Is the Munich dysphagia Test–Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration?

Buhmann, Carsten; Flügel, Till; Bihler, Moritz; Gerloff, Christian; Niessen, Almut; Hidding, Ute; Nienstedt, Julie Cläre; Pflug, Christina

doi:10.1016/j.parkreldis.2018.10.031

Cited by 16 publications

(13 citation statements)

References 40 publications

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“…A number of existing clinical tools have been shown to be unreliable in detecting PD-related dysphagia. For example, swallowing questionnaires were found to detect swallowing problems in 12–27% of the PwPD, with <10% of the PwPD reporting spontaneously about dysphagia ( 61 – 63 ). Clinical bedside predictors of aspiration used for stroke, like the “normal” water swallow test ( 64 ), have been shown to be unreliable in PD ( 65 ).…”

Section: Introductionmentioning

confidence: 99%

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

et al. 2020

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Background: Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments. Objective: The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD. Results: Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii Fit TM training for cognition. Conclusions: Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these "orphan" symptoms, from the very beginning of the disease. The concept "the sooner the better" should be applied to multidisciplinary non-pharmacological management in PD.

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Section: Introductionmentioning

confidence: 99%

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

et al. 2020

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“…Patients screened at risk for aspiration should then undergo further testing either with flexible endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing study (VFSS). The only PD‐specific questionnaire‐based screening tool for swallowing problems was found to be not sufficiently predictive for FEES‐proven aspiration . Today, the 3‐ounce water swallow test is frequently used to screen individuals with different diseases for aspiration risk—the test required to drink approximately 90 mL of water from a cup without interruption .…”

Section: Introductionmentioning

confidence: 99%

“…The only PD-specific questionnaire-based screening tool for swallowing problems was found to be not sufficiently predictive for FEES-proven aspiration. 5,6 Today, the 3-ounce water swallow test is frequently used to screen individuals with different diseases for aspiration risk-the test required to drink approximately 90 mL of water from a cup without interruption. 7 Criteria for referral for subsequent investigation are an inability to complete the task, coughing or choking as well as hoarse or wet voice either during or within 1 minute of test completion.…”

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confidence: 99%

Swallowing speed is no adequate predictor of aspiration in Parkinson's disease

Pflug

Niessen

Buhmann

et al. 2019

Neurogastroenterology Motil

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Background There is still a lack of a clinical test to reliably identify patients with Parkinson's disease (PD) being at risk for aspiration. Methods In this prospective, controlled, cross‐sectional study, we assessed if swallowing speed for water is a useful clinical test to predict aspiration proven by flexible endoscopic evaluation of swallowing (FEES). Due to this, we measured the swallowing speed for 90 mL water in 115 consecutive and unselected PD outpatients of all clinical stages and 32 healthy controls. Key Results Average swallowing speed was lower in patients compared with controls (6.5 ± 3.9 mL/s vs 8.5 ± 3.2 mL/s; P < .01). The disease‐independent widely used threshold of <10 mL/s showed insufficient sensitivity of 88% and specificity of 19% with high false‐positive rates of 63% for patients and 69% for controls. Receiver operating characteristic (ROC) analysis was carried out to define a suitable cutoff value for detection of aspiration of water (area under the curve 0.72, P < .001) in PD patients. The optimized cutoff value was 5.5 mL/s with a sensitivity of 69% and a specificity of 64%. Conclusion and Inferences Measuring swallowing speed is prone to methodological errors and not suitable as a screening instrument to predict aspiration in PD patients.

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“…proposed tests required clinical or instrumental evaluation, such as respectively the Functional Dysphagia Scale [19] and the Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) [20]. Finally, very recently two different tools for dysphagia screening in PD failed to show a reliable performance as compared to a non invasive swallowing-respiration assessment system or to FEES, respectively [21,22]. Among the screening tests, the DYMUS had been already validated for another chronic and progressive neurological disorder, multiple sclerosis [9,10].…”

Section: Discussionmentioning

confidence: 99%

From DYMUS to DYPARK: Validation of a Screening Questionnaire for Dysphagia in Parkinson’s Disease

et al. 2021

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Dysphagia is a common debilitating symptom in people with Parkinson’s Disease (PD), adequate screening of swallowing disorders is fundamental. The DYMUS questionnaire has shown very good characteristics for the screening of dysphagia in Multiple Sclerosis, and it might also prove useful for screening dysphagia in PD. The primary aim was to test and validate the DYMUS questionnaire in PD patients. This is an observational multicentric study involving 103 patients affected by PD. All subjects filled in the DYMUS and the Eating Assessment Tool (EAT-10) questionnaires. A subgroup of patients (n = 53) underwent a fiber-optic endoscopic evaluation of swallowing (FEES) and their dysphagia was scored by means of the Dysphagia Outcome Severity Scale (DOSS). DYMUS showed a relatively high level of internal consistency (Cronbach’s alpha 0.79). A significant positive correlation was found between the DYMUS and the EAT-10 scores (p < 0.001), while a negative correlation was found between the DYMUS and the DOSS scores (p < 0.001). DYMUS showed a good sensitivity and specificity compared to FEES for detecting dysphagia (area under the curve: 0.82, p < 0.001). The ROC curve analysis showed that a DYMUS score ≥ 6 represents a reliable cut-off for the risk of dysphagia. The DYMUS questionnaire proved to be a reliable screening tool to detect dysphagia in patients suffering from PD. It is easy to understand, it can be self-administered and therefore adequate for adoption in the clinical practice with the more convenient name of DYPARK.

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Is the Munich dysphagia Test–Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration?

Cited by 16 publications

References 40 publications

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review

Swallowing speed is no adequate predictor of aspiration in Parkinson's disease

From DYMUS to DYPARK: Validation of a Screening Questionnaire for Dysphagia in Parkinson’s Disease

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