Dysphagia in Parkinson’s Disease

Abstract

More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists, speech-language therapists, and other clinicians in their daily work with PD patients and associated swallowing difficulties. Furthermore areas with an urgent need for future clinical research are identified.

Characteristics of Early Oropharyngeal Dysphagia in Patients with Multiple System Atrophy

“…Therefore, a greater amount of vallecular residue implies a reduced tongue base retraction and pharyngeal contraction in MSA-P compared with MSA-C. Vallecular residue after swallowing is one of the common findings of dysphagia in PD, which is observed more frequently than pyriform sinus residue [19]. However, because most of the patients (81%) with MSA-C also showed some degree of vallecular residue, the difference between the two subtypes does not seem to reflect a pathophysiological difference.…”

Enteral feeding in neurological disorders

“…In the early stages, dysphagia can be asymptomatic;71 however, with disease progression it can pose serious clinical challenges 72. Patients with advanced dysphagia are prone to choking (up to 50% report choking in attempts to swallow)73 and aspiration, which increases the risk of pneumonia, a main cause of death in late-stage Parkinson's disease 74.…”

Speech and Communication Changes Reported by People with Parkinson’s Disease

“…Dysphagia is also common in PD, and, in the same way, prevalence data for swallowing disorders vary; a prevalence of up to 80% has been reported during the course of the disease [13]. In a meta-analysis, the pooled prevalence of oropharyngeal dysphagia, based on subjectively reported data on swallowing disorders, was found to be 35% among people with PD, whereas the prevalence of swallowing dysfunction, based on objective measures, was found to be 82% in the same population [14].…”