Drooling is no early sign of dysphagia in Parkinson′s disease

Nienstedt, Julie Cläre; Buhmann, Carsten; Bihler, Moritz; Niessen, Almut; Plaetke, Rosemarie; Gerloff, Christian; Pflug, Christina

doi:10.1111/nmo.13259

Cited by 22 publications

(33 citation statements)

References 28 publications

(67 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nienstedt et al found that in 110 PD patients with a mean disease duration of 9.7 years, half had drooling, and this was associated with dysphagia. In addition, they observed that 59% of patients with severe drooling had dysphagia [35]. Drooling was, as in other studies, also associated with cognitive performance.…”

Section: Discussionsupporting

confidence: 61%

Drooling in Parkinson’s Disease: Prevalence and Progression from the Non-motor International Longitudinal Study

et al. 2020

View full text Add to dashboard Cite

Sialorrhoea in Parkinson's disease (PD) is an often neglected yet key non-motor symptom with impact on patient quality of life. However, previous studies have shown a broad range of prevalence figures. To assess prevalence of drooling in PD and its relationship to quality of life, we performed a retrospective analysis of 728 consecutive PD patients who had a baseline and follow-up assessment as part of the Non-motor International Longitudinal Study (NILS), and for whom drooling presence and severity were available, assessed through the Non-Motor Symptoms Scale (NMSS). In addition, we analysed the prevalence of associated dysphagia through self-reported outcomes. Quality of life was assessed through the PDQ-8 scale. Baseline (disease duration 5.6 years) prevalence of drooling was 37.2% (score ≥ 1 NMSS question 19), and after 3.27 ± 1.74 years follow-up, this was 40.1% (p = 0.17). The prevalence of drooling increased with age (p < 0.001). The severity of drooling, however, did not change (p = 0.12). While in 456 patients without drooling at baseline, only 16% (n = 73) had dysphagia (question 20 of the NMSS), in those with drooling this was 34.3% (p < 0.001). At follow-up, the number of patients with dysphagia had increased, 20.4% with no drooling had dysphagia, and 43.6% with drooling had dysphagia. Both at baseline and follow-up, drooling severity was significantly positively associated with quality of life (PDQ-8; r = 0.199; p < 0.001). In moderately advanced PD patients, subjective drooling occurs in over one-third of patients and was significantly associated with decreased quality of life. Dysphagia occurred significantly more often in patients with drooling.

show abstract

Section: Discussionsupporting

confidence: 61%

Drooling in Parkinson’s Disease: Prevalence and Progression from the Non-motor International Longitudinal Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Data in this study based on the same patient collective of our previous research on the prevalence of dysphagia and its typical findings in PD …”

Section: Methodsmentioning

confidence: 99%

“…4,5 Depending on the examined patient cohort and the survey procedure, the prevalence rates for dysphagia in PD patients vary between 11% and 95%. 1,2 Several clinical factors, such as age, 6,7 gender, [8][9][10] Body Mass Index (BMI), 11 disease duration, 12 disease severity, 11,13 drooling, 14,15 deep brain stimulation (DBS), 16 depression, 17 and cognitive function 14,18 are considered risk factors for clinically relevant dysphagia. Many patients are not aware of their swallowing dysfunction and do not report dysphagia unless asked.…”

Section: Introductionmentioning

confidence: 99%

Predictive clinical factors for penetration and aspiration in Parkinson's disease

Nienstedt

Bihler

Niessen

et al. 2018

Neurogastroenterology Motil

Self Cite

View full text Add to dashboard Cite

Background Do the current swallow‐specific subquestions of neurological diagnostic tools reflect the objective swallowing function in Parkinson's disease (PD) patients or are clinical factors superior to predict critical aspiration? Methods In a cross‐sectional, observational study a total of 119 Parkinson outpatients were examined clinically and by flexible‐endoscopic evaluation of swallowing (FEES). Self‐reported dysphagia by subquestions of the MDS‐UPDRS and NMS questionnaire and history of subjective aspiration signs were collected. Key Results Nearly, all PD patients showed deglutition abnormalities in FEES (113/119) while only 12%‐27% of them reported swallowing problems in the swallow‐specific subquestions of neurological standard diagnostic tools (MDS‐UPDRS and NMS‐Quest), and the answers were heterogeneous and poorly reproducible. With a sensitivity of up to a maximum of 50%, self‐reported dysphagia is therefore no reliable tool for identifying dysphagia in PD. While most clinical parameters were linked to dysphagia to some extent, logistic regression analysis revealed high age (Odds Ratio (OR) 1.1 in years, 95% CI 1.03‐1.18, P < 0.01), gender (OR 0.3 for females, 95% CI 0.08‐0.97, P = 0.04), and affirmed subjective aspiration signs (OR 8.6, 95% CI 3.05‐26.52, P < 0.001) as the most significant predictors for critical dysphagia. Conclusions and Inferences Self‐perception of swallowing is no reliable tool for identifying dysphagia and questionnaires are insufficient for detecting previous aspiration. Consequent and specific asking for previous subjective aspiration signs is the single most important measure for identifying PD patients at risk for critical aspiration.

show abstract

“…Increased drooling (sialorrhea) was also deemed a sign of penetration or aspiration (67) until Nienstedt et al (62,68) found that drooling cannot be considered an early sign of dysphagia. Therefore, instrumental methods [FEES and Videofluoroscopic Swallow Study (VFSS)] are the most valid and reliable methods of detecting risk of aspiration and penetration in PwPD (67,68), particularly if they present with the following four symptoms: delayed mastication, reduced lingual motility prior to transfer, aspiration, and total swallow time (69). This information is crucial when evaluating studies on swallowing therapy and the validity of outcome measures.…”

Section: Swallowing Symptomsmentioning

confidence: 99%

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

et al. 2020

View full text Add to dashboard Cite

Background: Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments. Objective: The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD. Results: Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii Fit TM training for cognition. Conclusions: Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these "orphan" symptoms, from the very beginning of the disease. The concept "the sooner the better" should be applied to multidisciplinary non-pharmacological management in PD.

show abstract

Drooling is no early sign of dysphagia in Parkinson′s disease

Abstract: Although frequent in PD, drooling and dysphagia are only weakly related and drooling cannot be viewed as an early sign of dysphagia. Our data further suggest that the underlying cause of drooling is located in the voluntary oral phase, which is negatively influenced by cognitive deficits.

Cited by 22 publications

References 28 publications

Drooling in Parkinson’s Disease: Prevalence and Progression from the Non-motor International Longitudinal Study

Drooling in Parkinson’s Disease: Prevalence and Progression from the Non-motor International Longitudinal Study

Predictive clinical factors for penetration and aspiration in Parkinson's disease

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

Contact Info

Product

Resources

About