Arquivo da tag: Parkinson’s disease

Swallowing impairment and pulmonary dysfunction in Parkinson’s disease: the silent threats.

J Neurol Sci. 2014 Apr 15;339(1-2):149-52. doi: 10.1016/j.jns.2014.02.004. Epub 2014 Feb 14.

Abstract

INTRODUCTION:

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.

OBJECTIVE:

The objective of this study was to investigate whether there is an association between pulmonary impairment and swallowing dysfunction in PD patients.

METHODS:

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).

RESULTS:

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.

CONCLUSION:

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.

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A Swallowing Clinical Assessment Score (SCAS) to evaluate outpatients with Parkinson’s disease

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.

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Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia.

Arch Phys Med Rehabil. 2012 Nov;93(11):2080-4. doi: 10.1016/j.apmr.2012.07.010. Epub 2012 Jul 27.
 

Abstract

OBJECTIVE:

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.

DESIGN:

Clinical survey.

SETTING:

Tertiary care center.

PARTICIPANTS:

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.

INTERVENTIONS:

Not applicable.

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.

RESULTS:

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.

CONCLUSIONS:

Patients with Parkinsonism dysphagia and aspiration pneumonia had longer swallowing time than those without, but there was no difference in displacement of hyoid bone.

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Respiratory-swallowing coordination and swallowing safety in patients with Parkinson’s disease

Troche MS; Huebner I; Rosenbek JC; Okun MS; Sapienza CM

Dysphagia;26(3):218-24, 2011 Sep.

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.

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Impaired food transportation in Parkinson’s disease related to lingual bradykinesia

Umemoto G; Tsuboi Y; Kitashima A; Furuya H; Kikuta T

Dysphagia;26(3):250-5, 2011 Sep.

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.

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Awareness of dysphagia in Parkinson’s disease

Bayés-Rusiñol À; Forjaz MJ; Ayala A; Crespo Mde L; Prats A; Valles E; Petit C; Casanovas M; Garolera-Freixa M

Rev Neurol;53(11):664-72, 2011 Dec 1.

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.

 

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Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal Dysphagia: effects on quality of life

Heijnen BJ; Speyer R; Baijens LW; Bogaardt HC

Dysphagia; 27(3): 336-45, 2012 Sep

ABSTRACT:

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.

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