Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status

Abstract

Introduction Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously. Objective The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES). Methods A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS). Results The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL: p ≤ 0.001; 5 mL: p ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found. Conclusion These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.

Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia– towards an integrated FEES report

“…Thus, the YPRSRS has been translated into a variety of different languages [ 24 – 26 ], has received independent testing for reliability and validity [ 27 ] and has been used in a high number of clinical trials [ 28 – 33 ]. Contrasting with this the BRACS, which is somewhat more complicated to score, has so far been only adopted in one study on dysphagia in Parkinson’s disease [ 34 ]. Semiquantitative assessment of premature spillage and delayed or absent swallowing reflex may be based on comparatively simple scores that have been shown reasonable interrater reliability.…”

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

“…Male gender and cognitive impairment were recently identified as predictors of dysphagia in PD ( Wang et al, 2021 ). Indeed, the contribution of cognition to effective swallowing was evident when swallowing was found to be significantly impaired under attention-demanding cognitive and motor dual-task interference ( Ardenghi et al, 2021 ; Labeit et al, 2021 ). These findings highlight the fact that swallowing function is not purely reflexive but requires mental capacity.…”

“…In addition to posture, it is important to consider adequate lighting and as few distractions as possible when eating or drinking. Patients with cognitive impairment should concentrate on their swallowing and avoid performing concomitant tasks during eating ( Ardenghi et al, 2021 ). Using a cue card may be beneficial with instructions for patients with PD to read the cue card silently and aim to commence swallowing on reading the word swallow on the card ( Figure 5 ).…”

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

“…In parallel, a rapid reorganization of the pharyngeal motor cortex in the unaffected hemisphere allows compensatory adaptive changes able to recover swallowing function after stroke [15]. As regards Parkinson's disease, evidence of swallowing safety impairment during increased attention load supports the idea that supramedullary drive affects the swallowing plan [16,17 ▪ ], while cortical compensation mechanisms can occur during the early disease stages [18]. Involvement of nondopaminergic pathways [19,20], such as the cholinergic pedunculopontine nucleus [21], together with peripheral abnormalities affecting the pharyngeal muscles, such as fast-to-slow fiber-type transition [22], can be contributing factors in Parkinson's disease-related dysphagia…”