Swallowing disorders and respiratory impairment are frequent in Parkinson‘s disease (PD) patients, and aspiration pneumonia remains the leading cause of death among these subjects.
The objective of this study was to investigate whether there is an association between pulmonary impairment and swallowing dysfunction in PD patients.
A cross-sectional study with a comparison group was conducted with PD patients. Subjects were submitted to demographic questionnaires and underwent spirometric and videofluorographic assessments. Significance level was considered at 95% (p<0.05).
Among 35 PD patients, 40% presented with swallowing complaints. However, 22% of the clinically asymptomatic patients presented airway food penetration when submitted to videofluoroscopy. In 20% of PD patients material entered the airways and there was contact with the vocal folds in 7%. However, there was an efficient cleaning with residue deglutition in almost all patients. No penetration/aspiration was detected among the controls. Respiratory parameters were below the normal predicted values in PD patients when compared to the healthy controls.
These data suggest an association between pulmonary dysfunction and swallowing impairment in PD patients; even in patients without swallowing complaints, impaired pulmonary function can be detected.
Fernanda Loureiro, Ana Caline Nóbrega, Marília Sampaio, Natalie Argolo, André Dalbem, Ailton Melo, Irenio Gomes
Aims: This study proposes a standardized Swallowing Clinical Assessment Score (SCAS) in PD. Methods: 174 idiopathic PD patients and 22 controls were evaluated in a transversal study. The SCAS comprised of twelve items that identify the occurrence of specific alterations in the oral and pharyngeal phases. Each alteration was given a weight in accordance to its relevance in compromising the act of swallowing. Results: The SCAS follows a theoretical scoring system ranging from 0 to 354 points, where zero corresponds to the ability to swallow without alteration. Scores ≤2 points indicate normal swallowing; functional swallowing ranges from ≥2 and ≤15 points; mildly altered ranges from ≥15 and ≤35 points; moderately altered ranges from ≥35 and ≤60 points. Scores in excess of 60 points indicate severe alteration. Conclusions: The SCAS proposed here is only part of the global assessment of dysphagia. Its main applications are: to screen swallowing difficulties in PD, even with no complaints, thus facilitating early diagnosis; to monitor the development of alterations in swallowing in an objective manner; and to assess the effectiveness of strategies for swallowing rehabilitation.
To quantitatively measure which dysphagic features, including swallowing time and hyoid bone displacement, would be associated with increased risk of aspiration pneumonia in dysphagic Parkinsonism patients.
Tertiary care center.
Patients with Parkinsonism and dysphagia (N=25), referred for videofluoroscopic swallowing study, were recruited by retrospective review of medical records. They were divided into 2 groups according to the history of aspiration pneumonia.
MAIN OUTCOME MEASURE:
Swallowing time including onset of pharyngeal swallowing, oral transit time and pharyngeal transit time, and maximum hyoid bone displacement including total, horizontal, and vertical displacement during swallowing in thin and thick bariums were recorded.
Patients with history of aspiration pneumonia had significantly longer pharyngeal transit time (4.14 vs 2.31s, P=.038) and onset of pharyngeal swallowing (2.16 vs 1.04s, P=.031) than those without, when swallowing thin barium. Patients with aspiration pneumonia also had significantly longer swallowing time when swallowing thick barium (oral transit time: 7.14 vs 2.33s, P=.018; pharyngeal transit time: 6.39 vs 1.23s, P=.004; onset of pharyngeal swallowing: 5.11 vs .31s, P=.006). There was no significant difference in hyoid bone displacement between the 2 groups.
Patients with Parkinsonism dysphagia and aspiration pneumonia had longer swallowing time than those without, but there was no difference in displacement of hyoid bone.
The purpose of this study was to determine if individuals with Parkinson’s disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A â‰¤ 2; Group 2 = P-A â‰¥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.
This study aimed to analyze quantitatively videofluoroscopic (VF) images of patients with Parkinson’s disease (PD), to evaluate if the predicted factors of the oral phase of swallowing deteriorated with PD progression, and to demonstrate a relationship between the abnormal movements of the tongue and food transportation. Thirty PD patients were recruited and divided into mild/moderate (Hoehn & Yahr stages II and III) and advanced (stages IV and V) groups. They underwent measurement of tongue strength and VF using 5 ml of barium gelatin jelly as a test food. We measured the speed of bolus movement and the range of tongue and mandible movements during oropharyngeal transit time. The maximum tongue pressure of the mild/moderate group was significantly larger than that of advanced group (p = 0.047). The oropharyngeal transit time of the mild/moderate group was significantly shorter than that of the advanced group (p = 0.045). There was a significant negative correlation between the speed of tongue movement and the oropharyngeal transit time (p = 0.003, R = -0.527). Prolonged mealtimes and the ejection of insufficiently masticated food from the oral cavity into oropharynx were associated with PD progression. These results indicate the importance of the oral phase of swallowing in PD patients.
INTRODUCTION AND AIM: In order to be able to assess the level of awareness of swallowing disorders in Parkinson’s disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. PATIENTS AND METHODS: A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. RESULTS: The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well. The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. CONCLUSIONS: The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis. A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.
This study compares the effects of traditional logopedic dysphagia treatment with those of neuromuscular electrical stimulation (NMES) as adjunct to therapy on the quality of life in patients with Parkinson’s disease and oropharyngeal dysphagia. Eighty-eight patients were randomized over three treatment groups. Traditional logopedic dysphagia treatment and traditional logopedic dysphagia treatment combined with NMES at sensor or motor level stimulation were compared. At three times (pretreatment, post-treatment, and 3 months following treatment), two quality-of-life questionnaires (SWAL-QOL and MD Anderson Dysphagia Inventory) and a single-item Dysphagia Severity Scale were scored. The Functional Oral Intake Scale was used to assess the dietary intake. After therapy, all groups showed significant improvement on the Dysphagia Severity Scale and restricted positive effects on quality of life. Minimal group differences were found. These effects remained unchanged 3 months following treatment. No significant correlations were found between dietary intake and quality of life. Logopedic dysphagia treatment results in a restricted increased quality of life in patients with Parkinson’s disease. In this randomized controlled trial, all groups showed significant therapy effects on the Dysphagia Severity Scale and restricted improvements on the SWAL-QOL and the MDADI. However, only slight nonsignificant differences between groups were found.
Changes that occur as a natural part of senescence in the complex action of deglutition predispose us to dysphagia and aspiration. As the “baby-boomers” begin to age, the onset of swallowing difficulties will begin to manifest in a greater number of our population. Recent advances in the evaluation of normal and abnormal swallowing make possible more precise anatomical and physiological diagnoses. Coupled with an understanding of swallowing physiology, such detailed evaluation allows greater opportunity to safely manage dysphagia with directed therapy and appropriate surgical intervention. The current study is a discussion of the changes that occur in deglutition with normal aging, contemporary evaluation of swallowing function, and some of the common causes of dysphagia in elderly patients.
A doença de Parkinson se caracteriza por alteração da motilidade involuntária que pode levar ao comportamento da articulação da palavra da voz e da deglutição em alguma fase da doença. O objetivo é relacionar o atendimento fonoaudiológico de acordo com o estágio da doença, aplicando técnicas fonoaudiológicas tradicionais possibilitando a intervenção na mobilidade e na flexibilidade oromuscular para a articulação dos sons, coordenação das estruturas da fala, controle e aumento da capacidade respiratória e dos distúrbios específicos da deglutição, visando aplicabilidade de técnicas fonoaudiológicas compatíveis com a doença de Parkinson, além de verificar se a alteração olfatória referida e constatada em avaliação fonoaudiológica, tem relação com possível déficit cognitivo (memória olfatória) ou faz parte do processo de senilidade. Foram selecionados 47 pacientes do ambulatório de distúrbios do movimento do INDC/UFRJ, com diagnóstico de doença de Parkinson, avaliados segundo a escala de Hoehn & Yahr, com queixas relativas à articulação da palavra, da fonação e da deglutição e encaminhados ao setor de fonoaudiologia. Dos 47 pacientes, selecionou-se 23 no estágio II da referida escala, visando aplicação mensal do exame TMF (tempo máximo fonatório) por um período de um ano e três meses, avaliando coaptação de pregas vocais, dinâmica respiratória, equilíbrio de força aerodinâmica rouca (85%), articulação disártrica (74%), anosmia (72%), tremor de língua (70%), disfagia (49%), sialismo presente (49%), ATM com deslocamento (47%), reflexo protetivo de tosse e pigarreio ausentes (28%) ritmo de fala bradilálico (23%), tremor da mandíbula (15%). No TMF, o maior percentual de alteração foi em eficiência glótica (34%) e o menor em hipercontração de pregas vocais (17%). A aplicação de técnicas fonoaudiológicas relativas aos distúrbios da comunicação oral e deglutição do paciente com doença de Parkinson no ambulatório de fonoaudiologia no INDC/UFRJ vem … Parkinson.
Objetivo: descrever as alterações nas fases oral, farínfea e esofágica da deglutição de pacientes idosos com doença de Parkinson (DP) avaliados pela videofluoroscopia, comparando com as queixas relatadas pelos mesmos; comparar as alterações entre pacientes com doença de Parkinson e um grupo de idosos com mais de 60 anos sem alterações neurológicas (grupo controle). Método: foram levantadas as principais queixas quanto à deglutição e avaliados pela videofluoroscopia 25 pacientes com doença de Parkinson (DP), sendo 19 do sexo masculino e 6 do sexo feminino entre o II e IV estágio da doença, segundo a escala modificada de Hoehn e Yahr. Os pacientes foram avaliados em todas as consistências alimentares. Os achados foram comparados com o grupo controle. Resultados: na fase oral, as alterações mais comuns foram: dificuldade no movimento de preparo e organização do bolo alimentar, fechamento labial inadequado, tremor da língua em repouso e durante a mastigação e permanência do meio de contraste em cavidade oral. Na fase faríngea foi observada estase em valéculas, recessos piriformes e esfíncter esofágico superior, necessidade de múltiplas deglutições para limpeza e aspiração laringo-traqueal. Na fase esofágica, presença de contrações terciárias, diminuição do peristaltismo, presença de refluxo gastroesofágico. Conclusão: pacientes com doença de Parkinson podem apresentar alterações nas fases oral, faríngea e esofágica da deglutição mais freqüentes do que em idosos sem alterações neurológicas .