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

Abstract

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.

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

“…This supported the supposition that despite the water screen's low-cost and easy administration, the use of a speedbased water swallow screen may not be effective for identifying PWPD in non-advanced stages who are experiencing dysphagia but have not yet been referred for formal diagnostic assessment. Our findings agree with Pflug et al [19] that swallow speed ability in a water screen test does not accurately reflect dysphagia or aspiration risk. Different methodologies exploring volume may be more sensitive to detecting aspiration risk in PD [10].…”

“…Participants were provided with 3 ounces of room temperature water via cup, as measured by syringe, and were cued to "drink the water as fast and as comfortably as they could on consecutive sips". Previous research has investigated the application of swallowing speed with a water swallow protocol to detect airway invasion [18,19,20], but with inconsistent findings related to the measure of swallow speed during this test. Therefore, while we did not specifically measure swallow speed, the decreased synchrony of the respiratory-swallow pattern in PWPD [18,21] may be used to identify episodes of aspiration causing an active airway response.…”

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

“…Dysphagia is not just a symptom of late stage PD. In a recent study, Pflug et al (60) used fiberoptic endoscopic evaluation of swallowing (FEES) on 119 consecutive PwPD and found that 20% of the patients with a disease duration of <2 years had aspiration and that 12% (7 out of 57 patients) with H&Y 2 suffered from severe aspiration. Thus, there is a need to manage dysphagia and avoid complications as early as possible.…”

“…Clinical bedside predictors of aspiration used for stroke, like the “normal” water swallow test ( 64 ), have been shown to be unreliable in PD ( 65 ). The Dutch guidelines estimating the maximum swallowing volume or the maximum swallowing speed ( 66 ) were not a suitable screening instrument to predict aspiration in PD patients ( 60 ). Increased drooling (sialorrhea) was also deemed a sign of penetration or aspiration ( 67 ) until Nienstedt et al ( 62 , 68 ) found that drooling cannot be considered an early sign of dysphagia.…”

Dysphagia Screening in Parkinson's Disease. A diagnostic accuracy cross‐sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS)

“…Simple water-swallowing tests, measurements of volume and speed while drinking fluids and swallowing questionnaires are not predictive of aspiration in PD patients. 9,10 Considering the complex pathophysiology behind dysphagia in PD and the increase of impairments with swallowing solid food, 2 dysphagia and aspiration could be noticeable earlier in this patient group when multi-texture screening tools are applied. The Gugging Swallowing Screen (GUSS), 11 a widely used multi-texture tool developed and validated for acute stroke patients, might be applicable.…”