Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Labeit, Bendix; Claus, Inga; Muhle, Paul; Regner, Liesa; Suntrup‐Krueger, Sonja; Dziewas, Rainer; Warnecke, Tobias

doi:10.1111/ene.14603

Cited by 17 publications

(14 citation statements)

References 57 publications

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“…Further, the central control of swallowing has come into focus in recent years. Clinical data and neuroimaging research has drawn attention to a widely distributed cortical and subcortical brain network ( Malandraki et al, 2011a ; Labeit et al, 2020a ). Study results in Parkinson’s disease and stroke suggest adaptive cortical neuroplasticity and allocation of attentional resources as a compensatory mechanism for the disease-related swallowing dysfunction ( Teismann et al, 2011 ; Suntrup et al, 2013a ; Labeit et al, 2020a ).…”

Section: Introductionmentioning

confidence: 99%

“…Clinical data and neuroimaging research has drawn attention to a widely distributed cortical and subcortical brain network ( Malandraki et al, 2011a ; Labeit et al, 2020a ). Study results in Parkinson’s disease and stroke suggest adaptive cortical neuroplasticity and allocation of attentional resources as a compensatory mechanism for the disease-related swallowing dysfunction ( Teismann et al, 2011 ; Suntrup et al, 2013a ; Labeit et al, 2020a ). In addition, neurostimulation techniques in dysphagia rehabilitation also modulate the cortical swallowing network ( Suntrup et al, 2013b , 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Labeit

Muhle

Itter

et al. 2022

Front. Aging Neurosci.

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Background“Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.Materials and methods64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.Results32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.ConclusionsSwallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Labeit

Muhle

Itter

et al. 2022

Front. Aging Neurosci.

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“…Swallowing impairment for food and liquid was classified according to the following ordinal scale as previously published 37 – 39 : No signs of dysphagia. Mild dysphagia: premature bolus spillage at least into the piriform sinus or/and pharyngeal residue > coating in at least 2 out of 3 swallowing trials of at least 1 consistency, but no signs of penetration or aspiration.…”

Section: Methodsmentioning

confidence: 99%

Dysphagia for medication in Parkinson’s disease

Labeit

Berkovich²,

Claus

et al. 2022

npj Parkinsons Dis.

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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.

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“…Male gender and cognitive impairment were recently identified as predictors of dysphagia in PD ( Wang et al, 2021 ). Indeed, the contribution of cognition to effective swallowing was evident when swallowing was found to be significantly impaired under attention-demanding cognitive and motor dual-task interference ( Ardenghi et al, 2021 ; Labeit et al, 2021 ). These findings highlight the fact that swallowing function is not purely reflexive but requires mental capacity.…”

Section: Dysphagia In Parkinson’s Diseasementioning

confidence: 99%

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

Bhidayasiri

Phuenpathom

Tan

et al. 2022

Front. Aging Neurosci.

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Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson’s disease (PD). Those that affect the lower GI tract, such as constipation, are the most frequently reported GI problems among patients with PD. Upper GI issues, such as swallowing dysfunction (dysphagia) and delayed gastric emptying (gastroparesis), are also common in PD but are less well recognized by both patients and clinicians and, therefore, often overlooked. These GI issues may also be perceived by the healthcare team as less of a priority than management of PD motor symptoms. However, if left untreated, both dysphagia and gastroparesis can have a significant impact on the quality of life of patients with PD and on the effectiveness on oral PD medications, with negative consequences for motor control. Holistic management of PD should therefore include timely and effective management of upper GI issues by utilizing both non-pharmacological and pharmacological approaches. This dual approach is key as many pharmacological strategies have limited efficacy in this setting, so non-pharmacological approaches are often the best option. Although a multidisciplinary approach to the management of GI issues in PD is ideal, resource constraints may mean this is not always feasible. In ‘real-world’ practice, neurologists and PD care teams often need to make initial assessments and treatment or referral recommendations for their patients with PD who are experiencing these problems. To provide guidance in these cases, this article reviews the published evidence for diagnostic and therapeutic management of dysphagia and gastroparesis, including recommendations for timely and appropriate referral to GI specialists when needed and guidance on the development of an effective management plan.

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Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Cited by 17 publications

References 57 publications

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Dysphagia for medication in Parkinson’s disease

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

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