágie pri cievnych mozgových príhodách (23) . Medzi inštrumentálne zobrazovacie metódy prehĺtacieho aktu používané na diagnostiku dysfágie patrí endoskopické vyšetrenie prehĺtanie (FEES-fiberoptic endoscopic evaluation of swallowing) a videofluoroskopické vyšetrenie (VFS), ktoré sa bohužiaľ na Slovensku na väčšine pracovísk rutinne nerealizujú. ...
Huntington´s disease is an inherited neurodegenerative disease that results in various motor, cognitive and psychiatric disturbances. Although speech and swallowing difficulties have a major negative impact on quality of life, little attention has been paid to them in our literature. In this review, we describe their typical symptomatology and the most common diagnostic and therapeutic approaches used from the speech therapist´s point of view in our country. We emphasize the peculiarities of the disease and the important role that the care of speech therapists has from the early stages, as well as in the prevention of serious complications, such as aspiration, among others.
... For both steps, all participants were eligible to participate if they were over 20 years of age; with no known medical history of dysphagia; had a Swallowing Disturbance Questionnaire (SDQ) (Manor et al., 2007) score <11, indicating no suspicion for dysphagia, were able to give a written informed consent; and could follow simple verbal instructions. In addition, all participants indicated that they do not avoid eating crackers due to swallowing disorders or allergies. ...
Background:
Quantitative measures can increase precision in describing swallowing function, improve interrater and test-retest reliability, and advance clinical decision-making. The Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST) are functional tests for swallowing that provide quantitative results.
Aims:
To explore the relationship between TOMASS and TWST; evaluate test-retest and interrater reliability; explore age and gender effects; and gather normative data.
Methods & procedures:
Healthy community dwelling participants (n = 298, ≥ 20 years old) were recruited. Of those, 126 were included in the reliability study. Participants completed the TWST and TOMASS.
Outcomes & results:
Associations between TWST and TOMASS measures were found using Pearson's correlation coefficient. Age was positively associated with an increase in the number of bites (n = 292, r = 0.15, p = 0.009), masticatory cycles (n = 291, r = 0.33, p < 0.0001) and duration (n = 292, r = 0.32, p < 0.0001) for the TOMASS. For the TWST, age was positively associated with an increase in duration (n = 296, r = 0.23, p < 0.0001), and negatively associated with volume (n = 296, r = -0.205, p < 0.0001), and swallowing capacity (n = 296, r = -0.24, p < 0.0001). Females required more bites, masticatory cycles, swallows and longer time than males in TOMASS. In TWST, females required more swallows, longer time, and had lower volume per swallow and reduced swallowing capacity than males. Intraclass correlation coefficient (ICC) revealed good test-retest reliability and moderate to excellent interrater reliability.
Conclusions & implications:
This study provides support for the validity of the TOMASS and TWST. Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Extended chewing time and increased number of masticatory cycles might be compensatory behaviours for reduced oral processing abilities that are motor, sensory and/or mechanical.
What this paper adds:
The TOMASS and TWST are functional tests of swallowing that provide quantitative results. They are easy to incorporate as part of the clinical evaluation of swallowing due to low cost and quick administration. Age and gender effects were found for the TWST and TOMASS, but they were only tested on relative measures rather than absolute measures. Different types of crackers used for TOMASS led to differences in performance and in normative values. What is already known on the subject Associations between performance during TWST and TOMASS were found: time, number of swallows and time per swallow were correlated, meaning that need for more time and more swallows is reflected in both drinking and chewing. The study provides further support for age and gender effects in TWST and TOMASS, on both relative and also on absolute measures, which were not investigated previously. Longer durations in TOMASS and TWST with an increase in age, are likely to be the result of compensatory behaviours to allow safe swallowing. Normative data for a country-specific cracker are presented (Israel). What are the potential or actual clinical implications of this work? Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Establishing country specific norms for commonly available crackers is necessary, since crackers size and ingredients, such as fat content and moisture, influence chewing and swallowing. There is a balancing act between safety and efficiency in older adults' swallowing behaviour. Reducing pace in eating and drinking probably supports safer swallowing.
Dysphagie ist ein klinisch relevan- tes Problem bei Parkinson-Syndro- men. Das umfasst neben der idio- pathischen Parkinson-Erkrankung auch die atypischen Parkinson- Syndrome. Bei allen Parkinson- Syndromen ist das Dysphagie-be- dingt erhöhte Aspirationsrisiko mit einer reduzierten Lebensquali- tät assoziiert, und Aspirationsp- neumonien sind ebenfalls bei al- len Parkinson-Syndromen die Haupttodesursache. Der Dyspha- gie muss ein besonderes Augen- merk gewidmet werden, um das Bewusstsein für dieses Symptom sowohl bei Patienten als auch bei Behandlern zu stärken und die Versorgung von Betroffenen zu verbessern.
Purpose:
Patient reported outcome measures (PROMs) are increasingly used to inform value-based healthcare. Within speech-language pathology (SLP), there is no synthesis of validated PROMs to guide professional practice. This scoping review systematically identifies and evaluates condition-specific PROMs across adult SLP practice.
Method:
A literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, and Web of Science. Abstracts and full texts were screened in Covidence. Relevant studies that validated PROMs in English were extracted and assessed using the "Checklist to operationalise measurement characteristics of PROMs" by two independent reviewers.
Result:
Ninety-seven articles provided validation data for 71 PROMS across seven SLP practice areas. These included voice (n = 18), swallowing (n = 14), language (n = 11), fluency (n = 8), speech (n = 4), laryngectomy (n = 3), and cognitive-communication (n = 2). No PROMs were identified for augmentative and alternative communication (AAC) (n = 0). Quality ratings were variable on the Francis et al. checklist.
Conclusion:
A range of validated PROMs were identified to guide SLP practice in measuring patient perceptions across a range of practice areas in adults. Opportunities for further development in SLP practice areas with limited PROMs, such as speech, cognitive-communication, and AAC are also highlighted.
La disfagia es un síntoma descrito como la sensación de dificultad para deglutir los elementos sólidos o líquidos por alteración de una de las 4 fases de la deglución. La enfermedad de Parkinson (EP) es un proceso neurodegenerativo progresivo cuya afectación principal se da en la pars compacta de la sustancia negra. El cuestionario SDQ (Swallowing Disturbances Questionnaire), es una escala de autoevaluación que comprende 15 preguntas sobre la frecuencia de síntomas de disfagia al momento de la alimentación en el paciente con EP. La disfagia es un síntoma no motor presente en la EP. Evaluamos la prevalencia de disfagia en 200 pacientes con EP del Instituto Nacional de Ciencias Neurológicas del Perú detectados mediante el Cuestionario SDQ, así también comparamos diferentes características demográficas, nosológicas y terapéuticas que tienen éstos pacientes. Se evaluó a 35 pacientes que tuvieran valores según el cuestionario SDQ positivos para presencia de Disfagia (17,5%). La pregunta 5 del Cuestionario SDQ fue la que presentó la mayor cantidad de respuestas positivas. Se puede suponer la correlación entre salivación y presencia o empeoramiento de disfagia. 29 de 35 pacientes utilizaban en su terapéutica Levodopa. 18 de 35 se encontraban en el Estadio 3 de la clasificación de Hoehn y Yahr.
Introdução. A Doença de Parkinson (DP) é considerada a segunda doença neurodegenerativa mais prevalente, cursa com sintomas motores e não motores, dentre esses a disfagia, que compromete a deglutição, levando a hidratação e nutrição inadequadas. Objetivo. Identificar os fatores associados ao estado nutricional de pacientes com DP em um hospital de referência no Pará. Método. Estudo de abordagem quantitativa, de caráter descritivo e de corte transversal. Foram incluídos os pacientes diagnosticados com DP de ambos os sexos, na faixa etária ≥18 anos, e em atendimento no ambulatório do hospital Ophir Loyola em Belém-PA, e foram excluídos os pacientes diagnosticados com outras patologias neurológicas. A amostra foi calculada através de cálculo estatístico, os dados foram coletados através de um formulário eletrônico no google forms, e realizada análise estatística pelo teste de Correlação de Pearson e Teste G. Resultados. A pesquisa foi realizada com 60 participantes, sendo encontrada associação significante entre disfagia e os estágios de incapacidade da doença (p=0,0027), e correlação entre disfagia e idade (p=0,0005), a maioria dos pacientes possuíam estado nutricional de eutrofia (71,7%). Conclusão. Foi identificado que a disfagia possui alta relação com a DP, e quanto maior o estágio de incapacidade da doença, maior é o risco de disfagia, assim como o risco de disfagia é correlacionado com a idade, e quanto maior a idade, também é maior o risco de disfagia. Entretanto, não foram encontradas associações significativas destas variáveis com o estado nutricional.
Pre-frailty is a state between frailty and robustness. Frail and pre-frail elderly are both susceptible to dysphagia. Pre-frail elderly may respond better to intervention rather than frail people. Therefore, detection and intervention for dysphagia should be done early in pre-frail elderly. Expiratory muscle strength training (EMST) is a recent intervention for dysphagia. However, effectiveness of EMST on pre-frail elderly are still unclear. This study aimed to investigate effectiveness of expiratory muscle training on dysphagia risk of pre-frail elderly.
The Autonomic Nervous System (ANS) is the medium between the central nervous system and the enteric nervous system; the latter exhibits a high degree of autonomy from central nervous control; it is the only human system that developed its own independent organization in evolutionary changes. In the last decade, the scientific knowledge of ANS has been given a major boost mainly regarding enteric sense-motor functions. Often neurological diseases result in ANS GI impairment that, in some cases, cannot always be counteracted by vegetative compensatory mechanisms, or modified by therapeutic treatment. Structures, gastrointestinal motility, and functional gastrointestinal disorders are described with particular attention to autonomic gastrointestinal dysfunction recognized in main neurological diseases. Furthermore, laboratory and instrumental tests for the diagnosis of dysmotility of the gastrointestinal system and suggestions for the management of gastro-enteric failure are reported, to support diagnosis and management of gastrointestinal ANS dysfunction.
Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population.
Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls.
Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia.
Results There was a significant difference ( p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed self-awareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them.
Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.
Parkinson's disease (PD) is a neurodegenerative disease that occurs predominantly in the elderly, and the number of patients with PD is exploding with the aging population. One important factor that interferes with the quality of life of patients with PD is dysphagia. Dysphagia in PD is highly prevalent and does not necessarily correlate with severity of the disease. Dysphagia causes weight loss, aspiration pneumonia, and drooling. Dysphagia in PD can occur in all swallowing stages (anticipatory, preparatory, oral, pharyngeal, and esophageal) due to various lesion sites outside of the basal ganglia circuit and medullary swallowing centers. Because patients with PD are often unaware of their dysphagia and have subclinical aspiration, PD patients without dysphagia should be interviewed, and if dysphagia is suspected, aggressive evaluation of dysphagia should be done by videofluorography or videoendoscopy. It is important to estimate the site of the lesion based on the pattern of dysphagia and determine a treatment plan.
Gastrointestinal (GI) dysfunction is a common nonmotor symptom in Parkinson's disease (PD) as well as other parkinsonian syndromes and may precede the onset of motor symptoms by decades. Involvement of all segments of the GI tract can lead to altered responses to medications and worsened quality of life for patients. While some GI symptoms occur in isolation, others overlap. Therefore, understanding the changes in different segments of the GI tract and how they relate to altered responses to PD treatment can guide both diagnostic and pharmacological interventions. Gut microbiota plays a critical role in immune activity and modulation of the enteric and central nervous systems. Understanding this bidirectional relationship helps to elucidate the pathogenesis of neurodegeneration. This review will describe the current understanding of how GI dysfunction develops in parkinsonian syndromes, common symptoms in PD and related disorders, and available treatments.
Dysphagia is a clinically relevant problem in Parkinson's disease as well as in atypical Parkinsonian syndromes, such as multiple system atrophy and diseases from the spectrum of 4‑repeat tauopathies, which affect most patients to a varying degree in the course of their disease. This results in relevant restrictions in daily life due to impaired intake of food, fluids, and medication with a subsequent reduction in quality of life. This article not only gives an overview of the pathophysiological causes of dysphagia in the various Parkinson syndromes, but also presents screening, diagnostic and treatment procedures that have been investigated for the different diseases.
Background: Brain, nerve, and muscle disorders are extremely prevalent in sub-Saharan Africa (SSA) and are often chronic. Awareness of and insight into oropharyngeal disorders in neurological disease are the most important factors for optimal functional outcome. Due to the complexity and hierarchy of neurological systems, functional (psychogenic, nonorganic) neurological disorders pose a particular challenge: their clinical presentation is often dramatic and gives rise to insecurity in patients as well as in health workers. Furthermore, myths about the oropharyngeal region and unfamiliarity with its neuroanatomy and neurophysiology may lead to unnecessary and even harmful treatments. Methodology: This qualitative literary review describes a selection of common neurological disorders associated with speech and swallowing difficulties. Results/Discussion: Stepwise, the reader is guided through these disorders and their associated neuroanatomy while noting helpful clinical features, reader-friendly figures, and treatment suggestions. The glossary emphasizes the attribution of brain, nerve, and muscle dysfunction to speech, language, and swallowing pathology, allowing for renewed familiarization with specific issues and the speech and language therapeutic options in this multifaceted field.
Importance
Patient-reported outcome measures (PROMs) allow clinicians and researchers to assess health-related information from a patient’s perspective. These measures have been used more frequently over the last several decades, but an associated minimal clinically important difference (MCID) is needed to optimize their utility. This narrative review identified the top 100 most-cited otolaryngology-related PROM development and validation publications and assessed the presence and characteristics of the PROMs’ associated MCID.
Observations
In this narrative review, a literature search in Scopus and Web of Science was conducted on June 29, 2022, using keywords related to PROM development and validation studies in otolaryngology and reference lists. Studies that met the definition of a PROM and assessed an otolaryngologic disorder or study population were included for full-text review. After full-text review of 188 articles, the top 100 most-cited PROM development and validation publications, resulting in 106 total PROMs, were chosen for review. A total of 39 (37%) of the identified PROMs had an associated MCID. Of those reporting an MCID, 14 (35.9%) used an anchor-based method, 12 (30.8%) used a distribution-based method, 10 (25.6%) used both, and 3 (7.7%) did not specify or used neither method. Rhinology had the greatest number of PROMs with an associated MCID (16 of 24, 66%), and pediatrics had the fewest (1 of 13, 7.7%). The median number of citations of PROMs with an MCID was higher than those without an MCID.
Conclusions and Relevance
The majority of the most-cited PROMs in otolaryngology lack an associated MCID. These data indicated that there are a multitude of PROMs that have been cited hundreds of times and used for decades without the ability to identify whether a particular change in score on the instrument is clinically meaningful. There is a need to determine and validate MCIDs for commonly used PROMs to aid clinical research and trial interpretation.
NÖROLOJİK HASTALIKLARDA YUTMA BOZUKLUĞU VE TIBBİ BESLENME TEDAVİSİ
This study aimed to characterize dysphagic patients with inclusion body myositis (IBM) with cricopharyngeal bar (CPB) (n=17; IBM-CPB(+)) by comparing their swallowing function and muscle magnetic resonance imaging data with IBM patients without CPB (n=28; IBM-CPB(-)). IBM-CPB(+) patients were older at diagnosis and had more frequent obstruction-related dysphagia and stronger knee extension than IBM-CPB(-) patients. IBM-CPB(+) patients also had less intramuscular fatty infiltration than IBM-CPB(-) patients on T1-weighted magnetic resonance images of the rectus femoris (2.6% versus 10.3%, p < 0.05), vastus lateralis (27.8% versus 57.1%, p < 0.01), vastus intermedius (17.6% versus 43.5%, p < 0.01), vastus medialis (14.1% versus 39.1%, p < 0.01), deltoid (5.5% versus 18.7%, p < 0.05), biceps (6.6% versus 21.1%, p < 0.001), and triceps (12.9% versus 33.0%, p < 0.05). These findings suggest that IBM-CPB(+) patients were older, frequently exhibited obstruction-related dysphagia, had stronger knee extension, and had less fatty infiltration of the limb muscles compared to IBM-CPB(-) patients, and provide valuable information on the clinical subset of IBM-CBP(+) patients in order to expand the knowledge of the clinical heterogeneity in IBM.
Objectives
To identify all outcomes, their definitions, outcome measurement instruments (OMIs), timepoints and frequency of measurement applied in clinical trials in oropharyngeal dysphagia (OD) interventions in Parkinson’s disease (PD). This scoping review is the first stage of a larger project establishing a core outcome set for dysphagia interventions in Parkinson’s disease (COS-DIP).
Design
Scoping review.
Methods
Six electronic databases and one trial registry were searched without language restrictions until March 2022. Bibliography lists of included studies were also reviewed. Study screening and data extraction were conducted independently by two reviewers using Covidence. The scoping review protocol is registered and published ( http://hdl.handle.net/2262/97652 ).
Results
19 studies with 134 outcomes were included. Trial outcomes were mapped to a recommended taxonomy for COSs and merged. 39 outcomes were identified. The most frequently measured were general swallowing-related outcomes, global quality-of-life outcomes and swallowing-related perceived health status outcomes. The applied outcomes, their definitions, OMIs, timepoints and frequency of measurement showed a high variability across all studies.
Conclusions
The high variability of outcomes emphasises the need for an agreed standardised COS. This will inform clinical trial design in OD in PD, increase the quality of OD trials in PD and facilitate synthesising and comparing study results to reach conclusion on the safety and effectiveness of OD interventions in PD. It will not prevent or restrict researchers from examining other outcomes.
Trial registration number
The COS-DIP study, including the scoping review, was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 ( www.comet-initiative.org , registration number: 1942).
With the aging of the population, the incidence of dysphagia has gradually increased and become a major clinical and public health issue. Early screening of dysphagia in high-risk populations is crucial to identify the risk factors of dysphagia and carry out effective interventions and health management in advance. In this study, the current epidemiology, hazards, risk factors, preventive, and therapeutic measures of dysphagia were comprehensively reviewed, and a literature review of screening instruments commonly used globally was conducted, focusing on their intended populations, main indicators, descriptions, and characteristics. According to analysis and research in the current study, previous studies of dysphagia were predominantly conducted in inpatients, and there are few investigations and screenings on the incidence and influencing factors of dysphagia in the community-dwelling elderly and of dysphagia developing in the natural aging process. Moreover, there are no unified, simple, economical, practical, safe, and easy-to-administer screening tools and evaluation standards for dysphagia in the elderly. It is imperative to focus on dysphagia in the community-dwelling elderly, develop unified screening and assessment tools, and establish an early warning model of risks and a dietary structure model for dysphagia in the community-dwelling elderly.
Parkinson's disease is no longer considered only a motor disorder. It has become evident that the pathological changes are broad, the progression seems to follow a pattern suggesting transynaptic transmission via templation of proteins in a prion-like fashion, and that these pathological changes usually antedate the motor symptoms by decades. This book emphasizes treatment options for Parkinson's disease, critically assessing pharmacologic and surgical interventions for all aspects of the disease. Evidence from randomized controlled clinical trials is highlighted to develop practical recommendations for clinical practice. Lessons learnt from clinical trials – and controversies and future challenges – are all addressed. Readers will find the necessary clinical and scientific foundations for the understanding of the disease, the underpinnings of the pathological processes, the identification of disease biomarkers, and the basis for solid therapeutics. Chapters are authored by an international team of specialists who bring their expertise to improving the management of this disease.
Purpose of review:
Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice.
Recent findings:
The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues.
Summary:
Screening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing.
Spor küresel dünyada giderek büyüyen dev bir sektör haline gelmiştir.
Bu sebeple spor kulüplerinden ve sporculardan beklentiler artmıştır. Ülkelerin
ve kulüplerin spordaki başarısının temelinde, sporcunun en iyi performansı
sağlıklı bir şekilde sürdürebilir olması yatmaktadır. Bundan dolayı spor, sağlık
ve sosyal bilimciler, sporun gelişimi için bilimsel ve akademik çalışmaların
sınırlarını genişletmek durumunda kalmışlardır.
Yapılması gereken bir atletik görevin yerine getirilmesi sırasında başarı
için ortaya konulan çabaların bütünü sportif performans olarak tanımlanabilir.
Sporcunun başarısı ve performansının değerlendirilmesinde yarışma ve
antrenman sırasında sonuca etki eden tüm etmenler dikkate alınmak
zorundadır.
Sağlıklı yaşam uygulamalarıyla sportif faaliyetlere katılımın artması
sporcu sayısını arttırmıştır. Sporcuların hem profesyonel hem de amatör
büyük bir kitle haline dönüşmesi sporcu sağlığı konusunun önemini
arttırmaktadır. Sporcularda meydana gelen sağlık sorunları insan bedenini
meydana getiren tüm vücut sistemlerini etkileyebilmektedir
Parkinson hastalığı (PH) olan kişilerin büyük bir kısmında, hastalıklarının seyri sırasında yutma bozukluğu (disfaji) gelişir. Hastalar tarafından genellikle arka planda tutulan disfaji, katı veya sıvı bolus alımını zorlaştırır, yaşam kalitesini azaltır ve PH'de başta gelen ölüm nedenlerinden biri olan aspirasyon pnömonisine yol açar. Yutma bozukluğu gelişiminde hastalık evresi, kilo kaybı, Birleşik Parkinson Hastalığı Derecelendirme Ölçeği (UPDRS) bölüm III skorunun >26 olması, demans ve siyalore gibi klinik öngörücüler bulunmaktadır. PH’de disfajinin altta yatan patofizyolojisi tam olarak anlaşılamamasına rağmen dopaminerjik ve dopaminerjik olmayan mekanizmalardaki bozulmaların rol oynayabileceği bildirilmiştir. PH'de ortaya çıkan disfajinin değerlendirmesinde tarama araçları, klinik yutma değerlendirmesi ve enstrümental yöntemler yutma bozukluğu riski taşıyan hastaları belirlemek için kullanılabilir. Altın standart olarak düşünülen videofloroskopik yutma çalışması (VFYÇ) ve fiberoptik endoskopik yutma değerlendirmesi (FEYD) gibi enstrümantal yöntemler ile Parkinson hastalarının yutma fazlarındaki tipik bozulma paternleri belirlenebilir, disfaji daha erken tanılanabilir, aspirasyon olayları doğru bir şekilde tespit edilebilir ve erken müdahale sağlanabilir. PH ile ilişkili disfajinin yönetimi, kompansatuar, rehabilitatif ve tıbbi-farmakolojik yöntemleri içerir. Dopaminerjik ilaçların optimize edilmesi bazı durumlarda faydalı olabilir. Nöromuskuler elektriksel stimülasyon (NMES), derin beyin stimülasyonu (DBS) ve transkraniyal manyetik stimülasyonun (TMS) PH ile ilişkili disfajinin tedavisinde faydalı etkilerine yönelik daha fazla araştırmaya ihtiyaç vardır. Bu derlemenin amacı, PH ile ilişkili yutma bozukluklarının epidemiyolojisi, patofizyolojisi, değerlendirilmesi ve yönetimi hakkında genel bir bakış açısı sunmak ve gelecekteki klinik araştırmalar için yol gösterici olmaktır.
We have established that in the Becker strain of pseudorabies virus (PRV), the glycoprotein gIII gene is not essential for growth in cell culture. This was accomplished by construction and analysis of viral mutants containing two defined deletion mutations affecting the gIII gene. These mutations were first constructed in vitro and introduced into Escherichia coli expression plasmids to verify structure and protein production. Each mutation was then crossed onto PRV by cotransfection of plasmid DNA and parental viral DNA by using gIII-specific monoclonal antibodies as selective and screening reagents. One resultant virus strain, PRV-2, contained an in-frame deletion of a 402-base-pair (bp) SacI fragment contained within the gIII gene. Another virus strain, PRV-10, contained a deletion of a 1,480-bp XhoI fragment removing 230 bp of the upstream, putative transcriptional control sequences and 87% of the gIII coding sequence. The deletion mutants were compared with parental virus by analysis of virion DNA, gIII specific RNA, and proteins reacting with gIII specific antibodies. Upon infection of PK15 cells, the deletion mutants did not produce any proteins that reacted with two gIII specific monoclonal antibodies. However, two species of truncated glycosylated proteins were observed in PRV-2 infected cells that reacted with antiserum raised against bacterially produced gIII protein. PRV-10 produced no detectable gIII-specific RNA or protein. PRV-10 could be propagated without difficulty in tissue culture. Virus particles lacking gIII were indistinguishable from parental PRV virus particles by analysis of infected-cell thin sections in the electron microscope. We therefore conclude that expression of the gIII gene was not absolutely essential for PRV growth in tissue culture.
To assess the contribution of visuoperceptual function to complex visuomotor responding in Parkinson's disease, 14 patients with idiopathic PD and 12 normal controls matched for age, education and general intellectual function were administered a visual tracing task. No difference was found between the groups on two visuoperceptual tests, the Benton Line Orientation test and a test of trajectory judgement. However, patients were significantly impaired in tracing a sawtooth design when two consecutive angles of the sawtooth were occluded. This impairment occurred in reproducing the basic form of the stimulus and not with accuracy of fine detail. These results suggest higher-order perceptual motor dysfunction independent of any breakdown in basic visuoperceptual processing or loss of fine motor control. It is concluded that Parkinsonian patients are unable to use sensory information accurately to plan and execute complex or new movements.
The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.
Summary There is conjoining experimental and clinical evidence supporting a fundamental role of the basal ganglia as a sensory analyser engaged in central somatosensory control. This study was aimed at investigating the functional anatomy of sensory processing in two clinical conditions characterized by basal ganglia dysfunction, i.e. Parkinson's and Huntington's disease. Based on previously recorded data of somatosensory evoked potentials, we expected deficient sensory-evoked activation in cortical areas that receive modulatory somatosensory input via the basal ganglia. Eight Parkinson's disease patients, eight Huntington's disease patients and eight healthy controls underwent repetitive H215O-PET activation scans during two experimental conditions in random order: (i) continuous unilateral high-frequency vibratory stimulation applied to the immobilized metacarpal joint of the index finger and (ii) rest (no vibratory stimulus). In the control cohort, the activation pattern was lateralized to the side opposite to stimulus presentation, including cortical (primary sensory cortex (S1); secondary sensory cortex (S2)) and subcortical (globus pallidus, ventrolateral thalamus) regional cerebral blood flow (rCBF) increases ( P < 0.001). Between-group comparisons (P < 0.01) of vibration-induced rCBF changes
Dysphagia is common in children with severe developmental disabilities. The nature of these difficulties can predispose them to foreign body ingestion. This article presents a case that highlights the need for vigilance in diagnosing dysphagia in children with multiple and complex developmental disabilities where severe cognitive impairment and an inability to communicate may mask the presence of underlying problems.
Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.
Gastrointestinal abnormalities in Parkinson's disease (PD) have been known for almost two centuries, but many aspects concerning their pathophysiology have not been completely clarified. The aim of this study was to characterize the oropharyngeal dynamics in PD patients with and without levodopa-induced dyskinesia. Fifteen dyskinetic, 12 nondyskinetic patients, and a control group were included. Patients were asked about dysphagia and evaluated with the Unified Parkinson's Disease Rating Scale Parts II and III and the Hoehn and Yahr scale. Deglutition was assessed using modified barium swallow with videofluoroscopy. Nondyskinetic patients, but not the dyskinetic ones, showed less oropharyngeal swallowing efficiency (OPSE) for liquid food than controls (Dunnett, P = 0.02). Dyskinetic patients tended to have a greater OPSE than nondyskinetic (Dunnett, P = 0.06). Patients who were using a higher dose of levodopa had a greater OPSE and a trend toward a smaller oral transit time (Pearson's correlation, P = 0.01 and 0.08, respectively). Neither the report of dysphagia nor any of the PD severity parameters correlated to the videofluoroscopic variables. In the current study, dyskinetic patients performed better in swallowing function, which could be explained on the basis of a greater levodopa dose. Our results suggest a role for levodopa in the oral phase of deglutition and confirm that dysphagia is not a good predictor of deglutition alterations in PD.
The progressive, neurodegenerative process underlying idiopathic Parkinson's disease is associated with the formation of proteinaceous inclusion bodies that involve a few susceptible neuronal types of the human nervous system. In the lower brain stem, the process begins in the dorsal motor nucleus of the vagus nerve and advances from there essentially upwards through susceptible regions of the medulla oblongata, pontine tegmentum, midbrain, and basal forebrain until it reaches the cerebral cortex. With time, multiple components of the autonomic, limbic, and motor systems become severely impaired. All of the vulnerable subcortical grays and cortical areas are closely interconnected. Incidental cases of idiopathic Parkinson's disease may show involvement of both the enteric nervous system and the dorsal motor nucleus of the vagus nerve. This observation, combined with the working hypothesis that the stereotypic topographic expansion pattern of the lesions may resemble that of a falling row of dominos, prompts the question whether the disorder might originate outside of the central nervous system, caused by a yet unidentified pathogen that is capable of passing the mucosal barrier of the gastrointestinal tract and, via postganglionic enteric neurons, entering the central nervous system along unmyelinated praeganglionic fibers generated from the visceromotor projection cells of the vagus nerve. By way of retrograde axonal and transneuronal transport, such a causative pathogen could reach selectively vulnerable subcortical nuclei and, unimpeded, gain access to the cerebral cortex. The here hypothesized mechanism offers one possible explanation for the sequential and apparently uninterrupted manner in which vulnerable brain regions, subcortical grays and cortical areas become involved in idiopathic Parkinson's disease.
The aim of this study was to assess the reflex and oral, pharyngeal, esophageal phase of swallowing in patients with Parkinson's disease (PD). Eighteen patients with PD and 22 healthy control subjects were investigated using electromyography (EMG) and esophageal scintigraphy. This study demonstrated delayed triggering of the swallowing reflex (443+/-84 ms in patients with PD vs. 230+/-96 ms in controls, p<0.05) and prolongation of laryngeal movement (980+/-140 vs. 649+/-145 ms, p<0.05). We found prolongation of the esophageal phase of swallowing (14.46+/-5.30 vs. 7.45+/-1.64 s, p<0.001) in PD patients. The dysphagia limit i.e. the maximum amount of water swallowed at once was smaller in PD patients than in controls (6.23+/-3.67 vs. >20 ml). Dysphagia was observed in all patients studied although only 13 of them complained about it. In the remaining five cases swallowing impairment was subclinical and it consisted of decreased dysphagia limit and prolongation of the esophageal phase. Dysphagia at the subclinical level may be one of the early symptoms of PD.
Acid reflux is becoming increasingly well recognized as an important factor in the pathophysiology of diseases that affect the respiratory tract. The pathophysiologic mechanisms responsible for the production of reflux-induced respiratory symptoms involve direct chemical injury, as well as neural reflexes. Acid reflux has been suggested as a causal factor in the development of asthma, chronic cough, pneumonia, and apnea. Although these symptoms are significant causes of illness and healthcare use, patients who suffer from these conditions often do not report typical reflux symptoms, such as heartburn and acid regurgitation. The purpose of this article is to describe the pathogenesis and clinical syndromes affecting the respiratory tract that are commonly encountered in clinical practice and their treatment.
This investigation was designed to study to what extent dysphagia in the elderly is accompanied by other chest symptoms and if it leads to a reduction in body weight and quality of life. To this end 796 persons, randomly taken from a population register, replied to a questionnaire concerning swallowing difficulties and other chest symptoms. Chest pain, heartburn, and regurgitation occurred significantly more frequently in subjects who admitted feelings of obstruction in the throat or chest during the ingestion of food (p less than 0.001) than in the rest, as did so-called heart problems (p less than 0.05). People with dysphagia had more often gained weight over the last 5 years than people without dysphagia (p less than 0.05). Psychosocial problems in those with dysphagia were given as anxiety at mealtimes and the wish to eat alone. Of those with dysphagia, 40% had consulted a physician, but despite this these patients had as many problems as those who had not seen a doctor. It is apparent that difficulty in swallowing in the elderly leads to physical and psychosocial problems that may reduce their quality of life.
We investigated swallowing abnormalities in patients with Parkinson's disease, the relationship between these abnormalities and general parkinsonian signs, as well as the response to therapy. Twenty patients and 13 controls were evaluated with clinical rating scales and modified barium swallows before and after oral levodopa (in combination with carbidopa). Fifteen patients, but only 1 control, had abnormal swallows (chi 2 = 11.722, df = 1, p less than 0.001). Abnormalities included disturbances of oral and pharyngeal phases of swallowing. Patients without dysphagia frequently had abnormal swallows, including silent aspiration. Seven patients had improved swallowing after levodopa, whereas 1 worsened. Improvement in general parkinsonian signs was not a reliable indicator of improved swallowing.
Videofluoroscopy was used to examine movement patterns during swallowing and speech production in 6 parkinsonian subjects and 6 age-matched controls. Motility patterns for liquid and semisolid swallows were documented. We performed temporospatial analyses of oropharyngeal structures, particularly the velum, which is prominently involved in both motor speech production and swallowing. Differences were found between groups and conditions. All of the parkinsonian subjects exhibited abnormal oropharyngeal movement patterns and timing during the volitional oral as well as the pharyngeal stage of swallowing; only 50% of these subjects admitted to any swallowing difficulty upon questioning. Two of the subjects with Parkinson's disease aspirated liquids. Duration of velar movement during speech production significantly differentiated the groups (p less than 0.01), reflecting reduced range of velar motion. Our findings suggest that rigidity and bradykinesia underlie the volitional speech abnormality as well as the disordered oral and pharyngeal stages of swallowing. Findings indicate that parkinsonian patients may be "silent aspirators" with decreased cough reflexes and lack of awareness of aspiration. The clinical value of videofluoroscopic monitoring of swallowing is that aspiration may be detected and managed early.
A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques.
Several tasks examined the status of implicit and explicit memory in three patients with a ruptured anterior communicating artery (ACoA) aneurysm, one patient with bilateral temporal lobe damage sustained from herpes encephalitis (HE), 12 Alzheimer's disease (AD) patients, and 16 elderly normal controls demographically matched to the AD patients. All subjects completed word stem-completion repetition priming, pursuit-rotor tracking, and a fragmented pictures test, followed by explicit memory tests. ACoA, HE, and AD patients were impaired on all explicit tests. HE and AD patients were impaired on stem-completion priming, but were intact on other implicit tests. ACoA patients were intact on all implicit tests given. Discussion of these results considers similarities and differences in extent of basal forebrain and temporal lobe damage.
To determine whether there is a complex sensory disturbance that may be contributing to the motor deficit in patients with Parkinson disease.
Comparison of performance by patients and healthy, age- and sex-matched subjects in tests of various sensory functions.
The Center for Human Performance and Testing at a university hospital and research center.
Ten subjects with Parkinson disease and 10 control subjects matched for age and sex.
Performance on 4 subjects of the Sensory Integration and Praxis Test: finger identification, graphesthesia, localization of tactile stimuli, and kinesthesia.
Data were analyzed using paired t tests for ratio data and the paired Wilcoxon test for ordinal data. Patients with Parkinson disease performed significantly worse (P = .001) than the control patients on the test of kinesthesia. There were no significant differences between the 2 groups on the other subtests.
Without visual guidance, patients with Parkinson disease had more difficulty in perceiving the extent of a movement made to a target away from the body, a task requiring reliance on proprioceptive feedback. Parkinsonian patients had no more difficulty than controls in making movements to a target on the surface of the body when they could use tactile sensations. Movement difficulties in patients with Parkinson disease may relate in part to a decrease in proprioception. Activities that enhance kinesthetic awareness may be an important adjunct to the treatment of these patients.
The effects upon the trajectories of practised slow (approximately 9 degrees/s) voluntary wrist-extension movements of applying vibration to the tendon of an antagonist muscle (flexor carpi radialis) during the course of the movement have been studied in patients with idiopathic Parkinson's disease and age-matched healthy individuals. In both patient and control groups, flexor vibration elicited undershooting of wrist-extension movements. Wrist extensor and flexor surface EMG recordings indicated that, in patients and controls, such undershooting resulted principally from sustained reductions in extensor (prime mover) activity. Small vibration reflexes were commonly elicited in the wrist flexors which, in both Parkinson's disease and healthy subjects, were usually otherwise virtually quiescent during these slow extension movements. The amplitudes of such vibration reflexes did not differ systematically between patient and control groups and appeared inadequate to have exerted an appreciable braking action upon the extension trajectories. However, the extent of vibration-induced undershooting was, on average, significantly less in the Parkinson's disease group. In a subgroup of patients with asymmetrical parkinsonism the effects of antagonist vibration upon wrist movements of the more and less affected limb were compared. The degree of vibration-induced undershooting was significantly smaller on the more affected side. This finding suggests that disturbed proprioceptive guidance of voluntary movements in Parkinson's disease is related to the severity of clinical motor deficits. A small number Parkinson's disease patients were studied 'ON' and 'OFF' their routine anti-parkinsonian medication. A non-significant tendency was found for vibration-induced errors to be less marked in the 'OFF' state. In a separate series of experiments, under isometric conditions, vibration-induced EMG changes were recorded whilst subjects attempted to maintain a steady (15% maximum) voluntary wrist extensor effort. Results in control subjects suggested that prolonged flexor vibration produced significant tonic reflex reciprocal inhibition of the extensor muscles. However, the strength of reflex inhibition appeared sufficient to account for only a small fraction of the undershooting observed during the movement tasks. Thus, our results are consistent with the existence of an abnormality of higher-level proprioceptive integration in Parkinson's disease in which there is a mismatch of sensory (proprioceptive) and motor (corollary discharge) information.
This study describes five patients with slowly developing dysphagia secondary to oculopharyngeal muscular dystrophy (OPMD), a progressive neurological disorder characterized by gradual onset of dysphagia, ptosis, and facial and trunk limb weakness. OPMD is a genetic disorder that affects formerly healthy adults who typically begin to experience symptoms in the fourth or fifth decade of life. Despite the debilitating nature of the disease, it is common for affected individuals to live to old age. Because of the gradual progression of dysphagia, as well as the deterioration of articulation, resonance, and breath support, patients with OPMD may come to the attention of physicians, nurses, and speech pathologists before a diagnosis is made. We hope to heighten awareness of how these subjects developed strategies to cope with their swallowing problems without medical intervention until the disease was producing marked symptoms. Patients with suspected dysphagia should be questioned about overt problems with eating and swallowing, but also about their adaptations and compensatory strategies. A Clinical Interview Questionnaire is included that may yield additional information about hidden dysphagia.
This paper reviews the main neuropsychological features of movement disorders such as Parkinson's disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), Huntington's disease (HD), corticobasal degeneration (CBD), and diffuse Lewy body disease (DLBD). These neurodegenerative disorders all share a prominent frontal lobe-like syndrome which can be explained by damage to connections between the basal ganglia and the cortical areas involved in movement, and in behavioural and mood control. In this paper different types of cognitive and mood alteration are described in an attempt to identify additional reasons for the differential diagnosis of parkinsonism-like syndromes.
Stroke is a common problem, producing a variety of neurological problems that affect eating. Dysphagia is a particular concern because of its potential for airway obstruction, malnutrition, and aspiration pneumonia. With chest infection reported in up to 32% of stroke patients, this is a major clinical issue. The following research questions are raised: (1) What are the incidence and outcomes of dysphagia and aspiration in acute stroke? (2) What screening interventions are available to detect dysphagia in patients with acute stroke and what effect have they on patient outcomes? A systematic review was carried out using methods and quality criteria of the NHS Centre for Reviews and Dissemination (1996), focusing on studies of adults with acute stroke. Data were extracted, collated, and presented descriptively. Two hundred forty-eight articles were retrieved with 26 meeting inclusion and quality criteria. Clinical dysphagia is common, associated with a range of deleterious outcomes and clearly linked to development of chest infection. Interpretation of aspiration on videofluoroscopy is not as straightforward but probably also confers additional risk. Further work is required on the relationship between aspiration and pneumonia, and pneumonia prevention. This will include exploration of the effects of screening, and the further development and validation of screening methods. While studies indicate current "best practice," in this important area of patient care further work is urgently required.
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in the elderly, and the leading cause of death among residents of nursing homes. Oropharyngeal aspiration is an important etiologic factor leading to pneumonia in the elderly. The incidence of cerebrovascular and degenerative neurologic diseases increase with aging, and these disorders are associated with dysphagia and an impaired cough reflex with the increased likelihood of oropharyngeal aspiration. Elderly patients with clinical signs suggestive of dysphagia and/or who have CAP should be referred for a swallow evaluation. Patients with dysphagia require a multidisciplinary approach to swallowing management. This may include swallow therapy, dietary modification, aggressive oral care, and consideration for treatment with an angiotensin-converting enzyme inhibitor.
The accuracy of patients' symptom localization in dysphagia is not clear. This study aims to determine the accuracy of patient localization and to determine the correlation of localization with motility disorders. We reviewed 100 patients after completion of EGD, manometry, and a dysphagia questionnaire. Proximal and midesophageal localization were rarely associated with a proximal cause of dysphagia. Distal localization correlated in 80% of cases. Fifty-seven percent of patients reporting diffuse symptoms had manometric abnormalities, but only 9% of patients with manometric abnormalities reported diffuse symptoms. In conclusion, patient localization in esophageal dysphagia is not accurate. The data suggest that proximal localization is especially inaccurate, whereas distal localization may be more accurate. Finally, there is no correlation between diffuse localization and diagnosis of motility disorders.