Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease

Abstract

Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 +/- 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients.

Anxiety, depression and swallowing disorders in patients with Parkinson's disease

“…The Swallowing Disturbance Questionnaire (SDQ) [19] for which a score of 11 or higher is correlated with the presence of swallowing problems and indicative that the patient should be referred for a complete swallowing evaluation. The questionnaire consists of five questions related to the oral phase of swallowing and 10 questions to the pharyngeal phase.…”

Dysphagia and Sialorrhea:

“…In Parkinson's disease, the prevalence of dysphagia is estimated to be from 32% to 70% (28) . Nevertheless, the risk posed by dysphagia is neglected or underestimated until the patient suffers the first episode of pneumonia (17,20) , despite the known high risk of aspiration and pneumonia associated with oropharyngeal dysphagia in PD patients (10,26) . In association with dysphagia, because of the difficulty of clearing the oral saliva, sialorrhea or at least sialostasis, can be observed.…”

Characterization of Corticobulbar Pharyngeal Neurophysiology in Dysphagic Patients With Parkinson's Disease

“…15 The 2 groups, self-reported dysphagic and selfreported nondysphagic patients, did not differ in mean age, severity, PD duration, or in anxiety and depression. However, the total SWAL-QOL score was significantly different between the groups (P ¼ .011; U ¼ 36), with the domains of burden (P ¼ .003; U ¼ 31.5), symptoms (P ¼ .003; U ¼ 43.5), and mental health (P ¼ .006; U ¼ 30) reduced significantly in self-reported dysphagic patients.…”

“…All patients completed the Swallowing Disturbance Questionnaire (SDQ) 15 and Swallowing Quality of Life Questionnaire (SWAL-QOL), 16 which are validated in PD, before the study day. All patients were unaware of their scores during the study.…”