A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value

Abstract

Background Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. Objective To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. Methods A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Results Eighty-five papers were used to inform the Panel’s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD.

The prevalence and associated factors of dysphagia in Parkinson's disease: A systematic review and meta-analysis

“…Our study showed that the prevalence of dysphagia detected using the water swallowing test was much lower than that of instrumental examination (33.6 vs. 57.3%). The diagnostic accuracy of water swallowing test relies on the retention of cough reflex and pharyngeal-laryngeal sensitivity ( 80 ). However, PD patients often have a weak cough reflex and silent aspiration, and the water swallowing test may underestimate the prevalence of dysphagia.…”

“…In addition, our study found that the prevalence of dysphagia in PD patients assessed using standardized questionnaires or scales were second only to instrumental examination (42.8 vs. 57.3%). Standardized questionnaires or scales that combine multiple aspects of clinical signs and symptoms, social life, or psychological implications associated with dysphagia, may be considered valid tools for screening for dysphagia ( 80 ). Although instrumental examination is indeed an objective and crucial modality for the diagnosis of dysphagia, its clinical application is limited due to its relatively expensive and the limitations of instrumentation and technology ( 47 , 82 ).…”

Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project

“…Dysphagia is closely related to neurological and neurodegenerative diseases such as stroke, dementia and Parkinson's disease, but also to sarcopenia, a skeletal muscle disorder due to loss of strength and muscle mass. [13][14][15][16]. Medication related adverse events, i.e.…”

Intestinal Transit in Early Moderate Parkinson’s Disease Correlates with Probable RBD: Subclinical Esophageal Dysmotility Does Not Correlate

“…Despite widespread pathology of the distal esophagus in PD, biomarkers of esophageal function have received little attention [11]. us, it is largely unknown whether subclinical esophageal dysfunction is present in early PD.…”