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

Abstract

Purpose Dysphagia is thought to be prevalent and a leading cause of morbidity and mortality in people with Parkinson disease (PwPD). The aim of this study was to compare the frequencies of atypical and extreme values for measures of swallowing physiology in PwPD and in an age- and sex-matched cohort of healthy adults. Atypical and extreme values were defined, respectively, as values falling in the 25% and 5% tails of the reference distribution for healthy adults under age 60 years. Method A standard videofluoroscopy (VF) protocol was performed in 17 adults with mild PD and 17 age- and sex-matched healthy adults using 20% w/v liquid barium ranging from thin to extremely thick consistency. Blinded VF analysis was performed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Frequencies for atypical and extreme values were tabulated by cohort and compared using odds ratios. Results Increased frequencies of atypical values (> 25%) were seen in the PwPD for prolonged swallow reaction time, prolonged time-to-laryngeal-vestibule-closure (LVC), and poor pharyngeal constriction. However, these findings were also observed in the healthy controls. The PwPD showed significantly higher odds of atypical values for narrow upper esophageal sphincter (UES) diameter on thin liquids, a short hyoid-burst-to-UES-opening interval on extremely thick liquids, and prolonged time-to-LVC, LVC duration, and UES opening duration on multiple consistencies. The frequencies of extreme values failed to show any significant cohort differences for any parameter. Conclusions In this study, a group of people with mild PD did not show clear evidence of swallowing impairments distinct from the changes seen in a healthy age-matched control group when odds ratios were used to compare the frequencies of atypical values between PwPD and the control group; only a few parameters showed significant differences. These were findings of significantly higher frequencies in PwPD of prolonged LVC and UES opening duration. Supplemental Material https://doi.org/10.23641/asha.15032241

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

“…In PWPD, however, larger volumes were significantly associated with occurrences of airway invasion. PWPD have been shown to take larger than expected bolus sip size on thicker consistencies [ 46 ] and all cup volume trials in this sample were of thickened consistencies. This suggests that the volume of liquid being taken per administration in PWPD, regardless of consistency, significantly elevates the risk of episodes of airway invasion.…”

Differences in pharyngeal swallow event timing: Healthy aging, Parkinson disease, and amyotrophic lateral sclerosis

“…A number of studies have reported prolonged timing measures in PwPD compared to healthy controls, including prolonged swallow reaction time, delay in onset of airway closure, prolonged airway closure duration, prolonged UES opening duration, and delayed relaxation of hyoid elevation after the swallow. 13 , 14 , 15 , 28 On the contrary, Nagaya and colleagues found no differences in stage transition duration, pharyngeal response duration (i.e., duration from initiation of maximal hyoid excursion to the hyoid return to rest), pharyngeal transit duration (i.e., duration from the arrival of the bolus head at the mandibular ramus until the bolus tail passed through the upper esophageal sphincter), duration of UES opening, and total swallow duration (i.e., time from initiation of posterior bolus movement until the bolus tail passed through the UES) when comparing patients with PD to controls, 29 despite the patients having moderate or severe PD (Hoehn &Yahr [H&Y] scale scores of 3–5). 30 …”

“…Altered timing has been reported in several studies of swallowing in individuals with neurological conditions including neurodegenerative diseases. 9 , 10 , 11 , 12 , 13 , 14 , 15 These studies have frequently included patients with diverse etiologies (e.g., stroke, acquired brain injury, Parkinson disease [PD], amyotrophic lateral sclerosis [ALS], neuromuscular diseases) and have not explored disease‐specific differences. Given the heterogenous progression and characteristics of these diseases, it may not be appropriate to group these conditions together, and expect common patterns in swallowing.…”

Maximum lingual pressure impacts both swallowing safety and efficiency in individuals with amyotrophic lateral sclerosis

“…Several timing metrics pertaining to swallow reaction and laryngeal vestibule closure (LVC) were selected for analysis to better characterize relationships between swallowing safety and MAIP. These metrics were defined and rated in accordance with the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method decribed in full detail by Steele and colleagues 43 and prior work by Waito, Mancopes, and Gandhi 44–46 . The specific timing metrics for the current study included (1) LVC Duration (amount of time in milliseconds (msec) between LVC onset and laryngeal vestibule opening); (2) Time‐to‐LVC (hyoid burst to onset of LVC in msec); and (3) Swallow Reaction Time (interval between bolus passing ramus of mandible and onset of LVC in msec).…”

“…These metrics were defined and rated in accordance with the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method decribed in full detail by Steele and colleagues 43 and prior work by Waito, Mancopes, and Gandhi. [44][45][46] The specific timing metrics for the current study included (1) LVC Duration (amount of time in milliseconds (msec) between LVC onset and laryngeal vestibule opening); (2) Time-to-LVC (hyoid burst to onset of LVC in msec); and (3) Swallow Reaction Time (interval between bolus passing ramus of mandible and onset of LVC in msec). These timing metrics were analyzed on the first swallow of the 5-ml thin liquid, cup sip liquid, and 5-ml moderately thick bolus trials for a total of nine timing ratings per participant.…”