A simple bedside test to assess the swallowing dysfunction in Parkinson′s disease

Abstract

Background:Swallowing changes are common in Parkinson's disease (PD). Early identification is essential to avoid complications of aspiration.Objectives:To evaluate the swallowing ability of the PD patients and to correlate it with the indicators of disease progression.Materials and Methods:A total of 100 PD patients (70 males and 30 females) aged between 50 years and 70 years with varying stage, duration, and severity were enrolled in a cross-sectional study carried out between January and May 2012. A simple bedside water swallowing test was performed using standard 150 ml of water. Swallowing process was assessed under three categories-swallowing speeds (ml/s), swallowing volume (ml/swallow) and swallowing duration (s/swallow). Equal number of age and sex matched controls were also evaluated.Results:All of them completed the task of swallowing. A mean swallowing speed (27.48 ml/s), swallowing volume (28.5 ml/s), and swallowing duration (1.05 s/swallow) was established by the control group. The PD patients showed decreased swallowing speed (7.15 ml/s in males and 6.61 ml/s in females), decreased swallowing volume (14.59 ml/swallow and 14 ml/swallow in females), and increased swallowing duration (2.37 s/swallow and 2.42 s/swallow) which are statistically significant. There was a significant positive correlation between the severity, duration, and staging of the disease with the swallowing performance and a poor correlation between the subjective reports of dysphagia and the objective performance on water swallow test.Conclusion:The water swallowing test is a simple bedside test to identify the swallowing changes early in PD. It is recommended to do the test in all PD Patients to detect dysphagia early and to intervene appropriately.

Swallowing Speed as Potential Predictor of Aspiration in Parkinson’s Disease Patients

“…We found men swallowing faster than women (7.3 ± 4.2 ml/s vs. 5.1 ± 2.8 ml/s) which also fits the results of Kanna and Bhanu [13] (7.2 ± 3.4 ml/s in men and 6.6 ± 2.8 ml/s in women). Noteworthy, we detected a statistically significant lower swallowing speed for women exclusively in the patient cohort but not amongst controls.…”

“…Searching the literature revealed that the precedent terminology for swallowing speed is heterogeneous and includes particularly the terms "swallowing velocity" "swallowing capacity", "flux of ingestion" or "swallowing flow" as well [13,14,17,22,23]. Considering all these terms, we found five studies assessing swallowing speed primarily in PD patients but none with an objective evaluation of aspiration using either FEES or VFSS [11,13,[23][24][25]. Mean swallowing speed in our PD cohort (6.5 ± 3.9 ml/s) was significantly lower compared with controls (8.5 ± 3.2 ml/s) and in accordance to findings of Kanna and Bhanu [13] in 100 PD patients (7.0 ± 3.2 ml/s).…”

“…Considering all these terms, we found five studies assessing swallowing speed primarily in PD patients but none with an objective evaluation of aspiration using either FEES or VFSS [11,13,[23][24][25]. Mean swallowing speed in our PD cohort (6.5 ± 3.9 ml/s) was significantly lower compared with controls (8.5 ± 3.2 ml/s) and in accordance to findings of Kanna and Bhanu [13] in 100 PD patients (7.0 ± 3.2 ml/s). Studies with lower numbers of PD patients (n = 10 to 75) showed mean swallowing speeds of 4.3 ml/s to 9.5 ml/s [23][24][25].…”

“…Thus, it remains unclear if this threshold is reliable for PD patients. Noteworthy, a mean swallowing speed of 7.0 ml/s has been found in 100 PD patients suggesting that a threshold of 10 ml/s might be too high for patients with PD [13]. While it is consensus that average swallowing speed decreases with age in healthy subjects [14][15][16], data on gender differences in swallowing speed are controversial with the description of slower [10,15,17] or equal [16] speed in women when compared to men.…”

The safety issues and hardware-related complications of deep brain stimulation therapy: a single-center retrospective analysis of 478 patients with Parkinson’s disease

“…These swallowing-related disorders are likely the result of stereotyped movement and motor impairment of the epiglottis and throat muscles 23,24. Kanna and Bhanu also reported a high prevalence of swallowing-related diseases in patients with PD, the severity of which was associated with the duration and severity of PD 25. Therefore, it is particularly important to pay attention to the signs and symptoms of swallowing-related disease, for both early intervention and improvement of quality of life.…”