Motor subtypes and other risk factors associated with drooling in Parkinson's disease patients

Mao, Cheng‐Jie; Xiong, Yi‐Tong; Wang, F.; Yang, Yaping; Yuan, Wen Lun; Zhu, Carolyn W.; Chen, J.; Liu, Chun‐Feng

doi:10.1111/ane.12893

Cited by 16 publications

(27 citation statements)

References 32 publications

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“…They found disease-associated increase in numerous immune and angiogenesis mediators, but only in the stool of female PD patients while the stool of male patients did not differ significantly from controls [23]. Female PD patients have also shown higher predisposition to develop critical dysphagia [24], whereas male patients are more prone to severe drooling [25].…”

Section: Non-motor Symptomsmentioning

confidence: 98%

Parkinson’s Disease in Women and Men: What’s the Difference?

Cerri¹,

Mus²,

Blandini³

2019

Journal of Parkinson’s Disease

488

309

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Increasing evidence points to biological sex as an important factor in the development and phenotypical expression of Parkinson's disease (PD). Risk of developing PD is twice as high in men than women, but women have a higher mortality rate and faster progression of the disease. Moreover, motor and nonmotor symptoms, response to treatments and disease risk factors differ between women and men. Altogether, sex-related differences in PD support the idea that disease development might involve distinct pathogenic mechanisms (or the same mechanism but in a different way) in male and female patients. This review summarizes the most recent knowledge concerning differences between women and men in PD clinical features, risk factors, response to treatments and mechanisms underlying the disease pathophysiology. Unraveling how the pathology differently affect the two sexes might allow the development of tailored interventions and the design of innovative programs that meet the distinct needs of men and women, improving patient care.

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Section: Non-motor Symptomsmentioning

confidence: 98%

Parkinson’s Disease in Women and Men: What’s the Difference?

Cerri¹,

Mus²,

Blandini³

2019

Journal of Parkinson’s Disease

488

309

View full text Add to dashboard Cite

show abstract

“…5 In an early PD population [disease duration 3.5 years in patients with drooling ( n = 320)], male sex, motor severity, excess daytime sleepiness, impaired sleep quality, constipation, and nontremor-dominant subtype were among the clinical factors associated with worsened drooling. 25 With advanced PD [disease duration 5 years in patients with drooling ( n = 273)], drooling was associated with higher frequencies of speech disturbances and dysphagia, and increased severity of motor and nonmotor symptoms, depression and anxiety. 26 The mechanism of drooling in PD is multifactorial and includes reduced salivary swallowing and facial hypomimia, that, when severe, can lead to dribbling of accumulated saliva.…”

Section: Impact Of Sialorrhoea In Adult Neurological Diseasesmentioning

confidence: 99%

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®)

Morgante

Bavikatte

Anwar

et al. 2019

Ther Adv Neurol Disord

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Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients’ needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.

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“…23,24,28,31,39,43,50,51 Individuals with non-tremor dominant PD phenotypes were at higher risk of drooling. 31,52 The precise contribution of these factors remains unsettled. The uncertainty rests partly on general issues above regarding why estimates of drooling prevalence and flow rates exist, but variability in individual profiles of impairment and disability also contributes.…”

Section: Risk Factors For Drooling In Pdmentioning

confidence: 99%

“…When motor, age and duration variables are controlled, LDDE appears no longer associated with drooling severity. 23,24,52 Proulx et al 38 found an association of l-dopa and hyposalivation, but Persson et al 56 observed no differences in salivary secretion rate between pwPD and controls, nor between subgroups of pwPD taking versus not taking dopaminergic medication. Bagheri et al 45 established no difference in salivary flow rates between treated and de novo pwPD.…”

Section: Risk Factors For Drooling In Pdmentioning

confidence: 99%

<p>Sialorrhea in Parkinson’s disease: prevalence, impact and management strategies</p>

Miller¹,

Walshe²,

Walker³

2019

JPRLS

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Saliva plays an important part in oral health maintenance, mastication, deglutition and the start of the digestive process. It supports clear speech. Alterations to the composition and flow of saliva through hyper-or hyposecretion or anterior loss through the lips thus have potentially significant consequences. This article reviews the metrics, possible age and gender differences and diurnal variability of flow in healthy individuals. It then focuses on the ways in which this is altered in Parkinson's disease (PD) and the possible mechanisms for why people with PD drool. It reviews procedures for clinical assessment and management. Many studies report drooling prevalence >50% of people with PD, though in the early stages the impact may not yet be great. In PD, saliva flow is normal or even decreased compared to people without PD. Motorically sialorrhea arises from an interaction between oro-facial rigidity, lingual bradykinesia and aspects of oro-pharyngeal dysphagia. Postural, cognitive, attentional and pharmacological factors may also contribute. Objective evaluation of sialorrhea looks at the rate and variability of flow (milliliters or milligrams per unit time; swallow intervals; consistency). Since objective measures seldom reflect patient-reported lived experience, assessment includes rating scales that capture subjective concerns. Because altered salivary function impacts on (peri)oral health, assessment and monitoring of this is strongly advocated. Methods in each of these assessment domains are introduced. Clinical guidelines recommend behavioral interventions in the first instance, with pharmacological treatments, including botulinum injection, as follow-up possibilities. Surgical procedures are reserved for severe or intractable cases. High-quality evidence for the efficacy of behavioral interventions is lacking. Drug therapy efficacy is also under-studied, apart from botulinum toxin management. Few studies have examined surgical interventions in PD, though principles are well established from other populations. Strands of enquiry for improving our knowledge of behavioral interventions are suggested.

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Motor subtypes and other risk factors associated with drooling in Parkinson's disease patients

Abstract: Drooling is common, even in mild-to-moderate PD patients. PD patients with non-TD subtype are at a higher risk of drooling. Male sex, motor severity, excessive daytime sleepiness, poor nighttime sleep, and constipation are also associated with drooling in patients with PD.

Cited by 16 publications

References 32 publications

Parkinson’s Disease in Women and Men: What’s the Difference?

Parkinson’s Disease in Women and Men: What’s the Difference?

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®)

<p>Sialorrhea in Parkinson’s disease: prevalence, impact and management strategies</p>

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