Dysphagia in Parkinson’s disease: Prevalence, Impact and Management Challenges

Abstract

The aim of this review is to present an update of the prevalence, impact and management challenges of dysphagia in Parkinson's disease. In the last 5 years, the prevalence of dysphagia in Parkinson's disease (PD) has been reported with a wide range of values in the literature. The dysphagia prevalence ranged from 11% to 100% of the patients with PD. This variation, generally, depended on the disease stage and the procedure of swallowing assessment. In the management of dysphagia, compensatory techniques, rehabilitation exercises and deep-brain stimulation have been conducted. Despite of the lack of high scientific evidences of efficiency of the majority of these interventions, the positive aspects and benefits are described in the actual literature. Moreover, this review paper discuss about the importance of the dysphagia assessment and treatment in the best timing to prevent complications, as pulmonary and nutritional impairment, and to improve quality of life.

Examining the frequency of dysphagia and the predictive factors of dysphagia that require attention in patients with Parkinson's disease

“…Various studies describe PD as a disease that affects the whole body and suggest that its source is the intestines before affecting the brainstem, often leading to gastrointestinal disorders in the early stage of the disease [3]. PD as a neurological disorder that can affect the efficiency of the swallowing function with increased muscle tone, involuntary movements, and lack of coordination between movements resulting in dysphagia [4]. Although little is known about the pathophysiology of dysphagia in patients with PD, it seems that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in these patients [3].…”

“…MDT-PD identifies even mild oropharyngeal dysphagia with and without risk of aspiration in patients with PD [3]. Studies showed that early treatment of dysphagia can provide safer feeding for patients with PD in the long-term perspective [4]. However, the effect of dopaminergic drugs, especially levodopa, on swallowing function and their role in the treatment of dysphagia is controversial [8][9][10].…”

Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism

“…Swallow and cough disorders are often concomitant symptoms of neurological disease, [1][2][3][4][5][6] since both functions share central neural substrates and operate within the aerodigestive tract. [7][8][9][10][11][12] Disordered cough (dystussia) can compound the effects of disordered swallowing (dysphagia), increasing the risk for patients to develop fatal respiratory complications, [13][14][15][16][17] experience decreased quality of life, 18,19 and undergo a decline in nutrition and hydration status. 18 Decline in function and complications of disease also increase the frequency of hospitalizations, healthcare costs, burden of care, and mortality.…”

“…[7][8][9][10][11][12] Disordered cough (dystussia) can compound the effects of disordered swallowing (dysphagia), increasing the risk for patients to develop fatal respiratory complications, [13][14][15][16][17] experience decreased quality of life, 18,19 and undergo a decline in nutrition and hydration status. 18 Decline in function and complications of disease also increase the frequency of hospitalizations, healthcare costs, burden of care, and mortality. 20,21 Thus, it is critical to evaluate swallow and cough to promptly initiate rehabilitative strategies that promote health.…”

Risk feeding in the advanced stages of Parkinson's disease

“…These strategies have been shown to provide time-limited benefit in swallowing functionality and reduction of residues after swallowing, contributing to safer oral feeding and an improved quality of life. 1 As PD progresses, however, dysphagia, along with other symptoms, often becomes more troublesome with limited potential for improvement.…”