Dysphagia in Multiple System Atrophy of Cerebellar and Parkinsonian Types

Abstract

Objective: This study aimed to examine the relationship between dysphagia and activities of daily living (ADL) in patients with multiple system atrophy (MSA), and to characterize dysphagia in patients with the cerebellar (MSA-C) and parkinsonian (MSA-P) types.Methods: Sixty-one MSA patients (25 males, 36 females; 40 MSA-C, 21 MSA-P; mean age, 66.3 ± 11.0) were recruited. ADL was assessed on the Barthel index. They underwent tongue pressure measurements and videofluoroscopy (VF) by swallowing barium gelatin jelly. We measured the range of tongue root and mandibular movements during oropharyngeal transit time and used the functional dysphagia scale to rate the oral and pharyngeal stages with the VF images.Results: Significant correlations were found between the ADL and the dysphagia scores (R=−0.654, p<0.001), the ADL score and the tongue pressure (R=0.600, p<0.001), and the dysphagia scores and the tongue pressure (R= −0.679, p<0.001), in the 61 patients. In addition, the oropharyngeal transit time and the tongue pressure in the MSA-C group (R=−0.457, p=0.005), the tongue root and mandibular movements and the tongue pressure in the MSA-P group (R=0.458, p=0.040; R=0.538, p=0.016; respectively) were significantly correlated. Furthermore, the MSA-P group showed a significantly longer oropharyngeal transit time than the MSA-C group (p=0.049). Conclusion:These results suggest a correlation between the degree of dysphagia and deterioration in ADL in MSA patients. MSA-P patients tended to experience problems with propelling a bolus through the oropharynx, whereas MSA-C patients incompletely form a bolus in the oral phase.

Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders

“…Dysphagia may influence the association between ADL deterioration and the survival time. In fact, the disease duration and ADL were shown to be correlated with the dysphagia score, particularly with the pharyngeal phase score of MSA with predominant parkinsonism (101).…”

Endoscopic Characteristics of Dysphagia in Multiple System Atrophy Compared to Parkinson's Disease

“…Therefore, timely identification of dysphagia and intervention is essential to avoid complications. Nevertheless, studies objectively evaluating dysphagia in MSA are rare, and symptoms so far were assessed only by videofluoroscopic swallowing studies (VFSSs), manometric methods, or electrophysiological methods in small cohorts 4,11‐16 …”

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

“…Instrumental findings of oral phase dysfunction included delayed bolus transport from the oral cavity to the pharynx, insufficient movement of the tongue base, and disturbance of bolus holding in the oral cavity. Pharyngeal phase impairment included slowed upward relocation of the larynx, vallecular residue, constriction of the pharynx and pyriform sinus residue [20][21][22]24].…”

“…Further in the early stage of the disease, the swallowing dysfunction induced by parkinsonism in MSA-P patients appears worse than the dysfunction induced by cerebellar impairment in MSA-C patients, and progressive worsening of dysphagia in MSA-C seems related to overlapping parkinsonism [12,21,24]. A recent cross-sectional and longitudinal study retrospectively comparing the progression of oropharyngeal dysphagia in MSA subtypes found that patients with MSA-P required diet modification earlier than those with MSA-C, but no significant difference between the two groups was found in the latency of tube feeding onset [25].…”

“…Statements are based on core literature consisting of Class II to IV studies (Table 1) and on expert adaptation of knowledge from the literature on dysphagia, selected by applying the analogy principle [3,5,12,[20][21][22][23][24][25][27][28][29][30]34,37,49]. [19].…”