Changes in Chemosensitivity and Mechanosensitivity in Aging and Parkinson’s Disease

Leow, Li Pyn; Beckert, Lutz; Anderson, Tim; Huckabee, Maggie‐Lee

doi:10.1007/s00455-011-9347-z

Cited by 52 publications

(42 citation statements)

References 33 publications

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“…In the presence of airway compromise during swallowing, the ability to remove aspirate material from the airway is imperative. Assuming the ability to detect that a stimulus is intact, as it seems to be at least for moderate-stage PD [3, 18], the motor response must generate the airflow and dynamic compression necessary to aerosolize and remove aspirate particulates from the airway if effective coughing is to be achieved. These results strongly suggest that in those with both PD and airway compromise during swallowing, the effectiveness of the cough motor response is reduced.…”

Section: Discussionmentioning

confidence: 99%

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Wheeler-Hegland

Okun

Troche

2014

Lung

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Background Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson’s disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia. Methods Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration–aspiration score observed was used to determine whether the patient had dysphagia. Results There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia. Conclusions The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.

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Section: Discussionmentioning

confidence: 99%

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Wheeler-Hegland

Okun

Troche

2014

Lung

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“…In PD, tongue tremor, delayed swallowing trigger, impaired bolus formation, and pharyngeal motility disturbances can be documented by radiographic studies 7. Reduced sensation of the base of tongue and larynx can result in silent aspiration of liquids and solids 3, 5, 8, 9. However, unlike most other motor impairments of PD, swallowing problems often do not improve with dopaminergic treatment 5…”

mentioning

confidence: 99%

Comparison of dysphagia before and after deep brain stimulation in Parkinson's disease

et al. 2012

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Although dysphagia is a common problem for many Parkinson's disease (PD) patients, the effect of deep brain stimulation (DBS) on swallowing is unclear. Fourteen subjects with advanced PD underwent videofluorographic swallowing studies prior to bilateral DBS of the subthalamic nucleus (STN) and at 3 and 12 months postprocedure. They were tested under several stimulation and medication conditions. Subjects completed the Dysphagia Handicap Index at each time. There was a strong trend toward improved swallowing response for solid intake in the medication-free condition with the stimulator on compared with the stimulator off (P = .0107). Also, there was a trend toward improved oral preparation of thin liquids (P = .0368) in the medication-free condition when the stimulator was on versus off 12 months later. The remaining swallowing parameters showed no change or worsening of swallowing function regardless of stimulator or medication status. Results of the Dysphagia Handicap Index revealed significant improvement in subject self-perception of swallowing 3 and 12 months following the procedure compared with baseline on the functional subscale (P = .020 and P = .010, respectively), the emotional subscale (P = .013 and P = .003, respectively), and the total score (P = .025 and P = .003, respectively). These data suggest that bilateral STN-DBS does not substantively impair swallowing in PD. In addition, it may improve motor sequencing of the oropharyngeal swallow for solid consistencies (which are known to provide increased sensory feedback to assist motor planning of the oropharyngeal swallow). Subjects with advanced PD who are undergoing DBS may perceive significant improvement in swallowing ability despite the lack of objective improvements in swallowing function.

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“…22 Clement Clarke International Limited) with an obstructed flow rate of 6.6 L/min. [24][25][26][27] Participants were blinded to the doses presented. Try not to cough."…”

Section: Cough Reflex Sensitivitymentioning

confidence: 99%

The association between oral bacteria, the cough reflex and pneumonia in patients with acute stroke and suspected dysphagia

Perry

Huckabee

Tompkins

et al. 2019

J of Oral Rehabilitation

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Objective: To establish how oral bacteria are related to cough sensitivity and pneumonia in a clinical stroke population.Background: Stroke patients are at risk of colonisation by respiratory pathogens due, in part, to sudden discontinuation of effective oral hygiene. When combined with reduced cough reflex sensitivity, aspiration of contaminated oropharyngeal contents and can lead to pneumonia. Relationships between oral bacteria, cough sensitivity and pneumonia have not been established. Materials and methods:A total of 102 patients with acute stroke underwent saliva sampling and cough reflex testing at admission to hospital, discharge and one month.A qPCR assay compared levels of bacteria in saliva. Pneumonia events were recorded.Results: Relative levels of bacteria were lowest at admission to hospital (6.04 × 10 −6 ).There was a slight (non-significant) increase in bacterial levels at discharge (1.69 × 10 −2 , P = .73). By one month, bacterial levels had significantly increased (9.17 × 10 −2 ) relative to admission [P < .001] and discharge [P < .001]. Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are not typically found in healthy mouths, yet were detected in 22% of patients during hospitalisation. Combined bacterial levels measured at one month was associated with pneumonia (P = .004) but there was no relationship to cough sensitivity.Conclusion: Acute stroke patients were at increased risk of colonisation from respiratory pathogens throughout their recovery. The presence of these pathogens in saliva at one month was associated with adverse respiratory events. Data support the development of protocols to explore risk factors and sequelae of microbiological changes in stroke. K E Y W O R D SAspiration Pneumonia, CVA, oral hygiene, qPCR | 387 PERRY Et al.

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Changes in Chemosensitivity and Mechanosensitivity in Aging and Parkinson’s Disease

Cited by 52 publications

References 33 publications

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Sequential Voluntary Cough and Aspiration or Aspiration Risk in Parkinson’s Disease

Comparison of dysphagia before and after deep brain stimulation in Parkinson's disease

The association between oral bacteria, the cough reflex and pneumonia in patients with acute stroke and suspected dysphagia

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