Predicting Airway Invasion Using Screening Tools and Laryngeal Kinematics in People with Parkinson’s Disease: A Pilot Study

Abstract

Background: Dysphagia in Parkinson's disease (PD) is a common manifestation, particularly in advanced disease stages. However, the pathophysiology and time course of dysphagia progression remains unclear in non-advanced disease stages (e.g., Hoehn & Yahr stages I-III). Conflicting reports from investigations of the perception of dysphagia in people with PD further complicates our understanding of dysphagia in this population. Objective: The objectives of this research were to evaluate the ability of screening tools to detect swallowing impairments and how laryngeal kinematics predict the occurrence of abnormal swallowing events. Methods: 14 individuals with non-advanced PD, no previous history of dysphagia diagnosis, and self-reported difficulty swallowing participated. The Swallow Disturbance Questionnaire (SDQ) and 3-oz water swallow test (WSST) were administered, along with a videoflouroscopic swallow study (VFSS). Laryngeal kinematics were represented by laryngeal vestibule closure reaction time (LVrt) and laryngeal vestibule closure duration (LVCd). The Penetration-Aspiration Scale (PAS) was used to quantify airway invasion. Results: A logistic regression indicated a significant model of predicting airway invasion from our predictors (p = 0.003). LVrt and SDQ (p < 0.05) provided the largest impact (OR = 1.11; 1.17). The WSST showed no significance in predicting swallow impairment (p > 0.05). Conclusion: Decreased airway safety related to laryngeal kinematic function in PD may be manifesting at non-advanced disease stages to varied degrees. Our results support expectations of dysphagia manifestation in PD although screening practices may not adequately identify impairment. Future research should target specific laryngeal characteristics within this population to better understand the physiological cause of swallowing impairment and developof targeted interventions.

The Frequency of Atypical and Extreme Values for Pharyngeal Phase Swallowing Measures in Mild Parkinson Disease Compared to Healthy Aging

“…Neither the healthy control nor the PD group in our study was found to have any instances of incomplete LVC. This is in keeping with results from Dumican and Watts (2020) , who observed complete LVC in a cohort of individuals with nonadvanced PD. We did find increased frequencies of prolonged time-to-LVC across all consistencies in our PD cohort.…”

Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson’s Disease and Cerebrovascular Accident

“…Results also indicated significant differences in time-to-LVC and LVCd.However, these measures as predictors for abnormal swallows were not significant in CVA patients. While time-to-LVC predicting penetration or aspiration supports our hypothesis and the current literature in PD[8][9][10] the lack of predictive ability of time-to-LVC in the CVA group was not expected, as time-to-LVC is often described as one of the major contributors to airway invasion in post-stroke dysphagia and most neurogenic etiologies of dysphagia[21, 22].The association of prolonged LVCd and airway invasion in PWPD has been postulated elsewhere[10] although the lack of association between LVCd and airway invasion in CVA agrees with the existing literature[53], in that LVCd by itself is not a strong predictor of airway invasion.From a clinical standpoint these findings provide important distinctions and suggest the need for increased awareness of how dysphagia manifests in different neurologically impaired populations. Though current literature suggests that time-to-LVC is one of the strongest predictors of airway invasion across neurogenic etiologies of dysphagia [12], it is possible that subgroups may be inflating the predictive power of generalized measures (i.e., timeto-LVC).…”

“…The laryngeal impairments which lead to aspiration in PWPD are not as well understood as those in cerebrovascular accident (CVA), which is considered one of the leading causes of dysphagia [7]. While recent evidence suggests that time-to-laryngeal vestibule closure (LVC) and airway responses to penetrated material are impacted by PD [8][9][10], greater evidence is needed to elucidate those physiological impairments for which treatment might have the greatest impact for swallowing safety and efficiency. This is particularly true as the prevalence of dysphagia in PD has been reported as similar to that of CVA [11], yet our understanding of laryngeal kinematics in CVA is substantially more robust compared to PD.…”

“…After obtaining all PAS scores, data was transformed into a separate dichotomous variable to reflect either a "normal" and safe swallow (PAS score of 1 or 2) or "abnormal" (PAS score [3][4][5][6][7][8]. This method has been suggested as one of several appropriate approaches with this study design [26] and used in recent work [9] to quantify the PAS for statistical hypothesis testing.…”

Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson’s Disease and Cerebrovascular Accident

“…The laryngeal impairments which lead to aspiration in PWPD are not as well understood as those in cerebrovascular accident (CVA), which is considered one of the leading causes of dysphagia [7]. While recent evidence suggests that time-to-laryngeal vestibule closure (LVC) and airway responses to penetrated material are impacted by PD [8][9][10], greater evidence is needed to elucidate those physiological impairments for which treatment might have the greatest impact for swallowing safety and efficiency. This is particularly true as the prevalence of dysphagia in PD has been reported as similar to that of CVA [11], yet our understanding of laryngeal kinematics in CVA is substantially more robust compared to PD.…”