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Maas JJ, de Vries NM, IntHout J, Bloem BR, Kalf JG. Effectiveness of remotely delivered speech therapy in persons with Parkinson's disease - a randomised controlled trial. EClinicalMedicine 2024; 76:102823. [PMID: 39309726 PMCID: PMC11415969 DOI: 10.1016/j.eclinm.2024.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
Background Increasing evidence supports the merits of speech therapy in Parkinson's disease, but the current practice of multiple in-house treatments is demanding for patients. We therefore assessed the effectiveness of remotely delivered and personalised speech therapy on improving quality of life and speech quality in persons with Parkinson's disease. Methods We performed a single blinded randomised controlled trial (the PERSPECTIVE study), comparing 8 weeks of personalised remote speech therapy to no intervention (waiting list design). Patients with reduced speech intelligibility were included, regardless of disease stage or dysarthria severity. Patients were assigned randomly (1:1) to the intervention or control group. Measurements took place at baseline and after 8 weeks (both groups), and after 32 weeks (intervention group only). Patients were treated remotely by 20 experienced speech therapists. The primary outcome was disease-related quality of life at 8 weeks, assessed with the Parkinson's Disease Questionnaire 39 (PDQ-39). Data were analysed using analysis of covariance based on the intention-to-treat principle. This trial is registered in ClinicalTrials.gov, NCT03963388. Findings Between March 1, 2019, and March 27, 2021, 214 patients were enrolled in the intervention group (n = 109) or control group (n = 105). At the primary timepoint, the adjusted mean difference in PDQ-39 was -2.0 in favour of the intervention group (95% CI -4.0 to 0.1); p = 0.056). The intervention group scored better on the communication index score of the PDQ-39 (post hoc analysis), with an adjusted mean difference of -5.3 (95% CI -9.4 to -1.2; p = 0.011). We found no between-group differences on any other PDQ-39 domain. Follow-up measurements showed a significant reduction of the PDQ-39 compared to the primary timepoint with a difference of 2.40 (95% CI 0.77-4.02; p = 0.004). Interpretation Personalised remote speech therapy improved communication-related quality of life, but not overall quality of life. Funding Michael J. Fox Foundation, Gatsby Foundation, and Health∼Holland.
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Affiliation(s)
- Janna J.L. Maas
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Nienke M. de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, IQ Health; Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Johanna G. Kalf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
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Manfredini D, Ahlberg J, Aarab G, Bender S, Bracci A, Cistulli PA, Conti PC, De Leeuw R, Durham J, Emodi-Perlman A, Ettlin D, Gallo LM, Häggman-Henrikson B, Hublin C, Kato T, Klasser G, Koutris M, Lavigne GJ, Paesani D, Peroz I, Svensson P, Wetselaar P, Lobbezoo F. Standardised Tool for the Assessment of Bruxism. J Oral Rehabil 2024; 51:29-58. [PMID: 36597658 DOI: 10.1111/joor.13411] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences. METHODS The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications. RESULTS The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration. CONCLUSIONS The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.
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Affiliation(s)
- Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial, Diseases, University of Helsinki, Helsinki, Finland
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Steven Bender
- Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, Texas, USA
| | | | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Reny De Leeuw
- Department of Oral Health Science, Orofacial Pain Center, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| | - Justin Durham
- Newcastle University's School of Dental Sciences, Newcastle, UK
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dominik Ettlin
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | | | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Gary Klasser
- Department of Diagnostic Sciences, Louisiana State University School of Dentistry, New Orleans, Louisiana, USA
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilles J Lavigne
- Faculty of Dental Medicine, Universite de Montréal, Quebec, Montréal, Canada
| | - Daniel Paesani
- School of Dentistry, University of Salvador/AOA, Buenos Aires, Argentina
| | - Ingrid Peroz
- Department for Prosthodontics, Gerodontology and Craniomandibular Disorders, Charité Centre for Oral Sciences, Charité - University Medicine of Berlin, Berlin, Germany
| | - Peter Svensson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Summaka M, Nasser Z, Hannoun S, Daoud R, Zein H, Al-Thalaya Z, Hamadeh ZA, Koubaisy N, Jebahi F, Naim I, Harati H. The Radboud dysarthria assessment: validity and reliability of the Arabic version. Disabil Rehabil 2023:1-10. [PMID: 38149715 DOI: 10.1080/09638288.2023.2297809] [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: 06/12/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria. MATERIALS AND METHODS This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index-10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated. RESULTS Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and -0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001). CONCLUSION The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects.
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Affiliation(s)
- Marwa Summaka
- Doctoral School of Sciences and Technology, Lebanese University, Hadath, Lebanon
| | - Zeina Nasser
- Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, American University of Beirut, Beirut, Lebanon
| | - Rama Daoud
- Department of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hiba Zein
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Zahra Al-Thalaya
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zainab A Hamadeh
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Nour Koubaisy
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Fatima Jebahi
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, AZ, USA
| | - Ibrahim Naim
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Lebanese University, Hadath, Lebanon
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Battel I, Walshe M. An intensive neurorehabilitation programme with sEMG biofeedback to improve swallowing in idiopathic Parkinson's disease (IPD): A feasibility study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:813-825. [PMID: 36478035 DOI: 10.1111/1460-6984.12824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. AIMS Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. METHODS & PROCEDURES We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. OUTCOME & RESULTS Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. CONCLUSIONS & IMPLICATIONS An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. WHAT THIS PAPER ADDS What is already known on the subject Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds Recognizing the limitations of earlier studies, this within-subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3-month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post-intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice.
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Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Department of Biomedical, Surgical and Dental Sciences, University 'La Statale', Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
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Mobile health technology, exercise adherence and optimal nutrition post rehabilitation among people with Parkinson's Disease (mHEXANUT) - a randomized controlled trial protocol. BMC Neurol 2023; 23:93. [PMID: 36864377 PMCID: PMC9979434 DOI: 10.1186/s12883-023-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Although it is well known that regular physical activity and exercise, as well as maintaining adequate nutritional status is important to delaying symptom development and maintaining physical capacity and function in people with Parkinson's Disease (PD), many are unable to follow self-management recommendations. Active interventions have shown short-term effects, but there is a need for interventions that facilitate self-management over the course of the disease. Until now, no studies have combined exercise and nutritional interventions with an individual self-management approach in PD. Thus, we aim to examine the effect of a six-month mobile health technology(m-health)-based follow-up programme, focusing on self-management in exercise and nutrition, after an in-service interdisciplinary rehabilitation programme. METHODS A single-blinded, two-group randomised controlled trial. Participants are Adults aged 40 or older, with idiopathic PD, Hoehn and Yahr 1-3, living at home. The intervention group receives a monthly, individualized, digital conversation with a PT, combined with use of an activity tracker. People at nutritional risk get additional digital-follow-up from a nutritional specialist. The control group receives usual care. The primary outcome is physical capacity, measured by 6-min walk test (6MWT). Secondary outcomes are nutritional status, Health related quality of life (HRQOL), physical function and exercise adherence. All measurements are performed at baseline, after 3 months and after 6 months. Sample size, based on primary outcome, is set at 100 participants randomized into the two arms, including an estimated 20% drop out. DISCUSSION The increasing prevalence of PD globally makes it even more important to develop evidence-based interventions that can increase motivation to stay active, promote adequate nutritional status and improve self-management in people with PD. The individually tailored digital follow-up programme, based on evidence-based practice, has the potential to promote evidence-based decision-making and to empower people with PD to implement exercise and optimal nutrition in their daily lives and, hopefully, increase adherence to exercise and nutritional recommendations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04945876). First registration 01.03.2021.
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Dismore L, Montague K, Carvalho L, Guerreiro T, Jackson D, Guan Y, Walker R. A protocol for the evaluation of a wearable device for monitoring of symptoms, and cueing for the management of drooling, in people with Parkinson's disease. PLoS One 2023; 18:e0280727. [PMID: 36827274 PMCID: PMC9955579 DOI: 10.1371/journal.pone.0280727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/16/2022] [Indexed: 02/25/2023] Open
Abstract
Drooling is a common symptom of Parkinson's Disease (PD) experienced in up to 70% of people with PD (PwP). Drooling can be a major problem in PwP leading to adverse physical and psychosocial issues. Current medical treatments decrease the production of saliva, whereas the problem is due to decreased swallowing frequency, not over production of saliva. Such treatments are problematic as saliva is essential for good oral health. Therefore, non-invasive treatments options such as behavioural cueing methods are recommended. A wrist-worn device delivering haptic cueing has been demonstrated to be an effective treatment method to increase swallowing frequency and a socially acceptable solution for PwP. However, the device had limited functionality and was tested on a small sample size over a short period of usage. Further work is required to understand the real-world behaviours and usage of the intervention to understand the longer-term effects with a larger sample size. This research will deploy CueBand, a discrete and comfortable wrist-worn device designed to work with a smartphone application to support the real-world evaluation of haptic cueing for the management of drooling. We will recruit 3,000 PwP to wear the device day and night for the intervention period to gain a greater understanding of the effectiveness and acceptability of the technology within real-world use. Additionally, 300 PwP who self-identity as having an issue with drooling will be recruited into an intervention study to evaluate the effectiveness of the wrist-worn CueBand to deliver haptic cueing (3-weeks) compared with smartphone cueing methods (3-weeks). PwP will use our smartphone application to self-assess their drooling frequency, severity, and duration using visual analogue scales and through the completion of daily diaries. Semi-structured interviews to gain feedback about utility of CueBand will be conducted following participants completion of the intervention.
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Affiliation(s)
- Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, Innovation, Research and Development, North Tyneside General Hospital, North Shields, United Kingdom
| | - Kyle Montague
- Computer & Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Luis Carvalho
- Computer & Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Portugal, Portugal
| | - Dan Jackson
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yu Guan
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Innovation, Research and Development, North Tyneside General Hospital, North Shields, United Kingdom
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Two-year clinical progression in focal and diffuse subtypes of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:29. [PMID: 36806285 PMCID: PMC9937525 DOI: 10.1038/s41531-023-00466-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 02/19/2023] Open
Abstract
Heterogeneity in Parkinson's disease (PD) presents a barrier to understanding disease mechanisms and developing new treatments. This challenge may be partially overcome by stratifying patients into clinically meaningful subtypes. A recent subtyping scheme classifies de novo PD patients into three subtypes: mild-motor predominant, intermediate, or diffuse-malignant, based on motor impairment, cognitive function, rapid eye movement sleep behavior disorder (RBD) symptoms, and autonomic symptoms. We aimed to validate this approach in a large longitudinal cohort of early-to-moderate PD (n = 499) by assessing the influence of subtyping on clinical characteristics at baseline and on two-year progression. Compared to mild-motor predominant patients (42%), diffuse-malignant patients (12%) showed involvement of more clinical domains, more diffuse hypokinetic-rigid motor symptoms (decreased lateralization and hand/foot focality), and faster two-year progression. These findings extend the classification of diffuse-malignant and mild-motor predominant subtypes to early-to-moderate PD and suggest that different pathophysiological mechanisms (focal versus diffuse cerebral propagation) may underlie distinct subtype classifications.
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Helliesen JS, Kristiansen I, Brekke HK, Støkket RS, Bye A. Nutrition impact symptoms and the risk of malnutrition in people with Parkinson's disease: A cross-sectional study. J Hum Nutr Diet 2023; 36:40-50. [PMID: 35897145 DOI: 10.1111/jhn.13070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with Parkinson's disease (PD) often experience symptoms that affect their ability to eat. This may contribute to weight loss and increased risk of malnutrition. The present study aimed to quantify the extent of nutrition impact symptoms (NIS) in the population and a scoring system of NIS was incorporated in the tool used to identify malnutrition. METHODS In this cross-sectional study, members of the Norwegian Parkinson's Association, with any PD diagnosis and stage of illness, were invited to respond to an online 24-item questionnaire. Questions from two validated questionnaires, comprising the abridged Patient-Generated Subjective Global Assessment (aPG-SGA) and the Radboud Oral Motor Inventory for Parkinson's disease (ROMP), were adapted to an online format. RESULTS The questionnaire was sent to 3047 members, of which 508 persons (17%) responded (61% men). In total, 59% were categorised as well-nourished, 34% at risk of malnutrition and 6.5% as malnourished. One quarter of all participants reported symptoms that affected food intake. The most frequent symptoms were constipation (14.2%) and dry mouth (13.4%). Malnourished participants reported a mean ± SD of 3.4 ± 1.4 symptoms versus 0.1 ± 0.3 per well-nourished participant. Malnourished participants had more swallowing problems than well-nourished participants, with a mean ± SD total ROMP score of 15.5 ± 6.0 versus 9.0 ± 2.9 (p < 0.001). As the number of points in the ROMP score increased by one, the points in the aPG-SGA score increased with 37% (95% confidence interval = 0.309-0.428). CONCLUSIONS Risk of malnutrition was largely related to NIS, especially dysphagia in people with PD. Symptoms affecting food intake should be systematically mapped and treated in conjunction with PD to prevent malnutrition.
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Affiliation(s)
- Julie Sørbø Helliesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ida Kristiansen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Hilde Kristin Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway.,Department of Oncology, European Palliative Care Research Centre (PRC), Oslo University Hospital, Oslo, Norway
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9
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Gulati A, Kidane J, Chang JL. Patient Reported Outcome Measures for Salivary Function: A Systematic Review. Laryngoscope 2023. [PMID: 36606658 DOI: 10.1002/lary.30550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A number of patient-reported outcome measures (PROMs) assess quality of life and symptom severity in patients with salivary gland dysfunction, but many vary in the extent of validation and domain types addressed. We identified PROMs validated to measure salivary gland function and analyzed key properties. DATA SOURCES PubMed, Web of Science, Embase, PsycInfo, and CINAHL. REVIEW METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Validated instruments with >1 item to assess salivary gland-related symptoms were included. PROMs were evaluated for developmental methodology, structure, validity, and reliability using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. RESULTS A total of 2059 abstracts were retrieved, and 133 full-text articles were reviewed. Sixteen PROMs assessing xerostomia (n = 7), sialadenitis (n = 4), Sjogren's syndrome (n = 2), Parkinson's-associated sialorrhea (n = 2), and oral systemic sclerosis (n = 1) were identified. Most (n = 15) were developed de novo, one was adapted from a pre-existing questionnaire. Eleven PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and 10 included test-retest data. Regarding content validity, four PROMs were developed with both patient and physician input, but none were rated as "adequate." All included comparisons against other questionnaires (n = 7), salivary flow rate (n = 9), and/or healthy controls (n = 3). The most rigorously developed PROM, the Xerostomia Inventory, was rated adequate in 6 out of 7 domains. CONCLUSIONS Several PROMs evaluate salivary function. The abilties of these PROMs to meet design and validation standards were variable, with notable limitations in content validity for all tools. New and updated PROMs assessing obstructive and inflammatory salivary symptoms should utilize patient and provider input. LEVEL OF EVIDENCE N/A Laryngoscope, 2023.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Joseph Kidane
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.,Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Gonzalez-Robles C, Weil RS, van Wamelen D, Bartlett M, Burnell M, Clarke CS, Hu MT, Huxford B, Jha A, Lambert C, Lawton M, Mills G, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Schrag A. Outcome Measures for Disease-Modifying Trials in Parkinson's Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1011-1033. [PMID: 37545260 PMCID: PMC10578294 DOI: 10.3233/jpd-230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Multi-arm, multi-stage (MAMS) platform trials can accelerate the identification of disease-modifying treatments for Parkinson's disease (PD) but there is no current consensus on the optimal outcome measures (OM) for this approach. OBJECTIVE To provide an up-to-date inventory of OM for disease-modifying PD trials, and a framework for future selection of OM for such trials. METHODS As part of the Edmond J Safra Accelerating Clinical Trials in Parkinson Disease (EJS ACT-PD) initiative, an expert group with Patient and Public Involvement and Engagement (PPIE) representatives' input reviewed and evaluated available evidence on OM for potential use in trials to delay progression of PD. Each OM was ranked based on aspects such as validity, sensitivity to change, participant burden and practicality for a multi-site trial. Review of evidence and expert opinion led to the present inventory. RESULTS An extensive inventory of OM was created, divided into: general, motor and non-motor scales, diaries and fluctuation questionnaires, cognitive, disability and health-related quality of life, capability, quantitative motor, wearable and digital, combined, resource use, imaging and wet biomarkers, and milestone-based. A framework for evaluation of OM is presented to update the inventory in the future. PPIE input highlighted the need for OM which reflect their experience of disease progression and are applicable to diverse populations and disease stages. CONCLUSION We present a range of OM, classified according to a transparent framework, to aid selection of OM for disease-modifying PD trials, whilst allowing for inclusion or re-classification of relevant OM as new evidence emerges.
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Affiliation(s)
| | | | | | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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11
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Wang Q, Botchway BOA, Zhang Y, Liu X. Ellagic acid activates the Keap1-Nrf2-ARE signaling pathway in improving Parkinson's disease: A review. Biomed Pharmacother 2022; 156:113848. [PMID: 36242848 DOI: 10.1016/j.biopha.2022.113848] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is a familiar neurodegenerative disease, accompanied by motor retardation, static tremor, memory decline and dementia. Heredity, environment, age and oxidative stress have been suggested as key factors in the instigation of PD. The Keap1-Nrf2-ARE signaling is one of the most significant anti- oxidative stress (OS) pathways. The Keap1 is a negative regulator of the Nrf2. The Keap1-Nrf2-ARE pathway can induce cell oxidation resistance and reduce nerve injury to treat neurodegenerative diseases. Ellagic acid (EA) can inhibit the Keap1 to accumulate the Nrf2 in the nucleus, and act on the ARE to produce target proteins, which in turn may alleviate the impact of OS on neuronal cells of PD. This review analyzes the structure and physiological role of EA, along with the structure, composition and functions of the Keap1-Nrf2-ARE signaling pathway. We further expound on the mechanism of ellagic acid in its activation of the Keap1-Nrf2-ARE signaling pathway, as well as the relationship between EA in impairing the TLR4/Myd88/NF-κB and Nrf2 pathways. Ellagic acid has the potentiality of improving PD by activating the Keap1-Nrf2-ARE signaling pathway and scavenging free radicals.
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Affiliation(s)
- Qianhui Wang
- Department of Histology and Embryology, Medical College, Shaoxing University, Zhejiang, China
| | - Benson O A Botchway
- Institute of Neuroscience, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Zhang
- Department of Histology and Embryology, Medical College, Shaoxing University, Zhejiang, China
| | - Xuehong Liu
- Department of Histology and Embryology, Medical College, Shaoxing University, Zhejiang, China.
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12
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Maas JJL, De Vries NM, Bloem BR, Kalf JG. Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial). Trials 2022; 23:274. [PMID: 35395953 PMCID: PMC8990485 DOI: 10.1186/s13063-022-06160-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech. Background Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage. Methods We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden. Results The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022. Conclusions We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages. Trial registration ClinicalTrials.govNCT03963388. Registered on May 24, 2019
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Affiliation(s)
- J J L Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - N M De Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J G Kalf
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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13
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Warnecke T, Schäfer KH, Claus I, Del Tredici K, Jost WH. Gastrointestinal involvement in Parkinson's disease: pathophysiology, diagnosis, and management. NPJ Parkinsons Dis 2022; 8:31. [PMID: 35332158 PMCID: PMC8948218 DOI: 10.1038/s41531-022-00295-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Growing evidence suggests an increasing significance for the extent of gastrointestinal tract (GIT) dysfunction in Parkinson's disease (PD). Most patients suffer from GIT symptoms, including dysphagia, sialorrhea, bloating, nausea, vomiting, gastroparesis, and constipation during the disease course. The underlying pathomechanisms of this α-synucleinopathy play an important role in disease development and progression, i.e., early accumulation of Lewy pathology in the enteric and central nervous systems is implicated in pharyngeal discoordination, esophageal and gastric motility/peristalsis impairment, chronic pain, altered intestinal permeability and autonomic dysfunction of the colon, with subsequent constipation. Severe complications, including malnutrition, dehydration, insufficient drug effects, aspiration pneumonia, intestinal obstruction, and megacolon, frequently result in hospitalization. Sophisticated diagnostic tools are now available that permit more detailed examination of specific GIT impairment patterns. Furthermore, novel treatment approaches have been evaluated, although high-level evidence trials are often missing. Finally, the burgeoning literature devoted to the GIT microbiome reveals its importance for neurologists. We review current knowledge about GIT pathoanatomy, pathophysiology, diagnosis, and treatment in PD and provide recommendations for management in daily practice.
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Affiliation(s)
- T Warnecke
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, 48149, Münster, Germany
| | - K-H Schäfer
- Research and Transfer Working Group Enteric Nervous System (AGENS), University of Applied Sciences Kaiserslautern, Campus Zweibrücken, 66482, Zweibrücken, Germany
| | - I Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, 48149, Münster, Germany
| | - K Del Tredici
- Clinical Neuroanatomy, Department of Neurology, Center for Biomedical Research, University of Ulm, 89081, Ulm, Germany
| | - W H Jost
- Parkinson-Klinik Ortenau, 77709, Wolfach, Germany.
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14
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Nascimento D, Carmona J, Mestre T, Ferreira JJ, Guimarães I. Drooling rating scales in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2021; 91:173-180. [PMID: 34583888 DOI: 10.1016/j.parkreldis.2021.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Drooling is a clinically relevant non-motor symptom of people with Parkinson's disease (PwP). Several drooling rating scales are available. Nevertheless, the compelling scientific evidence supporting their validity is limited. This study aims to evaluate clinical rating scales for drooling, assessing their characteristics, clinimetric properties, and clinical utility classification. METHODS A systematic review was undertaken. Two reviewers performed independent literature searches using the CENTRAL®, CINAHL®, Embase®, MEDLINE®, SciElo®, and SPEECH BITE® databases. We used consensus-based standards for the selection of health measurement instruments (COSMIN) and the International Parkinson's disease and the Movement Disorders (MDS) criteria to evaluate the included rating scales. RESULTS The following six rating scales were identified: Drooling Impact Scale (DIS), Sialorrhea Scoring Scale (SSS), Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale (DRS), Sialorrhea Clinical Scale for Parkinson Disease (SCS-PD), and the Radboud Oral Motor inventory for Parkinson's disease - Saliva (ROMP-saliva). The scales had heterogeneous characteristics: (i) not all were created/adapted for PwP; (ii) different dimensions associated with drooling are assessed; (iii) cross-cultural adaptations are limited to some languages. The clinimetric properties showed: (i) target population size limitations; (ii) incomplete reliability analysis; (iii) lack of robust validity; (iv) sensitivity to change not fully explored. Following the MDS criteria, only one tool was classified as "recommended", the ROMP-saliva. CONCLUSIONS This review provides information for an adequate selection of a drooling rating scale for clinical and/or research purposes. To date, ROMP-saliva is the only scale with substantial evidence of its clinimetric properties adequacy and data in PwP.
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Affiliation(s)
- David Nascimento
- Laboratory of Clinical Pharmacology and Therapeutics Unit, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal; Swallowing Disorders Unit, Department of Otolaryngology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Jaqueline Carmona
- Alcoitão School of Health Sciences, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal.
| | - Tiago Mestre
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada; Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics Unit, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal; CNS - Campus Neurológico, Torres Vedras, Portugal.
| | - Isabel Guimarães
- Laboratory of Clinical Pharmacology and Therapeutics Unit, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal; Alcoitão School of Health Sciences, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal.
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15
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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: 26] [Impact Index Per Article: 8.7] [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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16
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Rozas NS, Tribble GD, Jeter CB. Oral Factors That Impact the Oral Microbiota in Parkinson's Disease. Microorganisms 2021; 9:microorganisms9081616. [PMID: 34442695 PMCID: PMC8402101 DOI: 10.3390/microorganisms9081616] [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: 06/19/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023] Open
Abstract
Patients with Parkinson’s disease (PD) are at increased risk of aspiration pneumonia, their primary cause of death. Their oral microbiota differs from healthy controls, exacerbating this risk. Our goal was to explore if poor oral health, poor oral hygiene, and dysphagia status affect the oral microbiota composition of these patients. In this cross-sectional case-control study, the oral microbiota from hard and soft tissues of patients with PD (n = 30) and age-, gender-, and education-matched healthy controls (n = 30) was compared using 16S rRNA gene sequencing for bacterial identification. Study participants completed dietary, oral hygiene, drooling, and dysphagia questionnaires, and an oral health screening. Significant differences in soft tissue beta-diversity (p < 0.005) were found, and a higher abundance of opportunistic oral pathogens was detected in patients with PD. Factors that significantly influenced soft tissue beta-diversity and microbiota composition include dysphagia, drooling (both p < 0.05), and salivary pH (p < 0.005). Thus, patients with PD show significant differences in their oral microbiota compared to the controls, which may be due, in part, to dysphagia, drooling, and salivary pH. Understanding factors that alter their oral microbiota could lead to the development of diagnostic and treatment strategies that improve the quality of life and survivability of these patients.
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Affiliation(s)
- Natalia S. Rozas
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
| | - Gena D. Tribble
- Department of Periodontics and Dental Hygiene, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBS-5318, Houston, TX 77054, USA;
| | - Cameron B. Jeter
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
- Correspondence: ; Tel.: +1-(713)-486-4427
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17
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Baert F, Vlaemynck G, Beeckman AS, Van Weyenberg S, Matthys C. Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture. J Food Sci 2021; 86:1039-1047. [PMID: 33521981 DOI: 10.1111/1750-3841.15595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages.
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Affiliation(s)
- Florence Baert
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium.,Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium
| | - Geertrui Vlaemynck
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Anne-Sophie Beeckman
- Speech Language Therapy, Postgraduate Course Dysphagia, Artevelde University of Applied Sciences, Campus Kantienberg, Voetweg 66, Gent, 9000, Belgium.,Speech Language Therapy, AZ Maria Middelares, Buitenring Sint-Denijs 30, Gent, 9000, Belgium
| | - Stephanie Van Weyenberg
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium.,Department of Endocrinology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium
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18
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Ayres A, Winckler PB, Jacinto-Scudeiro LA, Rech RS, Padovani MMP, Jotz GP, Olchik MR. Speech characteristics in individuals with myasthenia gravis: a case control study. LOGOP PHONIATR VOCO 2020; 47:35-42. [DOI: 10.1080/14015439.2020.1834614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Annelise Ayres
- Postgraduate Program in Health Sciences at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pablo Brea Winckler
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laís Alves Jacinto-Scudeiro
- Postgraduate Program in Medical Sciences at the Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafaela Soares Rech
- Speech Therapy Course, College of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Geraldo Pereira Jotz
- Postgraduate Program in Health Sciences at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maira Rozenfeld Olchik
- Speech Therapy Course, College of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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19
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Cardoso AR, Guimarães I, Santos H, Carvalho J, Abreu D, Gonçalves N, Ferreira JJ. Cross-cultural adaptation and validation of the Swallowing Disturbance Questionnaire and the Sialorrhea Clinical Scale in Portuguese patients with Parkinson's disease. LOGOP PHONIATR VOCO 2020; 46:163-170. [PMID: 32772888 DOI: 10.1080/14015439.2020.1792979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION To date, no valid outcome measure has been developed in European Portuguese (EP) to evaluate the Parkinsons' Disease (PD) patients' (PwP) reports regarding their swallowing disturbances. OBJECTIVES The aim of this study was to translate and cross-culturally adapt the Swallowing Disturbance Questionnaire (SDQ) and the Sialorrhea Clinical Scale for PD (SCS-PD) into EP and to determine its clinimetric properties in PwP. MATERIALS AND METHODS The original English SDQ and SCS-PD versions were cross-culturally adapted following recommendations established in international guidelines. The validation process involved 75 PwP and 65 healthy sex- and age-matched participants. RESULTS The EP versions of the SDQ and SCS-PD are equivalent to the original versions (content, depth, and scoring). Statistical analyses for the SDQ tool revealed good feasibility (missing data <5%), acceptability (no floor or ceiling effects), excellent internal consistency (Cronbach´s α = 0.95), good construct validity (78.5% revealed large to moderate loadings), moderate convergent validity (r = 0.60), good divergent validity (r = 0.40), good known-groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.700). Statistical analyses for the SCS-PD tool shows good feasibility, reasonable acceptability (floor effect), good internal consistency (Cronbach´s α = 0.85), good construct validity (85.7% showed between large to moderate loadings), good convergent validity (r = 0.78), good divergent validity (r = 0.39), good known groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.704). CONCLUSIONS The EP versions of the SDQ and SCS-PD maintained the characteristics of the original versions and therefore consistent tools to be used in PwP.
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Affiliation(s)
- Ana Rita Cardoso
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Isabel Guimarães
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Speech Therapy, Alcoitão Health School of Sciences, Estoril, Portugal
| | | | - Joana Carvalho
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Daisy Abreu
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nilza Gonçalves
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joaquim J Ferreira
- Clinical Pharmacology and Therapeutics Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Campus Neurológico Sénior, Torres Vedras, Portugal
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20
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Mestre TA, Freitas E, Basndwah A, Lopez MR, de Oliveira LM, Al-Shorafat DM, Zhang T, Lui JP, Grimes D, Fox SH. Glycopyrrolate Improves Disability From Sialorrhea in Parkinson's Disease: A 12-Week Controlled Trial. Mov Disord 2020; 35:2319-2323. [PMID: 32657457 DOI: 10.1002/mds.28196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the 12-week efficacy and safety of oral glycopyrrolate for moderate-to-severe sialorrhea in Parkinson's disease (PD). BACKGROUND Chronic moderate-to-severe sialorrhea has a negative impact on quality of life in PD. There is no robust evidence for oral treatments for sialorrhea longer than 1 week. METHODS This was a 12-week, double-blinded, placebo-controlled, parallel phase II study in patients with PD and Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 2.2 > 2. The intervention was glycopyrrolate up to 4.5 mg/d; the primary outcome was sialorrhea related-disability (Radboud Oral Motor Inventory for Parkinson's Disease-Saliva). We used an intention-to-treat analysis. A P < 0.05 was deemed significant. RESULTS We recruited 28 patients (age, 71.1 ± 6.9 years; PD duration, 11.4 ± 7.2 years; Radboud Oral Motor Inventory for Parkinson's Disease-Saliva, 22.4 ± 5.7). Glycopyrrolate was superior to placebo at 12 weeks in the Radboud Oral Motor Inventory for Parkinson's Disease-Saliva (between-group difference, 5.3; 95% confidence interval, 1.0-9.6). Dry mouth was the most common adverse event (glycopyrrolate, n = 6; placebo, n = 2). CONCLUSIONS The results support the efficacy of glycopyrrolate to treat sialorrhea-related disability up to 12 weeks and contribute to addressing unmet nonmotor care needs in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tiago A Mestre
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Canada
| | - Eliza Freitas
- Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Basndwah
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Canada
| | - Marta Ruiz Lopez
- Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,University Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Lais Machado de Oliveira
- Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Duha Mohammed Al-Shorafat
- Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Tinghua Zhang
- Ottawa Methods Center, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jane P Lui
- Department of Pharmacy, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David Grimes
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Canada
| | - Susan H Fox
- Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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21
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Thongchuam Y, Panyakaew P, Bhidayasiri R. Orofacial dystonia and asssociated bulbar symptoms in multiple system atrophy: A blinded video analysis. J Neurol Sci 2020; 417:116992. [PMID: 32622521 DOI: 10.1016/j.jns.2020.116992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Orofacial dystonia (OFD) is considered a supporting feature for a diagnosis of Multiple System Atrophy (MSA). However, the association of OFD with other adjacent symptoms has not been explored. OBJECTIVES To identify clinical characteristics of OFD and associated bulbar symptoms in MSA patients. METHODS In this blinded trial, video clips of 24 MSA patients were reviewed by two movement disorder neurologists who rated the presence of OFD. Analysis was performed to determine correlations between the presence of OFD and clinical demographics as well as associated bulbar symptoms. RESULTS There were 14 patients with MSA-P and 10 patients with MSA-C. OFD was identified in seven patients (29.16%) and MSA-P as the majority (85.71%). Oromandibular dystonia (OMD) was hardly ever identified in isolation with the most frequent combination being OMD with upper facial dystonia, blepharospasm and platysma dystonia. All OMD patients had the jaw-closing subtype. Mean onset of OFD was 1.7 (SD = 0.5) years after the first symptom onset and 1.1 years (SD = 0.4) after the introduction of levodopa. Patients with OFD used significantly higher levodopa equivalent daily dosage (LEDD) than those without (p = 0.02). There were moderate correlations between the presence of OFD and LEDD (r = 0.458, p = 0.02), and dysarthria (r = 0.639, p = 0.001) while a strong correlation was demonstrated between the presence of OFD and dysphagia (r = 0.9, p < 0.001). CONCLUSION OFD is probably a manifestation of motor fluctuations in MSA and its presence is significantly associated with bulbar symptoms. Neurologists should inquire about dysphagia when encountering MSA patients with OFD for early recognition and appropriate management.
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Affiliation(s)
- Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
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22
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Onder H. Drooling: the initial manifestation of Parkinson’s disease in a patient. Neurol Sci 2020; 41:1307-1308. [DOI: 10.1007/s10072-019-04153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
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23
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Tamtaji OR, Reiter RJ, Alipoor R, Dadgostar E, Kouchaki E, Asemi Z. Melatonin and Parkinson Disease: Current Status and Future Perspectives for Molecular Mechanisms. Cell Mol Neurobiol 2020; 40:15-23. [PMID: 31388798 DOI: 10.1007/s10571-019-00720-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
Abstract
Parkinson disease (PD) is a chronic and neurodegenerative disease with motor and nonmotor symptoms. Multiple pathways are involved in the pathophysiology of PD, including apoptosis, autophagy, oxidative stress, inflammation, α-synuclein aggregation, and changes in the neurotransmitters. Preclinical and clinical studies have shown that melatonin supplementation is an appropriate therapy for PD. Administration of melatonin leads to inhibition of some pathways related to apoptosis, autophagy, oxidative stress, inflammation, α-synuclein aggregation, and dopamine loss in PD. In addition, melatonin improves some nonmotor symptom in patients with PD. Limited studies, however, have evaluated the role of melatonin on molecular mechanisms and clinical symptoms in PD. This review summarizes what is known regarding the impact of melatonin on PD in preclinical and clinical studies.
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Affiliation(s)
- Omid Reza Tamtaji
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Russel J Reiter
- Department of Cellular and Structural Biology, UT Health San Antonio, San Antonio, TX, USA
| | - Reza Alipoor
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Islamic Republic of Iran
| | | | - Ebrahim Kouchaki
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran.
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24
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Jost WH, Friedman A, Michel O, Oehlwein C, Slawek J, Bogucki A, Ochudlo S, Banach M, Pagan F, Flatau-Baqué B, Dorsch U, Csikós J, Blitzer A. Long-term incobotulinumtoxinA treatment for chronic sialorrhea: Efficacy and safety over 64 weeks. Parkinsonism Relat Disord 2019; 70:23-30. [PMID: 31794936 DOI: 10.1016/j.parkreldis.2019.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking. This study investigated the efficacy and safety of repeated incobotulinumtoxinA injections for chronic sialorrhea over 64 weeks. METHODS Adults with sialorrhea were randomized (2:2:1) to incobotulinumtoxinA 75 U, incobotulinumtoxinA 100 U (n = 74 each), or placebo (n = 36) in the double-blind, placebo-controlled main period (NCT02091739). Eligible subjects entered the extension period and received dose-blinded incobotulinumtoxinA 75 or 100 U in three further 16±2-week injection cycles. Efficacy and safety assessments in subjects who received incobotulinumtoxinA throughout the study included unstimulated salivary flow rate (uSFR), subjects' Global Impression of Change Scale (GICS), Drooling Severity and Frequency Scale (DSFS), modified Radboud Oral Motor Inventory for Parkinson's Disease (mROMP) drooling, speech, and swallowing symptom scores, and incidence of adverse events (AEs). RESULTS In total, 173/184 subjects (94%) completed the main period and entered the extension period; 141 subjects received incobotulinumtoxinA 75 U (n = 69) or 100 U (n = 72) in both periods. Mean uSFR decreased consistently with repeated incobotulinumtoxinA 75 and 100 U treatment and by -0.16 and -0.17, respectively, at the end-of-study visit. Subjects' GICS, DSFS, and mROMP drooling scores also improved at all assessments. mROMP speech and swallowing scores remained stable. The most common treatment-related AEs during the extension period were dry mouth (4.4% and 11.1%) and dysphagia (1.5% and 4.2%). CONCLUSIONS Data support long-term efficacy and safety of repeated incobotulinumtoxinA treatment for sialorrhea, with no additional safety concerns reported over 64 weeks.
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Affiliation(s)
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.
| | - Olaf Michel
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany.
| | - Jaroslaw Slawek
- Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Gdansk, Poland.
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland.
| | - Stanislaw Ochudlo
- Department of Neurology and Stroke Unit, Medical University of Silesia, Katowice, Poland.
| | - Marta Banach
- Department of Neurology, Collegium Medicum, Jagiellonian University Medical College, Krakow, Poland.
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington DC, USA.
| | | | - Ulrike Dorsch
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - János Csikós
- Formerly of Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - Andrew Blitzer
- Department of Otolaryngology/Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA; NY Center for Voice and Swallowing Disorders, New York, NY, USA.
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25
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McNaney R, Miller N, Vines J, Olivier P, Ladha K, Jackson D, Walker R. The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson's disease: A pilot study. J Rehabil Assist Technol Eng 2019; 6:2055668319852529. [PMID: 31662884 PMCID: PMC6796203 DOI: 10.1177/2055668319852529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/27/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Daytime drooling is experienced by around 50% of Parkinson’s patients, who
fail to swallow saliva in sufficient volume or regularity, despite normal
production. This research explored the feasibility and acceptability of
using a cueing device, to improve drooling. Methods During a four-week intervention, 28 participants were asked to use a cueing
device for 1 h per day. During this time, the device vibrated
once-per-minute, reminding the participant to swallow their saliva. A daily
diary was used to collect self-report around swallowing severity, frequency,
and duration. This was filled out by participants for one week before, four
weeks during and for one week immediately after intervention. Diaries were
also collected for one week during a follow up, carried out four weeks after
intervention finished. Results Participants self-reported benefits in drooling severity
(p = 0.031), frequency (p ≤ 0.001), and
duration (p = 0.001) after using the device. Improvements
were maintained at follow up. Twenty-two participants explicitly reported a
positive benefit to their drooling during exit interview. All felt the
intervention and device were acceptable and usable. Conclusions Using a cueing device for one month had perceived benefit to drooling
severity, frequency and duration in patients with Parkinson’s. Participants
accepted the device and treatment protocol.
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Affiliation(s)
- Roisin McNaney
- School of Computer Science Electrical Engineering and Engineering Maths, University of Bristol, Bristol, UK
| | - Nick Miller
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - John Vines
- NORTHLab, Northumbria University, Newcastle upon Tyne, UK
| | - Patrick Olivier
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Karim Ladha
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Jackson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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26
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Bloem BR, Marks WJ, Silva de Lima AL, Kuijf ML, van Laar T, Jacobs BPF, Verbeek MM, Helmich RC, van de Warrenburg BP, Evers LJW, intHout J, van de Zande T, Snyder TM, Kapur R, Meinders MJ. The Personalized Parkinson Project: examining disease progression through broad biomarkers in early Parkinson's disease. BMC Neurol 2019; 19:160. [PMID: 31315608 PMCID: PMC6636112 DOI: 10.1186/s12883-019-1394-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our understanding of the etiology, pathophysiology, phenotypic diversity, and progression of Parkinson's disease has stagnated. Consequently, patients do not receive the best care, leading to unnecessary disability, and to mounting costs for society. The Personalized Parkinson Project (PPP) proposes an unbiased approach to biomarker development with multiple biomarkers measured longitudinally. Our main aims are: (a) to perform a set of hypothesis-driven analyses on the comprehensive dataset, correlating established and novel biomarkers to the rate of disease progression and to treatment response; and (b) to create a widely accessible dataset for discovery of novel biomarkers and new targets for therapeutic interventions in Parkinson's disease. METHODS/DESIGN This is a prospective, longitudinal, single-center cohort study. The cohort will comprise 650 persons with Parkinson's disease. The inclusion criteria are purposely broad: age ≥ 18 years; and disease duration ≤5 years. Participants are followed for 2 years, with three annual assessments at the study center. Outcomes include a clinical assessment (including motor and neuro-psychological tests), collection of biospecimens (stool, whole blood, and cerebrospinal fluid), magnetic resonance imaging (both structural and functional), and ECG recordings (both 12-lead and Holter). Additionally, collection of physiological and environmental data in daily life over 2 years will be enabled through the Verily Study Watch. All data are stored with polymorphic encryptions and pseudonyms, to guarantee the participants' privacy on the one hand, and to enable data sharing on the other. The data and biospecimens will become available for scientists to address Parkinson's disease-related research questions. DISCUSSION The PPP has several distinguishing elements: all assessments are done in a single center; inclusion of "real life" subjects; deep and repeated multi-dimensional phenotyping; and continuous monitoring with a wearable device for 2 years. Also, the PPP is powered by privacy and security by design, allowing for data sharing with scientists worldwide respecting participants' privacy. The data are expected to open the way for important new insights, including identification of biomarkers to predict differences in prognosis and treatment response between patients. Our long-term aim is to improve existing treatments, develop new therapeutic approaches, and offer Parkinson's disease patients a more personalized disease management approach. TRIAL REGISTRATION Clinical Trials NCT03364894 . Registered December 6, 2017 (retrospectively registered).
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Affiliation(s)
- B. R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W. J. Marks
- Verily Life Sciences, South San Francisco, CA USA
| | - A. L. Silva de Lima
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- CAPES Foundation, Ministry of Education of Brazil, Brasília/DF, Brazil
| | - M. L. Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T. van Laar
- Department of Neurology, Universtity Medical Center Groningen, Groningen, The Netherlands
| | - B. P. F. Jacobs
- Faculty of Science, University of Nijmegen, Nijmegen, The Netherlands
| | - M. M. Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. C. Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B. P. van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L. J. W. Evers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - J. intHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T. van de Zande
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T. M. Snyder
- Verily Life Sciences, South San Francisco, CA USA
| | - R. Kapur
- Neurology Platform, Verily Life Sciences, South San Francisco, CA USA
| | - M. J. Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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27
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Jost WH, Friedman A, Michel O, Oehlwein C, Slawek J, Bogucki A, Ochudlo S, Banach M, Pagan F, Flatau-Baqué B, Csikós J, Cairney CJ, Blitzer A. SIAXI: Placebo-controlled, randomized, double-blind study of incobotulinumtoxinA for sialorrhea. Neurology 2019; 92:e1982-e1991. [PMID: 30918101 PMCID: PMC6511076 DOI: 10.1212/wnl.0000000000007368] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective This pivotal phase III study, SIAXI, investigated the efficacy and safety of incobotulinumtoxinA for the treatment of chronic sialorrhea due to Parkinson disease (PD), atypical parkinsonism, stroke, or traumatic brain injury (TBI). Methods Adult patients with PD (70.7%), atypical parkinsonism (8.7%), stroke (19.0%), or TBI (2.7%) were randomized (2:2:1) to double-blind treatment with placebo (n = 36), or total doses of incobotulinumtoxinA 75 U (n = 74) or 100 U (n = 74), in a single treatment cycle. The coprimary endpoints were change in unstimulated salivary flow rate from baseline to week 4, and patients' Global Impression of Change Scale score at week 4. Adverse events were recorded throughout. Results A total of 184 patients were randomized. Both incobotulinumtoxinA dose groups showed reductions in mean unstimulated salivary flow rate at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.004). Patients' Global Impression of Change Scale scores also improved at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.002). A lasting effect was observed at week 16 post injection. The most frequent treatment-related adverse events in the incobotulinumtoxinA 75 U and 100 U groups were dry mouth (5.4% and 2.7% of patients) and dysphagia (2.7% and 0.0% of patients). Conclusions IncobotulinumtoxinA 100 U is an effective and well-tolerated treatment of chronic sialorrhea in adults. ClinicalTrials.gov identifier NCT02091739. Classification of evidence This study provides Class I evidence that incobotulinumtoxinA reduces salivary flow rates in patients with chronic sialorrhea due to PD, atypical parkinsonism, stroke, or TBI.
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Affiliation(s)
- Wolfgang H Jost
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY.
| | - Andrzej Friedman
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Olaf Michel
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Christian Oehlwein
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Jaroslaw Slawek
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Andrzej Bogucki
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Stanislaw Ochudlo
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Marta Banach
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Fernando Pagan
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Birgit Flatau-Baqué
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - János Csikós
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Claire J Cairney
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Andrew Blitzer
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
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Ruiz-Roca JA, Pons-Fuster E, Lopez-Jornet P. Effectiveness of the Botulinum Toxin for Treating Sialorrhea in Patients with Parkinson's Disease: A Systematic Review. J Clin Med 2019; 8:jcm8030317. [PMID: 30845700 PMCID: PMC6463012 DOI: 10.3390/jcm8030317] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 01/20/2023] Open
Abstract
The main objective was to assess the efficacy of botulinum toxin-based treatment for sialorrhea in adult patients with Parkinson's disease. The search was performed by using the Medline-PubMed, EMBASE and Cochrane Library databases from January 2000⁻December 2017, in English/Spanish in patients with Parkinson's disease and sialorrhea. The methodological quality of trials was carried out by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and the Newcastle⁻Ottawa Scale (NOS). Finally, a total of 21 articles were identified as fulfilling the inclusion criteria. There is no consensus regarding the site of injection of the toxin (single or multiple points), toxin dose or follow-up period. In all cases there was a reduction of sialorrhea. Treatment safety increases with the use of ultrasonography. Effects approximately occur at one week post-injection and for 3⁻5 months. Botulinum toxin is an effective therapeutic strategy or option in treating sialorrhea in adult patients with Parkinson's disease. More studies with a better design, larger samples and a longer follow-up period are required to confirm these data.
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Affiliation(s)
- Juan Antonio Ruiz-Roca
- Department of Stomatology, Faculty of Dentistry, University of Murcia, 30008 Murcia, Spain.
| | - Eduardo Pons-Fuster
- Research Investigations, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, Spain.
| | - Pia Lopez-Jornet
- Oral Medicine in the Department of Stomatology, Faculty of Dentistry, University of Murcia, 30008 Murcia, Spain.
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Presotto M, Rieder CRDM, Olchik MR. Validação de conteúdo e confiabilidade do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF). Codas 2019; 31:e20180230. [DOI: 10.1590/2317-1782/20192018230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/31/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Elaborar e realizar a validação de conteúdo, assim como verificar a confiabilidade entre examinador do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF). Método O estudo foi realizado em três etapas. Na primeira, foi elaborado o protocolo e validado seu conteúdo mediante análise de sete especialistas. Na segunda, aplicou-se o instrumento em 25 indivíduos com doença de Parkinson (DP) idiopática. Na terceira e última etapa, verificou-se a confiabilidade entre-examinador. Resultados A versão final do PADAF foi composta de 32 itens que avaliam a respiração, a fonação, a ressonância, a articulação e a prosódia. Mostrou-se válido, com índice de validade de conteúdo (IVC) bem acima daquele estabelecido na literatura e com perfeita concordância na verificação da confiabilidade entre examinador. Conclusão O PADAF para indivíduos com DP foi desenvolvido e teve seu conteúdo validado com perfeita confiabilidade do instrumento.
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Affiliation(s)
| | - Carlos Roberto de Mello Rieder
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Reynolds H, Miller N, Walker R. Drooling in Parkinson's Disease: Evidence of a Role for Divided Attention. Dysphagia 2018; 33:809-817. [PMID: 29785679 DOI: 10.1007/s00455-018-9906-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
Drooling is a frequently reported symptom in Parkinson's Disease (PD) with significant psychosocial impact and negative health consequences including silent aspiration of saliva with the associated risk of respiratory infections. It is suggested that in PD drooling is associated with inefficient oropharyngeal swallowing which reduces the effective clearance of saliva rather than hyper-salivation. This is compounded by unintended mouth opening and flexed posture increasing anterior loss of saliva. It is reported to occur most frequently during cognitively distracting concurrent tasks suggesting an impact from divided attention in a dual-task situation. However, this supposition has not been systematically examined. This study assessed whether frequency of saliva swallows reduced, and drooling severity and frequency increased, when people with PD engaged in a cognitively distracting task. 18 patients with idiopathic PD reporting daytime drooling on the Unified Parkinson's Disease Rating Scale (UPDRS) were recruited. They completed the Radboud Oral Motor Inventory for PD saliva questionnaire and the Montreal Cognitive Assessment. UPDRS drooling score, disease stage, duration, gender, and age were recorded. Swallow frequency and drooling severity and frequency were measured at rest and during a distracting computer-based language task. There was no significant difference between drooling severity at rest and during distraction (Wilcoxon signed rank test z = - 1.724, p = 0.085). There was a significant difference between at rest and distraction conditions for both drooling frequency (Wilcoxon signed rank test z = - 2.041, p = 0.041) and swallow frequency (Wilcoxon signed rank test z = - 3.054, p = 0.002). Participants swallowed less frequently and drooled more often during the distraction task. The frequency of saliva swallows and drooling are affected by divided attention in a dual-task paradigm. Further studies are needed to explore the exact role of attention in saliva management and the clinical applications in assessment and treatment.
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Affiliation(s)
- Hannah Reynolds
- South Tyneside NHS Foundation Trust, Department of Speech and Language Therapy, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, NE9 6SX, UK.
| | - Nick Miller
- Newcastle University Institute for Ageing, Newcastle University, Speech and Language Sciences, George VI Building, Newcastle upon Tyne, NE1 7RU, UK
| | - Richard Walker
- Northumbria Health NHS Foundation Trust, North Tyneside District Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.,Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Presotto M, Olchik MR, Kalf JG, Rieder CR. Translation, linguistic and cultural adaptation, reliability and validity of the Radboud Oral Motor Inventory for Parkinson's Disease – ROMP questionnaire. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:316-323. [DOI: 10.1590/0004-282x20180033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To translate and linguistically and culturally adapt to Brazilian Portuguese, and verify the reliability and validity of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP). Methods: The ROMP was translated and retranslated, and the instrument reliability was verified by analyzing the internal consistency and the reproducibility of the intra-examiner retest. The final version was applied to 27 participants with Parkinson's disease. Results: Internal consistency was 0.99 for the total ROMP and 0.96 to 0.99 for the three domains. Intraclass correlation coefficients for reproducibility were 0.99 for the total ROMP and 0.93 to 0.99 for the subscales. The ROMP and its subscales correlated substantially with the Likert-type scale, as well as with the unified Parkinson's disease rating scale II and III items. Conclusion: The linguistic and cultural equivalence of the ROMP in Brazilian Portuguese is now available, with excellent reliability and validity.
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Affiliation(s)
| | | | | | - Carlos R.M. Rieder
- Universidade Federal Ciências da Saúde de Porto Alegre, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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Vecchia DD, Kanazawa LKS, Wendler E, de Almeida Soares Hocayen P, Bruginski E, Campos FR, Stern CAJ, Vital MABF, Miyoshi E, Wöhr M, Schwarting RK, Andreatini R. Effects of ketamine on vocal impairment, gait changes, and anhedonia induced by bilateral 6-OHDA infusion into the substantia nigra pars compacta in rats: Therapeutic implications for Parkinson’s disease. Behav Brain Res 2018; 342:1-10. [DOI: 10.1016/j.bbr.2017.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/31/2017] [Indexed: 12/22/2022]
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Incorporating oral health into interprofessional care teams for patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 43:9-14. [DOI: 10.1016/j.parkreldis.2017.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/04/2017] [Accepted: 07/15/2017] [Indexed: 02/01/2023]
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Abstract
Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.
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Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF, Francis DO. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus 2017; 30:1-23. [PMID: 28375450 PMCID: PMC5675017 DOI: 10.1093/dote/dow028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability. DESIGN MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation. RESULTS Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment. CONCLUSION This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative.
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Affiliation(s)
- D. A. Patel
- Division of Gastroenterology, Hepatology and Nutrition
| | - R. Sharda
- Division of Gastroenterology, Hepatology and Nutrition
| | | | | | - N. Sathe
- Department of Health Policy and the Evidence-Based Practice Center
| | - D. F. Penson
- Departments of Urological Surgery, Health Policy, and Medicine and the Center for Surgical Quality and Outcomes Research
| | - I. D. Feurer
- Departments of Biostatistics and Surgery and the Center for Surgical Quality and Outcomes Research
| | - M. L. McPheeters
- Department of Health Policy and the Evidence-Based Practice Center
| | - M. F. Vaezi
- Division of Gastroenterology, Hepatology and Nutrition
| | - David O. Francis
- Department of Otolaryngology and the Evidence-Based Practice Center and the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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The Psychometric Properties of the Voice Handicap Index in People With Parkinson's Disease. J Voice 2017; 31:258.e13-258.e18. [DOI: 10.1016/j.jvoice.2016.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
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Hill F, Miller N, Walsh RA, Mockler D, McDowell R, Walshe M. Botulinum toxin for drooling in Parkinson’s disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fiona Hill
- Tallaght Hospital; Department of Speech & Language Therapy; Tallaght Dublin 24 Ireland
| | - Nick Miller
- Newcastle University; Institute of Health and Society; Newcastle upon Tyne UK NE1 4LP
| | - Richard A Walsh
- Tallaght Hospital; Department of Neurology; Tallaght Dublin 24 Ireland
| | - David Mockler
- Trinity Centre for Health Sciences, St. James Hospital; John Stearne Library; St James's Hospital Dublin 8 Dublin Ireland
| | - Ronald McDowell
- Royal College of Surgeons; Department of General Practice; Dublin 2 Ireland
| | - Margaret Walshe
- Trinity College Dublin; Clinical Speech and Language Studies; 7-9 South Leinster Street Dublin Ireland 2
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Pathophysiology underlying drooling in Parkinson’s disease: oropharyngeal bradykinesia. Neurol Sci 2016; 37:1987-1991. [DOI: 10.1007/s10072-016-2708-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
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Sveinbjornsdottir S. The clinical symptoms of Parkinson's disease. J Neurochem 2016; 139 Suppl 1:318-324. [PMID: 27401947 DOI: 10.1111/jnc.13691] [Citation(s) in RCA: 680] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 12/11/2022]
Abstract
In this review, the clinical features of Parkinson's disease, both motor and non-motor, are described in the context of the progression of the disease. Also briefly discussed are the major treatment strategies and their complications. Parkinson's disease is a slowly progressing neurodegenerative disorder, causing impaired motor function with slow movements, tremor and gait and balance disturbances. A variety of non-motor symptoms are common in Parkinson's disease. They include disturbed autonomic function with orthostatic hypotension, constipation and urinary disturbances, a variety of sleep disorders and a spectrum of neuropsychiatric symptoms. This article describes the different clinical symptoms that may occur and the clinical course of the disease. This article is part of a special issue on Parkinson disease.
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Affiliation(s)
- Sigurlaug Sveinbjornsdottir
- Department of Neurology, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK. .,Queen Mary School of Medicine and Dentistry, University of London, London, UK.
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Barbe AG, Bock N, Derman SHM, Felsch M, Timmermann L, Noack MJ. Self-assessment of oral health, dental health care and oral health-related quality of life among Parkinson's disease patients. Gerodontology 2016; 34:135-143. [DOI: 10.1111/ger.12237] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Nadine Bock
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Sonja Henny Maria Derman
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Moritz Felsch
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Köln Germany
| | - Lars Timmermann
- Department of Neurology; University of Cologne; Köln Germany
| | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
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Uludag IF, Tiftikcioglu BI, Ertekin C. Spontaneous Swallowing during All-Night Sleep in Patients with Parkinson Disease in Comparison with Healthy Control Subjects. Sleep 2016; 39:847-54. [PMID: 26943467 DOI: 10.5665/sleep.5640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/12/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Spontaneous saliva swallows (SS) appear especially during sleep. The rate of SS was rarely investigated in all-night sleep in patients with Parkinson disease (PD). Dysphagia is a frequent symptom in PD, but the rate of SS was never studied with an all-night sleep electroencephalogram (EEG). METHODS A total of 21 patients with PD and 18 age-matched healthy controls were included in the study. Frequencies of SS and coughing were studied in all-night sleep recordings of patients with PD and controls. During all-night sleep, video-EEG 12-channel recording was used including the electromyography (EMG) of the swallowing muscles, nasal airflow, and recording of vertical laryngeal movement using a pair of EEG electrodes over the thyroid cartilage. RESULTS The total number of SS was increased while the mean duration of sleep was decreased in PD when compared to controls. Sialorrhea and clinical dysphagia, assessed by proper questionnaires, had no effect in any patient group. The new finding was the so-called salvo type of consecutive SS in one set of swallowing. The amount of coughing was significantly increased just after the salvo SS. CONCLUSIONS In PD, the rate of SS was not sufficient to demonstrate the swallowing disorder, such as oropharyngeal dysphagia, but the salvo type of SS was quite frequent. This is a novel finding and may contribute to the understanding of swallowing problems in patients with dysphagic or nondysphagic PD.
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Affiliation(s)
- Irem Fatma Uludag
- Tepecik Education and Research Hospital, Department of Neurology, Izmir, Turkey
| | | | - Cumhur Ertekin
- Aegean University, Medical School Hospital, Department of Neurology, Izmir, Turkey
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Lee KD, Koo JH, Song SH, Jo KD, Lee MK, Jang W. Central cholinergic dysfunction could be associated with oropharyngeal dysphagia in early Parkinson's disease. J Neural Transm (Vienna) 2015. [PMID: 26199040 DOI: 10.1007/s00702-015-1427-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dysphagia is an important issue in the prognosis of Parkinson's disease (PD). Although several studies have reported that oropharyngeal dysphagia may be associated with cognitive dysfunction, the exact relationship between cortical function and swallowing function in PD patients is unclear. Therefore, we investigated the association between an electrophysiological marker of central cholinergic function, which reflected cognitive function, and swallowing function, as measured by videofluoroscopic studies (VFSS). We enrolled 29 early PD patients. Using the Swallowing Disturbance Questionnaire (SDQ), we divided the enrolled patients into two groups: PD with dysphagia and PD without dysphagia. The videofluoroscopic dysphagia scale (VDS) was applied to explore the nature of the dysphagia. To assess central cholinergic dysfunction, short latency afferent inhibition (SAI) was evaluated. We analyzed the relationship between central cholinergic dysfunction and oropharyngeal dysphagia and investigated the characteristics of the dysphagia. The SAI values were significantly different between the two groups. The comparison of each VFSS component between the PD with dysphagia group and the PD without dysphagia group showed statistical significance for most of the oral phase components and for a single pharyngeal phase component. The total score on the VDS was higher in the PD with dysphagia group than in the PD without dysphagia group. The Mini-Mental State Examination and SAI values showed significant correlations with the total score of the oral phase components. According to binary logistic regression analysis, SAI value independently contributed to the presence of dysphagia in PD patients. Our findings suggest that cholinergic dysfunction is associated with dysphagia in early PD and that an abnormal SAI value is a good biomarker for predicting the risk of dysphagia in PD patients.
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Affiliation(s)
- Kyung Duck Lee
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea
| | - Jung Hoi Koo
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea
| | - Sun Hong Song
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea
| | - Kwang Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea
| | - Moon Kyu Lee
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea. .,Biomedical Research Center, Gangneung Asan Hospital, Bangdong-ri, Sacheon-myeon, Gangneung, 210-711, Gangwon-do, Republic of Korea.
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A systematic review of self-reported swallowing assessments in progressive neurological disorders. Dysphagia 2014; 30:27-46. [PMID: 25280814 DOI: 10.1007/s00455-014-9579-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 09/23/2014] [Indexed: 12/11/2022]
Abstract
Dysphagia experienced as a consequence of neurodegenerative disease can have severe consequences on a patient's health and well-being. Regular assessment of swallowing function can assist to achieve adequate nutrition and hydration. Here we review subjective swallowing assessments currently available are suitable for use in people with neurodegenerative disease. Measurement properties were reviewed for each tool and coverage of the World Health Organization's International Classification of Functioning, Disability and Health (WHO ICF) was considered. Assessments were identified following a review of the published literature Instruments were reviewed on the basis of reliability and validity, as well as administrative properties, such an interpretability, acceptability, and feasibility. Tools were also evaluated according to the WHO ICF framework. In total, 19 studies were identified for full-text review from 13,315 abstracts. Nine self-reported dysphagia assessment tools suitable for use in progressive neurological disorders were identified. The Swallowing Quality of Life Questionnaire (SWAL-QOL) yields the strongest combination of reliability (including internal consistency and test-retest reliability) and convergent validity while simultaneously covering all WHO ICF domains. Lengthy administration time was identified as a limitation of the SWAL-QOL. The review highlights a relative lack of well-validated self-report questionnaires in dysphagia for people with progressive neurological disease. Additional validation and evaluation of the clinical utility of the tools currently available is required to further promote an informed selection of available assessments.
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Kalf JG, de Wit S. Orofaryngeale slikstoornissen bij neurodegeneratieve aandoeningen. Tijdschr Gerontol Geriatr 2014; 45:273-281. [PMID: 25253555 DOI: 10.1007/s12439-014-0091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neurodegenerative diseases are progressive degenerations of the brain with increasing movement disorders, like gait, speech and swallowing disorders combined with cognitive disorders, like dementia. Neurodegenerative diseases have in common that aspiration pneumonia is the most frequent cause of death in the end-stage of the disease. This article provides an overview of the prevalence, characteristics and treatments of oropharyngeal dysphagia resulting from multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Huntington's disease (HD), multiple sclerosis (MS) and dementia. The prevalence of dysphagia ranges from 32% in MS, 57% in patients with dementia to 73% in patients with MSA and almost 100% in patients with PSP or HD. Treatment is aimed at swallowing with less effort, swallowing more safely and/or optimal nutritional intake. When cognitive decline and behavioural changes increase, passive compensations like food adaptations and comfortable mealtime conditions become the principal interventions.
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Affiliation(s)
- J G Kalf
- Radboudumc Nijmegen, Afdeling Revalidatie, Sectie Logopedie, Nijmegen, The Netherlands,
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Abstract
OROPHARYNGEAL SWALLOWING DISORDERS IN PARKINSON'S DISEASE Parkinson's disease is one of the most common and best studied neurodegenerative diseases. The typical motor features, like hypokinesia and rigidity are also seen in chewing and swallowing, but this 'hypokinetic dysphagia' is a complaint that generally occurs in the later stages of the disease. However, consequences as choking on liquid or food and very slow eating and drinking can contribute to a decrease of the quality of life and in combination with decreased coughing capacity cause aspiration pneumonia. Hypokinetic dysphagia can also contribute to drooling, but hypomimia is the best predictor of that complaint. Several validated questionnaires are available in Dutch to assess dysphagia complaints and their severity. The behavioural treatment consists of compensatory techniques, like adapting head posture to avoid liquid aspiration. But also training exercises can be helpful to overcome hypokinesia, similar to talking louder to overcome hypokinetic speech. Medical treatment, either with levodopa or deep brain surgery in general does not provide clinical improvement of swallowing.
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Affiliation(s)
- J G Kalf
- Radboudumc Nijmegen, afdeling Revalidatie, sectie logopedie, Nijmegen, The Netherlands,
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JG K. Management of dysphagia and drooling in patients with Parkinson’s disease. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.12.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
SUMMARY Dysphagia and drooling are frequently reported consequences of Parkinson’s disease (PD) and this article aims to review their management. Several PD-specific and validated instruments are available for the screening and evaluation of dysphagia and drooling, including the Swallowing Disturbance Questionnaire (SDQ), Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD), Radboud Oral Motor Inventory for Parkinson’s Disease (ROMP), subscales for swallowing and saliva, and non-motor questionnaires that include items on dysphagia and drooling (e.g., Scales for Outcomes in Parkinson’s disease-Autonomic [SCOPA-AUT]; Non-motor Symptoms Questionnaire for Parkinson’s disease [PD-NMSQuest]; and Non-motor Symptoms Assessment Scale for Parkinson’s disease [NMSS]). For the behavioral treatment of dysphagia traditional techniques are helpful, however, exercise training might be more effective. Dysphagia appears to be resistant to drug treatment, but dysphagic patients may benefit from deep brain stimulation. For the treatment of drooling, swallow compensations should be tried, but when saliva reduction is required, botulinum-toxin injections are currently the best option. Overall, there is an urgent need for new approaches to treat dysphagia and drooling in PD.
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Affiliation(s)
- Kalf JG
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, Speech–Language Pathology, PO Box 9101, Internal code 898, 6500 HB Nijmegen, The Netherlands
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Kalf JG, de Swart BJM, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 2011; 18:311-5. [PMID: 22137459 DOI: 10.1016/j.parkreldis.2011.11.006] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/06/2011] [Accepted: 11/07/2011] [Indexed: 12/16/2022]
Abstract
Dysphagia is a potentially harmful feature, also in Parkinson's disease (PD). As published prevalence rates vary widely, we aimed to estimate the prevalence of oropharyngeal dysphagia in PD in a meta-analysis. We conducted a systematic literature search in February 2011 and two independent reviewers selected the papers. We computed the estimates of the pooled prevalence weighted by sample size. Twelve studies were suitable for calculating prevalence rates. Ten studies provided an estimate based on subjective outcomes, which proved statistically heterogeneous (p < 0.001), with a pooled prevalence estimate with random effect analysis of 35% (95% CI 28-41). Four studies provided an estimate based on objective measurements, which were statistically homogeneous (p = 0.23), with a pooled prevalence estimate of 82% (95% CI 77-87). In controls the pooled subjective prevalence was 9% (95% CI 2-17), while the pooled objective prevalence was 23% (95% CI 13-32). The pooled relative risk was 3.2 for both subjective outcomes (95% CI 2.32-4.41) and objective outcomes (95% CI 2.08-4.98). Clinical heterogeneity between studies was chiefly explained by differences in disease severity. Subjective dysphagia occurs in one third of community-dwelling PD patients. Objectively measured dysphagia rates were much higher, with 4 out of 5 patients being affected. This suggests that dysphagia is common in PD, but patients do not always report swallowing difficulties unless asked. This underreporting calls for a proactive clinical approach to dysphagia, particularly in light of the serious clinical consequences.
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Affiliation(s)
- J G Kalf
- Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, The Netherlands.
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Diurnal and nocturnal drooling in Parkinson's disease. J Neurol 2011; 259:119-23. [PMID: 21698387 PMCID: PMC3251785 DOI: 10.1007/s00415-011-6138-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/29/2011] [Accepted: 06/06/2011] [Indexed: 12/16/2022]
Abstract
Drooling as symptom of Parkinson's disease (PD) has thus far been poorly defined. This uncertainty is reflected by high variations in published prevalence rates. The aim of this study was to investigate the prevalence of saliva loss versus accumulation of saliva as a possible preliminary stage, and diurnal drooling versus nocturnal drooling. In addition, we evaluated the association between drooling severity and the severity of facial and oral motor disorders. We collected age, disease duration, UPDRS III and Hoehn & Yahr stage from 104 consecutive outpatients with PD. Diurnal and nocturnal drooling was evaluated with a validated questionnaire (ROMP-saliva). A speech pathologist, blinded for drooling severity, rated facial expression, involuntary mouth opening and difficulty with nose breathing and also interviewed patients about sleeping position and nose-breathing during the night. Thirty patients (29%) had no complaints with saliva control ('non-droolers'), 45 patients (43%) experienced accumulation of saliva or only nocturnal drooling ('pre-droolers'), and 29 (28%) had diurnal drooling (24 of which also drooled during the night; 'droolers'). The droolers had longer disease duration (10 vs. 7 years, p = 0.01) and drooling was independently associated with involuntary mouth opening (OR = 2.0; 95% CI 1.02-3.99) and swallowing complaints (OR = 1.2; 95% CI 1.03-1.31). Diurnal drooling-defined as dribbling of saliva while awake-is present in about 28% of PD patients. This is less than usually reported. Diurnal drooling typically appeared later in the disease course. The association with oral motor behavior should encourage the development of behavioral treatment approaches.
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