Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

Kwon, Miseon; Lee, Jae Hong

doi:10.14802/jmd.19048

Cited by 53 publications

(44 citation statements)

References 109 publications

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“…Out of all the items in the UPDRS, only two are directly related to eating activities, one is swallowing (i.e., dysphagia) and the other is cutting food and handling utensils, with both of them belonging to Part II. Consequently, recent studies show that dysphagia can be under-diagnosed due to lack of objective tools and/or poor self-awareness 24 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of real life eating difficulties in Parkinson’s disease patients by measuring plate to mouth movement elongation with inertial sensors

Kyritsis

Fagerberg

Ioakimidis

et al. 2021

Sci Rep

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Parkinson’s disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms. Despite the progressive nature of PD, early diagnosis, tracking the disease’s natural history and measuring the drug response are factors that play a major role in determining the quality of life of the affected individual. Apart from the common motor symptoms, i.e., tremor at rest, rigidity and bradykinesia, studies suggest that PD is associated with disturbances in eating behavior and energy intake. Specifically, PD is associated with drug-induced impulsive eating disorders such as binge eating, appetite-related non-motor issues such as weight loss and/or gain as well as dysphagia—factors that correlate with difficulties in completing day-to-day eating-related tasks. In this work we introduce Plate-to-Mouth (PtM), an indicator that relates with the time spent for the hand operating the utensil to transfer a quantity of food from the plate into the mouth during the course of a meal. We propose a two-step approach towards the objective calculation of PtM. Initially, we use the 3D acceleration and orientation velocity signals from an off-the-shelf smartwatch to detect the bite moments and upwards wrist micromovements that occur during a meal session. Afterwards, we process the upwards hand micromovements that appear prior to every detected bite during the meal in order to estimate the bite’s PtM duration. Finally, we use a density-based scheme to estimate the PtM durations distribution and form the in-meal eating behavior profile of the subject. In the results section, we provide validation for every step of the process independently, as well as showcase our findings using a total of three datasets, one collected in a controlled clinical setting using standardized meals (with a total of 28 meal sessions from 7 Healthy Controls (HC) and 21 PD patients) and two collected in-the-wild under free living conditions (37 meals from 4 HC/10 PD patients and 629 meals from 3 HC/3 PD patients, respectively). Experimental results reveal an Area Under the Curve (AUC) of 0.748 for the clinical dataset and 0.775/1.000 for the in-the-wild datasets towards the classification of in-meal eating behavior profiles to the PD or HC group. This is the first work that attempts to use wearable Inertial Measurement Unit (IMU) sensor data, collected both in clinical and in-the-wild settings, towards the extraction of an objective eating behavior indicator for PD.

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Section: Introductionmentioning

confidence: 99%

Assessment of real life eating difficulties in Parkinson’s disease patients by measuring plate to mouth movement elongation with inertial sensors

Kyritsis

Fagerberg

Ioakimidis

et al. 2021

Sci Rep

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“…Airway penetration and/or aspiration are often identified in PWPD, even with no or minimal complaints of swallowing difficulty [8,9]. The pathophysiological cause of decreased swallow safety in this population is thought to be multifactorial including poor bolus control, decreased esophageal function, and somatosensory deficits [10,11]. While laryngeal kinematics during swallowing, such as laryngeal vestibule closure reaction and duration times, are likely associated with dysphagia (specifically airway invasion) in PWPD, they have not been investigated until recently.…”

Section: Introductionmentioning

confidence: 99%

Predicting Airway Invasion Using Screening Tools and Laryngeal Kinematics in People with Parkinson’s Disease: A Pilot Study

Dumican

2020

JPD

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Background: Dysphagia in Parkinson's disease (PD) is a common manifestation, particularly in advanced disease stages. However, the pathophysiology and time course of dysphagia progression remains unclear in non-advanced disease stages (e.g., Hoehn & Yahr stages I-III). Conflicting reports from investigations of the perception of dysphagia in people with PD further complicates our understanding of dysphagia in this population. Objective: The objectives of this research were to evaluate the ability of screening tools to detect swallowing impairments and how laryngeal kinematics predict the occurrence of abnormal swallowing events. Methods: 14 individuals with non-advanced PD, no previous history of dysphagia diagnosis, and self-reported difficulty swallowing participated. The Swallow Disturbance Questionnaire (SDQ) and 3-oz water swallow test (WSST) were administered, along with a videoflouroscopic swallow study (VFSS). Laryngeal kinematics were represented by laryngeal vestibule closure reaction time (LVrt) and laryngeal vestibule closure duration (LVCd). The Penetration-Aspiration Scale (PAS) was used to quantify airway invasion. Results: A logistic regression indicated a significant model of predicting airway invasion from our predictors (p = 0.003). LVrt and SDQ (p < 0.05) provided the largest impact (OR = 1.11; 1.17). The WSST showed no significance in predicting swallow impairment (p > 0.05). Conclusion: Decreased airway safety related to laryngeal kinematic function in PD may be manifesting at non-advanced disease stages to varied degrees. Our results support expectations of dysphagia manifestation in PD although screening practices may not adequately identify impairment. Future research should target specific laryngeal characteristics within this population to better understand the physiological cause of swallowing impairment and developof targeted interventions.

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“…Differentiation oromotor signs in clinical stages may also facilitate optimizing the dopamine replacement therapies 43 and planning the site of deep brain stimulation 44 . Muscle-strengthening, movement-range and sensory-perceptual exercises improve lingual-wave delay and/or bolus control in oral phase 5,45 due central-peripheral mechanisms instead of muscular changes 46 . Intensive voice treatment (LSVT) targeting tongue root movement may improve coordination between breathing and swallowing or airway protection 47 .…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of swallowing problems in neurodegenerative populations is under-reported as first episode of aspiration and pneumonia 3,4 . Prevalence of dysphagia in PD has been reported as 20% to 80% 3 or 82% when the objective measures are used 5 . The causes of dysphagia in PD may be multifactorial, though muscle rigidity, slow, hesitant and incoordinated movements are major responsible factors 6 .…”

Section: Introductionmentioning

confidence: 99%

“…The temporal tongue 20,21 , velopharyngeal 22 , pharyngeal wall and oesophageal impairments ascribed to ‘enteric nervous system’ are early modifications documented in PD 5 . With appropriate technique the subtle oromotor differences might be the first sign of the disease 5 that go undiagnosed in early stages. Thus, present study was planned to investigate subtle oromotor signs during saline swallowing in early PD with non-invasive dynamic MRI.…”

Section: Introductionmentioning

confidence: 99%

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Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

Gudwani

Upadhyay

Sharma

et al. 2021

Preprint

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Background: Swallowing is complex phenomena comprising oral (preparatory and pre-swallow positioning), oropharyngeal, pharyngeal and esophageal phases. The timing of these phases is controlled by brain stem pattern generators including reflex for oropharyngeal propulsion and transit. Dysphagia in Parkinson's disease (PD) commonly observed at late stages with aspiration, pneumonia and hospitalization. Objective: Can subtle oromotor signs (if any) be observed for planning early interventions in PD Methods: The present study investigated oromotor function in fourteen early PD (onset ≤2years; H&Y ≤2.5) with dynamic MRI using saline (water) bolus and compared with seven age-matched healthy controls. Results: All the patients with PD were non-symptomatic for dysphagia by self-reporting, and on clinical assessment (Part-II MDS-UPDRS, Swallowing disturbance questionnaire, SDQ and Clinical assessment of dysphagia in neurodegeneration, CADN). Qualitatively MR images visualized, differences in PD compared to healthy controls for tongue-wave, velar-closure or release, bolus placement, oropharyngeal reflex-initiation, transit-time, epiglottic-closure-coordination and post-swallow oral or pharyngeal residue. Descriptive analysis showed higher variability of velar-closure, oropharyngeal- and pharygoesophageal-transit time in patient with PD. Group analysis (two-sample) show significant difference for velar-closure. Conclusion: Multiple lingual-waves, reverse-tongue thrust, with delayed velar control attributed to incoordinated muscular rhythm. Variable oropharyngeal transit time (0.64 to 2.25 msec) in PD ascribed to brainstem degenerative changes. Findings imply that subtle observable early oromotor signs as pre-clinical manifestation when evaluated with non-invasive, non-contrast dynamic MRI support early intervention, to prevent late-stage aspiration episodes and consequent hospitalizations.

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Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

Cited by 53 publications

References 109 publications

Assessment of real life eating difficulties in Parkinson’s disease patients by measuring plate to mouth movement elongation with inertial sensors

Assessment of real life eating difficulties in Parkinson’s disease patients by measuring plate to mouth movement elongation with inertial sensors

Predicting Airway Invasion Using Screening Tools and Laryngeal Kinematics in People with Parkinson’s Disease: A Pilot Study

Subtle oromotor signs in early Parkinson’s disease before clinical manifestations of dysphagia

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