The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review

Wei, Kuo-Chang; Wang, Tyng-Guey; Hsiao, Ming-Yen

doi:10.1007/s00455-023-10613-x

Cited by 8 publications

(3 citation statements)

References 138 publications

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“…After adjusting for potentially confounding factors of older age and longer disease duration, development of dysphagia in our nfvPPA group was associated with greater atrophy in a corticosubcortical network that has previously been implicated in the normal control of swallowing and its dysregulation in neurological disorders, as well as the development of speech apraxia in PPA. Middle frontal gyrus participates in regulating both reflexive and volitional swallowing in the healthy brain [ 11 , 12 ]; it is a key focus of neurodegenerative pathology in nfvPPA [ 36 ], and atrophy involving this region has also been correlated with orofacial apraxia in other PPA cohorts [ 21 , 31 ]. The additional involvement of right‐lateralized areas here aligns with previous work showing that right hemisphere stroke is a strong predictor of dysphagia [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…The additional involvement of right‐lateralized areas here aligns with previous work showing that right hemisphere stroke is a strong predictor of dysphagia [ 37 , 38 ]. Superior frontal gyrus has been implicated in the initiation of swallowing in Parkinson disease and after stroke [ 39 , 40 ]; in concert with more posterior parietal areas including supramarginal gyrus and basal ganglia structures including the caudate nucleus, prefrontal cortices link swallowing motor programmes with spatiotemporal movement planning and execution of coordinated muscle activity, guided by sensory feedback [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Based on available evidence in PPA and other neurodegenerative diseases [ 6 , 8 , 9 , 10 ], we hypothesized that dysphagia would be more prevalent and develop earlier in patients with nfvPPA versus other PPA syndromes and would be associated with more severe motor dysfunction and behavioural disturbance. We further hypothesized that dysphagia in PPA would be associated with regional brain atrophy involving frontosubcortical structures previously implicated in control of swallowing in the healthy brain [ 11 , 12 ] and in dysphagia accompanying stroke and parkinsonian disorders [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Dysphagia in primary progressive aphasia: Clinical predictors and neuroanatomical basis

Mazzeo,

Mulroy,

Jiang

et al. 2024

Euro J of Neurology

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Background and purposeDysphagia is an important feature of neurodegenerative diseases and potentially life‐threatening in primary progressive aphasia (PPA) but remains poorly characterized in these syndromes. We hypothesized that dysphagia would be more prevalent in nonfluent/agrammatic variant (nfv)PPA than other PPA syndromes, predicted by accompanying motor features, and associated with atrophy affecting regions implicated in swallowing control.MethodsIn a retrospective case–control study at our tertiary referral centre, we recruited 56 patients with PPA (21 nfvPPA, 22 semantic variant [sv]PPA, 13 logopenic variant [lv]PPA). Using a pro forma based on caregiver surveys and clinical records, we documented dysphagia (present/absent) and associated, potentially predictive clinical, cognitive, and behavioural features. These were used to train a machine learning model. Patients' brain magnetic resonance imaging scans were assessed using voxel‐based morphometry and region‐of‐interest analyses comparing differential atrophy profiles associated with dysphagia presence/absence.ResultsDysphagia was significantly more prevalent in nfvPPA (43% vs. 5% svPPA and no lvPPA). The machine learning model revealed a hierarchy of features predicting dysphagia in the nfvPPA group, with excellent classification accuracy (90.5%, 95% confidence interval = 77.9–100); the strongest predictor was orofacial apraxia, followed by older age, parkinsonism, more severe behavioural disturbance, and more severe cognitive impairment. Significant grey matter atrophy correlates of dysphagia in nfvPPA were identified in left middle frontal, right superior frontal, and right supramarginal gyri and right caudate.ConclusionsDysphagia is a common feature of nfvPPA, linked to underlying corticosubcortical network dysfunction. Clinicians should anticipate this symptom particularly in the context of other motor features and more severe disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dysphagia in primary progressive aphasia: Clinical predictors and neuroanatomical basis

Mazzeo,

Mulroy,

Jiang

et al. 2024

Euro J of Neurology

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The “Hedgehog‐Halo Sign” Is Associated with Gait Symptom Severity and Tap Response in Normal Pressure Hydrocephalus

Ha,

Lee,

Kim

et al. 2024

Movement Disord Clin Pract

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BackgroundReduced cerebrospinal fluid (CSF) clearance may play a vital role in the pathogenesis of normal pressure hydrocephalus (NPH), but the radiologic marker is yet to be elucidated.ObjectivesThis open‐label study presents two novel neuroimaging biomarkers based on enlarged perivascular spaces (ePVS) of the sub‐insular territory: the Hedgehog and Hedgehog‐Halo (H‐H) sign, designed to predict gait symptom severity and tap response in NPH.MethodsWe retrospectively reviewed 203 patients with possible NPH with baseline magnetic resonance imaging and gait analyses before and after lumbar puncture (LP). The Hedgehog/H‐H sign was scored using T2‐weighted images. The clinical severity at baseline and post‐tap gait improvement was compared in patients with and without Hedgehog/H‐H sign. The association between Hedgehog/H‐H sign and post‐tap gait outcomes was assessed using multivariate regression. The diagnostic performance of Hedgehog/H‐H sign was compared with conventional radiological markers.ResultsPatients with H‐H showed higher global disability and more severe gait impairment than those without any signs. Following LP, patients with Hedgehog/H‐H sign significantly improved in various gait parameters, unlike those with neither sign. Additionally, sub‐insular ePVS was significantly associated with post‐tap gait improvement after adjusting covariates. Finally, the Hedgehog/H‐H sign showed a higher performance than conventional markers in predicting post‐tap gait response.ConclusionsThe Hedgehog/H‐H sign is a useful neuroimaging biomarker related to the severity and tap response in NPH. This biomarker can be readily applied in clinical practice before undergoing LP, independent of conventional radiological signs. Further research is warranted to determine applicability in predicting post‐shunt gait response.

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Exploring the Neuropsychological Correlates of Swallowing Disorders in People with Parkinson’s Disease: a Cross-Sectional Study

Battista,

Aresta,

Tagliente

et al. 2024

Dysphagia

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The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review

Cited by 8 publications

References 138 publications

Dysphagia in primary progressive aphasia: Clinical predictors and neuroanatomical basis

Dysphagia in primary progressive aphasia: Clinical predictors and neuroanatomical basis

The “Hedgehog‐Halo Sign” Is Associated with Gait Symptom Severity and Tap Response in Normal Pressure Hydrocephalus

Exploring the Neuropsychological Correlates of Swallowing Disorders in People with Parkinson’s Disease: a Cross-Sectional Study

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