Dysphagia for medication in Parkinson’s disease

Abstract

Dysphagia is common in Parkinson’s disease (PD) and is assumed to complicate medication intake. This study comprehensively investigates dysphagia for medication and its association with motor complications in PD. Based on a retrospective analysis, a two-dimensional and graduated classification of dysphagia for medication was introduced differentiating swallowing efficiency and swallowing safety. In a subsequent prospective study, sixty-six PD patients underwent flexible endoscopic evaluation of swallowing, which included the swallowing of 2 tablets and capsules of different sizes. Dysphagia for medication was present in nearly 70% of PD patients and predicted motor complications according to the MDS-UPDRS-part-IV in a linear regression model. Capsules tended to be swallowed more efficiently compared to tablets, irrespective of size. A score of ≥1 on the swallow-related-MDS-UPDRS-items can be considered an optimal cut-off to predict dysphagia for medication. Swallowing impairment for oral medication may predispose to motor complications.

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

“…However, the importance of the length of the examination protocol was raised. In this context, it should be taken into account, that FEES protocols often provide 3 swallowing trials for 3 different consistencies, as in the following studies [9,22,23,29,[36][37][38][39][40][41]. It should be noted that the scenario of the intermittent event (with several, but < 50% of the trials of a single consistency) cannot occur with this protocol specification.…”

“…Dysphagia may lead to serious complications such as malnutrition and aspiration pneumonia [6], and thus can result in adverse functional outcomes, hospitalization and increased mortality [7,8]. In addition, dysphagia can lead to difficulty in medication adherence, and therefore, may also be involved in the development of motor fluctuations [9]. However, dysphagia not only causes medical complications, but often affects patient quality of life [10,11], which can be assessed using validated patient-reported outcome measures.…”

Gastrointestinal barriers to levodopa transport and absorption in Parkinson's disease

“…Video fluorographic examination of swallowing during an 'off' episode revealed tongue hypokinesia with tablets retained in the epiglottic vallecula, which was associated with reduced levels of levodopa plasma concentration and a 'no on' phenomenon. After to be swallowed more efficiently compared to tablets, irrespective of size [39]. Further prospective and controlled studies are needed to confirm the role of dysphagia in levodopa transport and absorption.…”

“…According to this classification, dysphagia for medication was present in nearly 70% of PwP and predicted motor complications according to the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part IV in a linear regression model (beta coefficient 0.5; p = 0.006). Capsules tended to be swallowed more efficiently compared to tablets, irrespective of size [39]. Further prospective and controlled studies are needed to confirm the role of dysphagia in levodopa transport and absorption.…”

Management and Treatment for Dysphagia in Neurodegenerative Disorders

“…In PD, all voluntary and involuntary motor processes in swallowing can be impaired: cognitive stage impairment due to depression and cognitive dysfunction [9], preparatory and oral stage impairment due to tremor and rigidity, pharyngeal stage impairment due to delayed swallowing reflex, decreased pharyngeal contractility, laryngeal elevation impairment [1,11], esophageal stage impairment due to upper esophageal sphincter (UES) dysfunction, and esophageal peristalsis impairment [12]. Furthermore, it should be noted that dysphagia can occur as a side effect of therapeutic medications in patients with PD [13]. Bilateral vocal fold movement disorders may also occur in patients with PD [14,15].…”