Dysphagia in Progressive Supranuclear Palsy: Radiologic Features

Abstract

Progressive supranuclear palsy (PSP) is a progressive degenerative extrapyramidal disease that often masquerades as Parkinson's disease (PD). Similar to PD, dysphagia frequently complicates the course of PSP. Because there is only one published report characterizing dysphagia in PSP, we reviewed the neurologic features and dynamic videofluoroscopic swallowing function study results in 10 dysphagic PSP patients. Abnormalities during multiple stages of ingestion were recorded in each patient. Uncoordinated lingual movements, absent velar retraction or elevation, impaired posterior lingual displacement, and copious pharyngeal secretions were noted in all patients. Tongue-assisted mastication, noncohesive lingual transfer, excessive oral bolus lingual leakage to the pharynx prior to active transfer, vallecular bolus retention, abnormal epiglottic positioning, and hiatal hernias were noted in at least half of the cohort. Although ingestion abnormalities in PSP are similar to those previously reported in PD, the number of studied patients and observed differences were too few to clearly differentiate the two diseases.

A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration

“…The degree of cognitive impairment positively correlates to both individual reports of difficulty and clinician-observed swallow impairment [20, 83]. Aberrant eating behaviors – namely, impulsive eating – are reported in PSP [79, 81, 84]. …”

“…The aim of these studies is typically to capture a broad spectrum of behaviors, and therefore they do not provide an in-depth description of the eating behaviors or their progression [35]. There is a paucity of research which evaluates swallowing impairment following FTLD, as only a few studies use instrumental investigation to fully describe the impairments [4, 8, 19, 20, 52, 79]. …”

“…Individuals with PSP are thought to present an accurate awareness of their difficulty eating and drinking when assessed by questionnaire and verified by VFSS [78, 79]. The degree of cognitive impairment positively correlates to both individual reports of difficulty and clinician-observed swallow impairment [20, 83].…”

“…Levodopa, commonly prescribed to treat dysphagia in individuals with Parkinson’s disease, is ineffective in treating the bradykinesia-related swallow impairments of PSP [79, 81, 82]. Postural modification in combination with modified diet texture presents the best current treatment option for managing dysphagia [79, 83]. …”

“…Mealtime disturbances are primarily managed by increased caregiver supervision. Recommended management techniques include locking food away, reducing access to large portions, monitoring for food-seeking or stealing, providing healthy alternatives to sweets, cueing the individual to slow down during meals, modifying diet texture as needed, and ensuring proper body positioning for safe swallowing (e.g., bolt upright) [16, 79, 85, 86]. Rehabilitation clinicians can assist caregivers in modifying the eating environment, providing appropriate cues during meals, managing dietary changes, and reducing aspiration risks [87].…”