Effectiveness of Interventions for Dysphagia in Parkinson Disease: A Systematic Review

Abstract

Purpose: Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD. Method: Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures. Results: Interventions were classified as follows: pharmacological ( n = 11), neurostimulation ( n = 8), and behavioral ( n = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS ( n = 17), FEES ( n = 6), and EMG ( n = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa. Conclusions: Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD. Supplemental Material https://doi.org/10.23641/asha.17132162

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

“…Data regarding whether dopaminergic PD medications can improve dysphagia are equivocal ( Gandhi and Steele, 2022 ). It has been suggested for many years that swallowing dysfunction is not solely related to nigrostriatal dopamine deficiency and may have a non-dopaminergic influence ( Hunter et al, 1997 ), which may explain the observed lack of response to dopaminergic medications in some cases.…”

“…It has been suggested for many years that swallowing dysfunction is not solely related to nigrostriatal dopamine deficiency and may have a non-dopaminergic influence ( Hunter et al, 1997 ), which may explain the observed lack of response to dopaminergic medications in some cases. A systematic review of interventions for dysphagia identified nine studies that had evaluated the efficacy of different dopaminergic medications (levodopa, carbidopa, apomorphine, domperidone, and rotigotine) with mixed results ( Gandhi and Steele, 2022 ). A study undertaken in 15 patients with advanced PD whose motor symptoms were responsive to levodopa only found clinically relevant, objective improvement of dysphagia after oral administration of levodopa and evaluation using FEES in about 50% of subjects ( Warnecke et al, 2016 ).…”

How I treat Parkinson's disease

“…Recent meta-analysis demonstrated the efficacy of the Lee Silverman Voice Treatment in increasing vocal loudness and functional communication among individuals with PD 69 . Speech language therapy (SLT) has potential benefits for PD dysphagia 70 . Intensive SLT is effective for hypophonia and can lead to some improvement of voice pitch but behavioral speech rehabilitation in PD still needs validation 71 .…”

Swallowing outcomes in dysphagia interventions in Parkinson’s disease: a scoping review

“…7 Furthermore, synthesising and comparing study results to direct treatment for people with OD in PD is necessary. Two recently published systematic reviews by Gandhi and Steele 8 and López-Liria et al 9 concluded that there is an ongoing significant…”

“…Furthermore, synthesising and comparing study results to direct treatment for people with OD in PD is necessary. Two recently published systematic reviews by Gandhi and Steele 8 and López-Liria et al 9 concluded that there is an ongoing significant lack of fundamental scientific evidence on the treatment of OD in PD. In an attempt to address this issue, Schindler et al 10 established a consensus on the treatment of OD in PD.…”