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Sugama J, Ishibasi M, Ota E, Kamakura Y, Saitoh E, Sanada H, Nakayama T, Nomura T, Yamada M, Nakagami G, Sato N, Shibata S, Hase T, Fukada J, Miki T, Arita M, Urai T, Okawa Y, Kitamura A, Dai M, Takahashi T, Tamai N, Tobita I, Noguchi H, Matsumoto M, Miura Y, Mukai K, Mugita Y, Yoshida M, Kurachi M, Shirasaka T, Yamane Y. Japanese clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. Jpn J Nurs Sci 2022; 19:e12496. [PMID: 35715990 DOI: 10.1111/jjns.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
AIM This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. METHODS In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. RESULTS Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. CONCLUSION The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.
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Affiliation(s)
- Junko Sugama
- Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Japan
| | - Miyuki Ishibasi
- Department of Frontier Practice Nursing, Division of Modern Gerontological Nursing, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Erika Ota
- Graduate School of Nursing Science, St.Luke's International University, Tokyo, Japan.,The Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Yayoi Kamakura
- Japanese Red Cross Toyota College of Nursing, Toyota, Japan
| | | | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takeshi Nomura
- Department of Intensive Care Unit, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Masako Yamada
- Graduate School of Nursing Science, St.Luke's International University, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sato
- Tokyo Hikari Nursing Station, Tokyo, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takashi Hase
- Department of Oral and Maxillofacial Surgery, Noto General Hospital, Nanao, Japan
| | - Junko Fukada
- School of Nursing & Health, Aichi Prefectural University, Nagoya, Japan
| | - Tatsuto Miki
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Mikiko Arita
- Department of Nursing, Osaka Shin-ai College, Ibaraki, Japan
| | - Tamae Urai
- Faculty of Nursing, Toyama Prefectural University, Toyama, Japan
| | - Yohei Okawa
- Department of Psychosomatic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Misako Dai
- Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Japan
| | - Toshiaki Takahashi
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Itoko Tobita
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroshi Noguchi
- Graduate School of Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Masaru Matsumoto
- School of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Yuka Miura
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kanae Mukai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masako Kurachi
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Narita, Japan
| | | | - Yukiko Yamane
- Graduate School of Nursing Science, Asahikawa Medical University, Asahikawa, Japan
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A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. J Neurol 2021; 269:1335-1352. [PMID: 34417870 PMCID: PMC8857094 DOI: 10.1007/s00415-021-10739-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD.
Objective To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients.
Methods A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.
Results Eighty-five papers were used to inform the Panel’s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10739-8.
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Lindroos E, Johansson K. Free from Dysphagia? A Test Battery to Differentiate Between Mild and No Dysphagia. Dysphagia 2021; 37:501-509. [PMID: 33846833 DOI: 10.1007/s00455-021-10295-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
Assessing mild oropharyngeal dysphagia (OD) raises the question where to draw the line between normal and pathological swallowing. There is a lack of clinical test methods appropriate in the subacute phase of recovery from dysphagia following stroke and other brain injuries. The aim of this pilot study was to investigate the diagnostic accuracy of a new test battery, called the Swallow Battery (SwaB), in relation to Fiberoptic Endoscopic Evaluation of Swallowing (FEES). SwaB consists of the validated tests Repetitive Saliva Swallowing Test (RSST), Timed Water Swallowing Test (TWST) and parts of the Test of Masticating and Swallowing Solids (ToMaSS). Nineteen adult patients with acquired brain injury who were enrolled in a rehabilitation programme underwent the SwaB and a FEES, both resulting in a pass or fail outcome. The pass or fail results were based on RSST's and TWST's suggested cutoffs, normative values of ToMaSS and on established rating scales used for FEES. The SwaB's ability to predict FEES results was 74% according to a binary logistic regression analysis, with a 92% correct prediction of fail results and 33% correct prediction of pass results. The ToMaSS was sensitive to small changes in eating ability, failing 13 out of 19 patients using 95% CI normative values as cutoff, including patients with a passed FEES. Alternative cutoffs were therefore suggested, depending on purpose of dysphagia assessment. The results of this study indicate that the SwaB may be a useful tool when assessing mild dysphagia following brain injury. Further studies of SwaB's validity and clinical utility are suggested.
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Affiliation(s)
- Emma Lindroos
- Department of Rehabilitation Medicine, Danderyd University Hospital, 182 88, Stockholm, Sweden.
| | - Kerstin Johansson
- Department of Speech and Language Pathology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Braden RO, Boyce JO, Stutterd CA, Pope K, Goel H, Leventer RJ, Scheffer IE, Morgan AT. Speech, Language, and Oromotor Skills in Patients With Polymicrogyria. Neurology 2021; 96:e1898-e1912. [PMID: 33589534 DOI: 10.1212/wnl.0000000000011698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether specific speech, language, and oromotor profiles are associated with different patterns of polymicrogyria, we assessed 52 patients with polymicrogyria using a battery of standardized tests and correlated findings with topography and severity of polymicrogyria. METHODS Patients were identified via clinical research databases and invited to participate, irrespective of cognitive and verbal language abilities. We conducted standardized assessments of speech, oromotor structure and function, language, and nonverbal IQ. Data were analyzed according to normative assessment data and descriptive statistics. We conducted a correlation analysis between topographic pattern and speech and language findings. RESULTS Fifty-two patients (33 male, 63%) were studied at an average age of 12.7 years (range 2.5-36 years). All patients had dysarthria, which ranged from mild impairment to anarthria. Developmental speech errors (articulation and phonology), oral motor structure and function deficits, and language disorder were frequent. A total of 23/29 (79%) had cognitive abilities in the low average to extremely low range. In the perisylvian polymicrogyria group (36/52), speech, everyday language, and oral motor impairments were more severe, compared to generalized (1 patient), frontal (3), polymicrogyria with periventricular nodular heterotopia (3), parasagittal parieto-occipital (1), mesial occipital (1), and other (7) patterns. CONCLUSIONS Dysarthria is a core feature of polymicrogyria, often accompanied by receptive and expressive language impairments. These features are associated with all polymicrogyria distribution patterns and more severe in individuals with bilateral polymicrogyria, particularly in the perisylvian region.
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Affiliation(s)
- Ruth O Braden
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Jessica O Boyce
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Chloe A Stutterd
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Kate Pope
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Himanshu Goel
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Richard J Leventer
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Ingrid E Scheffer
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia
| | - Angela T Morgan
- From Murdoch Children's Research Institute (R.O.B., J.O.B., C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Departments of Audiology and Speech Pathology (R.O.B., J.O.B., A.T.M.) and Paediatrics (C.A.S., R.J.L., I.E.S.), University of Melbourne; The Royal Children's Hospital (C.A.S., K.P., R.J.L., I.E.S., A.T.M.); Victorian Clinical Genetics Service (C.A.S., K.P.), Parkville, Victoria; Hunter Genetics (H.G.), John Hunter Hospital, New Lambton Heights, New South Wales; Austin Health (I.E.S.), Heidelberg, Victoria; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Parkville, Victoria, Australia.
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Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lewis C, Keage M, Watanabe M, Schubiger D, Velakoulis D, Walterfang M, Vogel AP. Characterization of Dysphagia and Longitudinal Changes in Swallowing Function in Adults with Niemann-Pick Disease Type C Treated with Miglustat. Dysphagia 2020; 36:362-373. [PMID: 32562141 DOI: 10.1007/s00455-020-10145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Niemann-Pick disease type C (NPC) is a rare, autosomal recessive neurodegenerative disease, characterized by progressive psychiatric and neurological deficits. Neurological symptoms include cognitive decline and dysphagia. Aspiration pneumonia secondary to dysphagia is a leading cause of death in NPC. Miglustat is currently the only approved disease-specific treatment shown to be effective in stabilizing neurological symptoms. Miglustat has previously been reported to halt or improve early dysphagia and cognitive symptoms. Here we examine the characteristics of dysphagia, the relationship between dysphagia and the presence of cognitive impairment, and longitudinal changes in swallowing function during miglustat treatment in adult-and-adolescent-onset NPC. Retrospective analysis of videofluoroscopic swallow studies (VFSS) was completed for ten adults with NPC (mean age 28.44 years ± 9.34 years). Participants were recruited through the Royal Melbourne Hospital in Australia between 2008 and 2015. The Bethlehem Swallowing Scale and the Penetration-Aspiration Scale were used to quantify VFSS data. Dysphagia was present in 90% of participants at baseline with reduced lingual function and a delayed swallowing reflex as the most common symptoms. Swallow impairment appeared to stabilize during miglustat therapy for periods up to 66 months, with no significant changes in scores (p > 0.05). Data were in accordance with the literature and support the use of miglustat as an efficacious treatment for reducing swallowing impairment and stabilizing cognitive function. Findings provide detailed information on the impairments experienced by patients, give context to events leading to aspiration in NPC and, importantly, inform how management of dysphagia can complement pharmaceutical treatment.
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Affiliation(s)
- Courtney Lewis
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Miyuki Watanabe
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | | | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia.
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- Redenlab, Melbourne, Australia.
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Vogel AP, Magee M, Torres-Vega R, Medrano-Montero J, Cyngler MP, Kruse M, Rojas S, Cubillos SC, Canento T, Maldonado F, Vazquez-Mojena Y, Ilg W, Rodríguez-Labrada R, Velázquez-Pérez L, Synofzik M. Features of speech and swallowing dysfunction in pre-ataxic spinocerebellar ataxia type 2. Neurology 2020; 95:e194-e205. [PMID: 32527970 DOI: 10.1212/wnl.0000000000009776] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine whether objective and quantitative assessment of dysarthria and dysphagia in spinocerebellar ataxia type 2 (SCA2), specifically at pre-ataxic and early disease phases, can act as sensitive disease markers. METHODS Forty-six individuals (16 with pre-ataxic SCA2, 14 with early-stage ataxic SCA2, and 16 healthy controls) were recruited in Holguin, Cuba. All participants underwent a comprehensive battery of assessments including objective acoustic analysis, clinician-derived ratings of speech function and swallowing, and quality of life assessments of swallowing. RESULTS Reduced speech agility manifest at the pre-ataxic stage was observed during diadochokinetic tasks, with the magnitude of speech deficit augmented in the early ataxic stage. Speech rate was slower in early-stage ataxic SCA2 compared with pre-ataxic SCA2 and healthy controls. Reduced speech agility and speech rate correlated with disease severity and time to ataxia onset, verifying that speech deficits occur prior to ataxia onset and increase in severity as the disease progresses. Whereas dysphagia was observed in both pre-ataxic and ataxic SCA2, it was not associated with swallowing-related quality of life, disease severity, or time to ataxia onset. CONCLUSIONS Speech and swallowing deficits appear sensitive to disease progression in early-stage SCA2, with syllabic rate a viable marker. Findings provide insight into mechanisms of disease progression in early-stage SCA2, signaling an opportunity for stratifying early-stage SCA2 and identifying salient markers of disease onset as well as outcome measures in future early-stage therapeutic studies.
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Affiliation(s)
- Adam P Vogel
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany.
| | - Michelle Magee
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Reidenis Torres-Vega
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Jacqueline Medrano-Montero
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Melissa P Cyngler
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Megan Kruse
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sandra Rojas
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sebastian Contreras Cubillos
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Tamara Canento
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Fernanda Maldonado
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Yaimee Vazquez-Mojena
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Winfried Ilg
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Roberto Rodríguez-Labrada
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Luis Velázquez-Pérez
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Matthis Synofzik
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
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8
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Keage M, Delatycki MB, Dyer J, Corben LA, Vogel AP. Changes detected in swallowing function in Friedreich ataxia over 12 months. Neuromuscul Disord 2019; 29:786-793. [DOI: 10.1016/j.nmd.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
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9
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Lewis C, Walterfang M, Velakoulis D, Vogel AP. A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration. Dement Geriatr Cogn Disord 2019; 46:285-297. [PMID: 30423586 DOI: 10.1159/000494210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) can result in a decline in behavior, language, and motor function. Mealtime disturbances are a common and significant outcome of FTLD. Disturbances during mealtimes can arise from dysphagia or may occur secondary to behavioral changes such as rapid eating, mealtime rigidity, and altered diet preferences. SUMMARY Few studies have comprehensively evaluated eating behavior or dysphagia in individuals presenting with FTLD pathology despite the potential impact on medical safety and individual quality of life. Dysphagia is reported in the late stages of frontotemporal dementia and early in the motor subtypes of FTLD. The identification of dysphagia can alert individuals and medical teams to disease progression and provide insight into the nature and spread of the underlying neuropathology. Improved understanding of eating behaviors can improve individual care and may enhance diagnostic accuracy. Key Message: Aberrant eating behavior and swallowing difficulties are reported in the conditions associated with FTLD neuropathology. The consequences of mealtime disturbances include health risks associated with an increased BMI and aspiration, reduction of an individual's independence, and an increase in caregiver stress and burden. Here we review and summarize the literature on eating behavior and swallow impairments (dysphagia) in each of the syndromes caused by FTLD.
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Affiliation(s)
- Courtney Lewis
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia, .,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany, .,Redenlab, Melbourne, Victoria, Australia,
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10
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Parkinson's Disease and Current Treatments for Its Gastrointestinal Neurogastromotility Effects. ACTA ACUST UNITED AC 2018; 16:489-510. [PMID: 30361854 DOI: 10.1007/s11938-018-0201-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Gastrointestinal disturbances are seen in nearly all patients with Parkinson's disease and lead to impaired quality of life, affect drug pharmacodynamics, and potentially worsen patient's existing motor fluctuations, leading to further disability. Recent evidence links abnormal accumulations of α-synuclein aggregates in the periphery (gut) as seen in the cortex which causes dysfunctions impacting every level of the gastrointestinal tract from the esophagus, to the stomach, small bowel, colon, and rectum and can even predate the onset of the central neurologic disorder itself. Many treatments exist for the clinical phenotypes that result from the autonomic dysfunction and neuropathy involved in this neurodegenerative disorder. The treatments for the gut dysfunction seen in Parkinson's disease (PD) depend on the specific area of the gastrointestinal tract affected. For dysphagia, behavioral therapies with speech pathology, neuromuscular electrical stimulation, or botulinum toxin injection may be helpful. For gastroparesis, domperidone may serve as an antiemetic while also blunting the hypotensive potential of Levodopa while new treatments such as ghrelin agonists may prove beneficial to help appetite, satiety, gastric emptying in those with constipation, and even improve constipation. Antibiotics such as rifaximin with poor systemic absorption may be used to treat small bacterial overgrowth also found in those with PD while the benefits of probiotics is yet to be determined. Finally, constipation in PD can be a reflection of pelvic floor dyssynergia, slow transit constipation, or both, thus treatments targeting the specific anorectal dysfunction is necessary for better outcomes.
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11
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Vogel AP, Rommel N, Oettinger A, Stoll LH, Kraus EM, Gagnon C, Horger M, Krumm P, Timmann D, Storey E, Schöls L, Synofzik M. Coordination and timing deficits in speech and swallowing in autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). J Neurol 2018; 265:2060-2070. [PMID: 29968200 DOI: 10.1007/s00415-018-8950-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare early onset neurodegenerative disease that typically results in ataxia, upper motor neuron dysfunction and sensorimotor peripheral neuropathy. Dysarthria and dysphagia are anecdotally described as key features of ARSACS but the nature, severity and impact of these deficits in ARSACS are not known. A comprehensive quantitative and qualitative characterization of speech and swallowing function will support diagnostics, provide insights into the underlying pathology, and guide day-to-day clinical management. METHODS 11 consecutive non-Quebec ARSACS patients were recruited, and compared to healthy participants from several published and unpublished cohorts. A comprehensive behavioural assessment including objective acoustic analysis and expert perceptual ratings of motor speech, the Clinical Assessment of Dysphagia in Neurodegeneration (CADN), videofluoroscopy and standardized tests of dysarthria and swallowing related quality of life was conducted. RESULTS Speech in this ARSACS cohort is characterized by pitch breaks, prosodic deficits including reduced rate and prolonged intervals, and articulatory deficits. The swallowing profile was characterized by delayed initiation of the swallowing reflex and late epiglottic closure. Four out of ten patients were observed aspirating thin liquids on videofluoroscopy. Patients report that they regularly cough or choke on thin liquids and solids during mealtimes. Swallowing and speech-related quality of life was worse than healthy controls on all domains except sleep. CONCLUSIONS The dysphagia and dysarthria profile of this ARSACS cohort reflects impaired coordination and timing. Dysphagia contributes to a significant impairment in functional quality of life in ARSACS, and appears to manifest distinctly from other ARSACS dysfunctions such as ataxia or spasticity.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. .,Center for Neurology, University Hospital Tübingen, Tübingen, Germany. .,Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia. .,Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Lisa H Stoll
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Jonquière, QC, Canada.,Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Jonquière, QC, Canada.,Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elsdon Storey
- Department of Medicine, Monash University, Melbourne, Australia
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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12
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Espitalier F, Fanous A, Aviv J, Bassiouny S, Desuter G, Nerurkar N, Postma G, Crevier-Buchman L. International consensus (ICON) on assessment of oropharyngeal dysphagia. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S17-S21. [PMID: 29396225 DOI: 10.1016/j.anorl.2017.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation). METHODS Following a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting. RESULTS For the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.
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Affiliation(s)
- F Espitalier
- Department of Otolaryngology-Head and Neck Surgery, CHU de Nantes, 44093 Nantes, France.
| | - A Fanous
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - J Aviv
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, USA
| | - S Bassiouny
- Department of Otolaryngology-Head and Neck Surgery, Ain Shams University, Cairo, Egypt
| | - G Desuter
- Department of Otolaryngology-Head and Neck Surgery, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Nerurkar
- Department of Otolaryngology-Head and Neck Surgery, Bombay Hospital, Mumbai, India
| | - G Postma
- Department of Otolaryngology, Center for Voice, Airway and Swallowing Disorders, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - L Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, hôpital européen Geroges-Pompidou, 75015 Paris, France
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13
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Vogel AP, Rommel N, Oettinger A, Horger M, Krumm P, Kraus EM, Schöls L, Synofzik M. Speech and swallowing abnormalities in adults with POLG associated ataxia (POLG-A). Mitochondrion 2017. [PMID: 28634151 DOI: 10.1016/j.mito.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mutations in the nuclear-encoded mitochondrial DNA polymerase gamma (POLG) can result in a wide spectrum of neurological deficits. A common presentation is progressive ataxia (POLG-A) which includes impaired speech and swallowing. The nature, severity and impact of these deficits in POLG-A is not known. A comprehensive quantitative and qualitative characterization of dysarthria and dysphagia in this recurrent ataxia disorder will assist in diagnostics, provide insights into the underlying pathology, and establish the foundation for future therapy trials. METHODS 14 consecutive patients with POLG (9 females, mean age=50.1y, SD=11.2) and 34 healthy controls were enrolled. Comprehensive assessments of motor speech and swallowing function, acoustic analysis of speech, videofluoroscopy and measures of quality of life were conducted. RESULTS The speech profile of individuals with POLG-A was characterized by poor control of pitch and strain-strangled voice quality, reduced rate of speech and longer variable silences between words, and articulatory breakdown including imprecise consonants and vowel distortions. Swallowing deficits included slower initiation of the swallow reflex, poor control of bolus and late epiglottic closure. Speech and swallowing related quality of life was worse than healthy controls. CONCLUSIONS The dysarthria and dysphagia profiles in POLG-A are largely symptomatic of impaired timing, indicating a mainly spinocerebellar deficit. Dysarthria and dysphagia contribute to a significant impairment in functional quality of life, and progress distinctly from other POLG-A dysfunctions like ataxia or cognitive impairment. Our assessments establish meaningful patient focused outcome measures that will be suitable for use in natural history studies and clinical trials.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia; Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Therapiezentrum, University Hospital Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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