Predictive clinical factors for penetration and aspiration in Parkinson's disease

Abstract

Background Do the current swallow‐specific subquestions of neurological diagnostic tools reflect the objective swallowing function in Parkinson's disease (PD) patients or are clinical factors superior to predict critical aspiration? Methods In a cross‐sectional, observational study a total of 119 Parkinson outpatients were examined clinically and by flexible‐endoscopic evaluation of swallowing (FEES). Self‐reported dysphagia by subquestions of the MDS‐UPDRS and NMS questionnaire and history of subjective aspiration signs were collected. Key Results Nearly, all PD patients showed deglutition abnormalities in FEES (113/119) while only 12%‐27% of them reported swallowing problems in the swallow‐specific subquestions of neurological standard diagnostic tools (MDS‐UPDRS and NMS‐Quest), and the answers were heterogeneous and poorly reproducible. With a sensitivity of up to a maximum of 50%, self‐reported dysphagia is therefore no reliable tool for identifying dysphagia in PD. While most clinical parameters were linked to dysphagia to some extent, logistic regression analysis revealed high age (Odds Ratio (OR) 1.1 in years, 95% CI 1.03‐1.18, P < 0.01), gender (OR 0.3 for females, 95% CI 0.08‐0.97, P = 0.04), and affirmed subjective aspiration signs (OR 8.6, 95% CI 3.05‐26.52, P < 0.001) as the most significant predictors for critical dysphagia. Conclusions and Inferences Self‐perception of swallowing is no reliable tool for identifying dysphagia and questionnaires are insufficient for detecting previous aspiration. Consequent and specific asking for previous subjective aspiration signs is the single most important measure for identifying PD patients at risk for critical aspiration.

Swallowing Speed as Potential Predictor of Aspiration in Parkinson&rsquo;s Disease Patients

“…Our study group recently proposed an alternative screening approach to detect clinically relevant aspiration in PD. We found a sensitivity of 86% and specificity of 79% by combining age, gender and aspiration signs [2]. These results have to be confirmed in further studies before implementation into clinical routine.…”

“…Despite its substantial relevance for morbidity and mortality, dysphagia in Parkinson's disease (PD) is still often overlooked. Usually, patients do not complain about dysphagia due to impaired self-perception of swallowing [1][2][3]. The swallowing act starts with the oral phase, continues with the pharyngeal phase and leads to the esophageal phase.…”

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

“…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].…”

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

“…A number of existing clinical tools have been shown to be unreliable in detecting PD-related dysphagia. For example, swallowing questionnaires were found to detect swallowing problems in 12-27% of the PwPD, with <10% of the PwPD reporting spontaneously about dysphagia (61)(62)(63). Clinical bedside predictors of aspiration used for stroke, like the "normal" water swallow test (64), have been shown to be unreliable in PD (65).…”