Drooling in Parkinson's Disease: A Novel Tool for Assessment of Swallow Frequency

Abstract

A non-invasive way to obtain objective measurements of swallowing frequency and thus indirectly, drooling was required as part of the study 'Drooling in Parkinson's disease: objective measurement and response to therapy'. A hard disk, digital recorder was developed, for use on a laptop computer, which was capable of collecting large quantities of swallowing data from an anticipated 40 patients and 10 controls. An electric microphone was taped to the subjects' larynx for recording the swallow sounds when drinking 150 ml of water and at rest for 30 minutes. The software provides an accurate visual display of the audio-signal allowing the researcher easy access to any segment of the recording and to mark and extract the swallow events, so that swallow frequency may be efficiently and accurately ascertained. Preliminary results are presented.

Dysautonomia rating scales in Parkinson's disease: Sialorrhea, dysphagia, and constipation—Critique and recommendations by movement disorders task force on rating scales for Parkinson's disease

“…Objective methods for evaluating salivary flow and volume include saliva collection,24, 25 suctioning,26 using a Lashley disk over the parotid (Stenson's) duct,12, 13 patient based swallowing counts,12, 13 or most commonly, by placing dental cotton pads in the mouth 26, 27–33. These objective tests are too time‐consuming and impracticable for routine use in the neurology clinic and do not quantify the discomfort or social embarrassment related to sialorrhea.…”

“…Concept Model : The Drooling Rating Scale12, 13 was developed in 2001 to evaluate sialorrhea in PD patients. Patients are given a score from 0 to 3 (“excessive dryness or no excess of saliva” to “continuous drooling, wet clothes, or constant use of handkerchief or tissue”) for severity of drooling over the preceding week in the following situations: sitting, standing, in bed, talking, and while eating or drinking.…”

Evaluation of Spontaneous Swallow Frequency in Healthy People and Those With, or at Risk of Developing, Dysphagia: A Systematic Review and Meta-Analysis.

“…As such, ve were rated of good quality, six as fair/good quality, seven as fair quality, with a single paper of poor quality (Appendix A). The raters agreed that the poor quality paper [12] failed in a number of key areas, including: an inadequate de nition of the study population; no sample size justi cation; high risk of researcher bias due to lack of blinding or confounding variables; and insu cient detail with regard to the study controls and inclusion/exclusion criteria.…”

Management of Dysphagia and Drooling in Patients With Parkinson’s Disease

“…Identification NMSS × × [34] PD-NMSQuest × × [33] SCOPA-AUT × × [32] SDQ × [30] Identification and severity DRS × [67] DSFS × [66] MDS-UPDRS: item 2.3 'chewing and swallowing' × [7] MDS-UPDRS: item 2.2 'saliva and drooling' × [7] ROMP: subscale for swallowing × [31] ROMP: subscale for drooling × [31] SCS-PD × [65] SWAL-QOL × with videofluoroscopy or flexible endoscopic evaluation of swallowing depends on the local availability and protocols, but are considered the gold standard of swallowing assessment. In addition, flexible endoscopic evaluation of swallowing can be used as a biofeedback tool during treatment [37].…”

“…Two questionnaires have been designed and validated for patients with PD: the Sialorrhea Clinical Scale for PD (SCSPD) [65] and the ROMP subscale for saliva [31], the latter having included the Drooling Severity and Frequency Scale (DSFS) adapted for PD [66]. The drooling rating scales is an (unvalidated) scale to rate drooling in PD [67]. The same nonmotor questionnaires as mentioned for dysphagia also have an item on drooling (Table 1).…”