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Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:176-187. [PMID: 37608845 PMCID: PMC10441627 DOI: 10.1007/s40141-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Purpose of Review Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions. Recent Findings Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations. Summary Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.
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Affiliation(s)
- Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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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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Glass TJ, Kelm-Nelson CA, Szot JC, Lake JM, Connor NP, Ciucci MR. Functional characterization of extrinsic tongue muscles in the Pink1-/- rat model of Parkinson disease. PLoS One 2020; 15:e0240366. [PMID: 33064741 PMCID: PMC7567376 DOI: 10.1371/journal.pone.0240366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/24/2020] [Indexed: 12/27/2022] Open
Abstract
Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem studies of PD, pathology has been reported in pharyngeal and laryngeal nerves and muscles. However, it is unknown whether PD is associated with neuromuscular changes in the tongue. Prior work in a rat model of PD (Pink1-/-) showed oromotor and swallowing deficits in the premanifest stage which suggested sensorimotor impairments of these functions. The present study tested the hypothesis that Pink1-/- rats show altered tongue function coinciding with neuromuscular differences within tongue muscles compared to wildtype (WT). Male Pink1-/- and WT rats underwent behavioral tongue function assays at 4 and 6 months of age (n = 7–8 rats per group), which are time points early in the disease. At 6 months, genioglossus (GG) and styloglossus (SG) muscles were analyzed for myosin heavy chain isoforms (MyHC), α-synuclein levels, myofiber size, centrally nucleated myofibers, and neuromuscular junction (NMJ) innervation. Pink1-/- showed greater tongue press force variability, and greater tongue press forces and rates as compared to WT. Additionally, Pink1-/- showed relative increases of MyHC 2a in SG, but typical MyHC profiles in GG. Western blots revealed Pink1-/- had more α-synuclein protein than WT in GG, but not in SG. There were no differences between Pink1-/- and WT in myofiber size, centrally-nucleated myofibers, or NMJ innervation. α-synuclein protein was observed in nerves, NMJ, and vessels in both genotypes. Findings at these early disease stages suggest small changes or no changes in several peripheral biological measures, and intact motor innervation of tongue muscles. Future work should evaluate these measures at later disease stages to determine when robust pathological peripheral change contributes to functional change, and what CNS deficits cause behavioral changes. Understanding how PD affects central and peripheral mechanisms will help determine therapy targets for speech and swallowing disorders.
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Affiliation(s)
- Tiffany J. Glass
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
- * E-mail:
| | - Cynthia A. Kelm-Nelson
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
| | - John C. Szot
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Jacob M. Lake
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Nadine P. Connor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Michelle R. Ciucci
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, United States of America
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D'Arrigo A, Floro S, Bartesaghi F, Casellato C, Sferrazza Papa GF, Centanni S, Priori A, Bocci T. Respiratory dysfunction in Parkinson's disease: a narrative review. ERJ Open Res 2020; 6:00165-2020. [PMID: 33043046 PMCID: PMC7533305 DOI: 10.1183/23120541.00165-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022] Open
Abstract
The presence of respiratory symptoms in Parkinson's disease (PD) has been known since the first description of the disease, even though the prevalence and incidence of these disturbances are not well defined. Several causes have been reported, comprising obstructive and restrictive pulmonary disease and changes in the central ventilatory control, and different pathogenetic mechanisms have been postulated accordingly. In our review, we encompass the current knowledge about respiratory abnormalities in PD, as well as the impact of anti-Parkinsonian drugs as either risk or protective factors. A description of putative pathogenetic mechanisms is also provided, and possible treatments are discussed, focusing on the importance of recognising and treating respiratory symptoms as a key manifestation of the disease itself. A brief description of respiratory dysfunctions in atypical Parkinsonism, especially α-synucleinopathies, is also provided. This review addresses current knowledge about respiratory dysfunctions in Parkinson's disease, from the aetiopathology to pharmacological and invasive treatments, describing the different clinical phenotypeshttps://bit.ly/2X7OLtN
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Affiliation(s)
- Andrea D'Arrigo
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Stefano Floro
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Francesca Bartesaghi
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Chiara Casellato
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Respiratory Unit, Dept of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.,Casa di Cura del Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, Dept of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Dept of Health Sciences, University of Milan, Milan, Italy.,III Neurology Clinic, ASST Santi Paolo e Carlo, Milan, Italy
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Nascimento WV, Arreola V, Sanz P, Necati E, Bolivar-Prados M, Michou E, Ortega O, Clavé P. Pathophysiology of Swallowing Dysfunction in Parkinson Disease and Lack of Dopaminergic Impact on the Swallow Function and on the Effect of Thickening Agents. Brain Sci 2020; 10:E609. [PMID: 32899758 PMCID: PMC7563552 DOI: 10.3390/brainsci10090609] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson's disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.
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Affiliation(s)
- Weslania Viviane Nascimento
- Medical School of Ribeirao Preto, University of São Paulo, São Paulo 14049-900, Brazil;
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (V.A.); (M.B.-P.); (O.O.)
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (V.A.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pilar Sanz
- Neurology Department, Hospital de Mataró, Universitat Autònoma de Barcelona, 08404 Mataró, Spain;
| | - Ediz Necati
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Near East University, Nicosia 99138, Cyprus;
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (V.A.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Emilia Michou
- Department of Speech Language Pathology: Communication Disorders and Dysphagia, University of Patras, 26334 Patras, Greece;
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (V.A.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (V.A.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
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Yu H, Takahashi K, Bloom L, Quaynor SD, Xie T. Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review. Front Neurol 2020; 11:547. [PMID: 32765388 PMCID: PMC7380112 DOI: 10.3389/fneur.2020.00547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
The effect of deep brain stimulation (DBS) on swallowing function in movement disorders is unclear. Here, we systematically reviewed this topic by searching keywords following PICOS strategy of problem (swallowing or swallow or dysphagia or aspiration) and intervention (deep brain stimulation, or DBS) in the PubMed and Web of Science in English in April 2020, with comparators [subthalamic nucleus (STN), globus pallidus interna (GPi), ventralis intermedius, (ViM), post-subthalamic area, or caudal zona incerta (PSA/cZi); ON/OFF DBS state/settings, ON/OFF medication state, Parkinson's disease (PD), dystonia, tremor], outcomes (swallowing function measures, subjective/objective) and study types (good quality original studies) in mind. We found that STN DBS at usual high-frequency stimulation could have beneficial effect (more so on subjective measures and/or OFF medication), no effect, or detrimental effect (more so on objective measures and/or ON medication) on swallowing function in patients with PD, while low-frequency stimulation (LFS) could have beneficial effect on swallowing function in patients with freezing of gait. GPi DBS could have a beneficial effect (regardless of medication state and outcome measures) or no effect, but no detrimental effect, on swallowing function in PD. GPi DBS also has beneficial effects on swallowing function in majority of the studies on Meige syndrome but not in other diseases with dystonia. PSA/cZi DBS rarely has detrimental effect on swallowing functions in patients with PD or tremor. There is limited information on ViM to assess. Information on swallowing function by DBS remains limited. Well-designed studies and direct comparison of targets are further needed.
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Affiliation(s)
- Huiyan Yu
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Department of Neurology, The University of Chicago Medicine, Chicago, IL, United States
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, The University of Chicago, Chicago, IL, United States
| | - Lisa Bloom
- Department of Neurology, The University of Chicago Medicine, Chicago, IL, United States.,Speech and Swallowing Service, The University of Chicago Medicine, Chicago, IL, United States
| | - Samuel D Quaynor
- Department of Neurology, The University of Chicago Medicine, Chicago, IL, United States
| | - Tao Xie
- Department of Neurology, The University of Chicago Medicine, Chicago, IL, United States
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Curtis JA, Molfenter S, Troche MS. Predictors of Residue and Airway Invasion in Parkinson's Disease. Dysphagia 2020; 35:220-230. [PMID: 31028481 PMCID: PMC8711115 DOI: 10.1007/s00455-019-10014-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/22/2019] [Indexed: 12/30/2022]
Abstract
Dysphagia is a highly prevalent disorder in Parkinson's Disease (PD) characterized by changes in swallowing kinematics, residue, and airway invasion. These changes can lead to serious medical morbidities including malnutrition, aspiration pneumonia, and death. However, little is known about the most predictive causes of residue and airway invasion in this patient population. Therefore, the aims of this study were to (1) assess how disease severity affects residue, airway invasion, and swallowing kinematics in PD; and (2) determine which swallowing kinematic variables were most predictive of residue and airway invasion. A secondary analysis of forty videofluoroscopic swallow studies (VFSS) from individuals with early through mid-stage PD was performed. Airway invasion (Penetration-Aspiration Scale 'PAS'), residue (Bolus Clearance Ratio 'BCR'), and ten spatiotemporal swallowing kinematic variables were analyzed. Statistical analyses were used to determine if disease severity predicted residue, depth of airway invasion, and swallowing kinematics, and to examine which swallowing kinematic variables were most predictive of residue and the presence of airway invasion. Results revealed that residue and the presence of airway invasion were significantly predicted by swallowing kinematics. Specifically, airway invasion was primarily influenced by the extent and timing of airway closure, while residue was primarily influenced by pharyngeal constriction. However, disease severity did not significantly predict changes to swallowing kinematics, extent of residue, or depth of airway invasion during VFSS assessment. This study comprehensively examined the pathophysiology underlying dysphagia in people with early to mid-stage PD. The results of the present study indicate that disease severity alone does not predict swallowing changes in PD, and therefore may not be the best factor to identify risk for dysphagia in PD. However, the swallowing kinematics most predictive of residue and the presence of airway invasion were identified. These findings may help to guide the selection of more effective therapy approaches for improving swallowing safety and efficiency in people with early to mid-stage PD.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 West, 120th Street, Thorndike Room 955, New York, NY, 10027, USA.
| | - Sonja Molfenter
- NYU Swallowing Research Lab, New York University, 665 Broadway, 9th Floor, New York, NY, 10012, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 West, 120th Street, Thorndike Room 955, New York, NY, 10027, USA
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Umemoto G, Furuya H. Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders. Intern Med 2020; 59:7-14. [PMID: 30996170 PMCID: PMC6995701 DOI: 10.2169/internalmedicine.2373-18] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/23/2019] [Indexed: 01/02/2023] Open
Abstract
Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.
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Affiliation(s)
- George Umemoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Japan
| | - Hirokazu Furuya
- Department of Neurology, Kochi Medical School, Kochi University, Japan
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Broadfoot CK, Abur D, Hoffmeister JD, Stepp CE, Ciucci MR. Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2019; 4:825-841. [PMID: 32104723 PMCID: PMC7043100 DOI: 10.1044/2019_pers-sig3-2019-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Individuals with Parkinson disease (PD) present with complex and variable symptoms, with recent findings suggesting that the etiology of PD extends beyond the involvement of just the basal ganglia. These symptoms include significant impairments in the speech and swallowing domains, which can greatly affect quality of life and therefore require therapeutic attention. This research-based update reviews the neurophysiological basis for swallowing and speech changes in PD, the effectiveness of various types of treatments, and implications for symptom evaluation and management. CONCLUSION The mechanisms responsible for swallowing and speech symptoms in PD remain largely unknown. Dopaminergic medication and deep-brain-stimulation do not provide consistent benefits for these symptoms suggesting a non-dopaminergic network is involved. Importantly, evidence suggests that symptoms of dysphagia and hypokinetic dysarthria may be early indications of PD, so it is critical to investigate the cause of these changes.
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Affiliation(s)
- C K Broadfoot
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
| | - D Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
| | - J D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
| | - C E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- Department of Otolaryngology, Boston University, Boston, MA
| | - M R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI
- Department of Surgery-Division of Otolaryngology Head & Neck Surgery, University of Wisconsin-Madison, Madison, WI
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Kwon M, Lee JH. Oro-Pharyngeal Dysphagia in Parkinson's Disease and Related Movement Disorders. J Mov Disord 2019; 12:152-160. [PMID: 31556260 PMCID: PMC6763715 DOI: 10.14802/jmd.19048] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022] Open
Abstract
Oro-pharyngeal dysphagia is a common symptom in patients with Parkinson’s disease (PD) and related disorders, even in their early stage of diseases. Dysphagia in these patients has been underdiagnosed, probably due to poor the self-awareness of the conditions and the underuse of validated tools and objective instruments for assessment. The early detection and intervention of dysphagia are closely related to improving the quality of life and decreasing the mortality rate in these patients. The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. The management of dysphagia and future research directions related to these disorders are also discussed.
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Affiliation(s)
- Miseon Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Schröder JB, Marian T, Claus I, Muhle P, Pawlowski M, Wiendl H, Suntrup-Krueger S, Meuth SG, Dziewas R, Ruck T, Warnecke T. Substance P Saliva Reduction Predicts Pharyngeal Dysphagia in Parkinson's Disease. Front Neurol 2019; 10:386. [PMID: 31040820 PMCID: PMC6477048 DOI: 10.3389/fneur.2019.00386] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/29/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Although patients with Parkinson's disease (PD) often suffer from oropharyngeal dysphagia, knowledge about the underlying pathophysiological mechanisms is limited. Substance P (SP) is a localization-independent neurotransmitter of the entire nervous system. Reduced levels of SP were found in saliva of patients with impaired cough reflex and in advanced stages of PD. The aim of the study was to investigate SP in PD patients in order to gain further insights into the underlying pathophysiology of PD-related dysphagia and to evaluate the potential of SP as a biomarker for early dysphagia. Methods: Flexible endoscopic evaluation of swallowing (FEES) was used to objectively assess pharyngeal swallowing function. From a cohort of 105 consecutive PD patients 20 subjects were recruited: in 10 of them pharyngeal dysphagia was excluded by FEES, the other 10 subjects showed signs of early pharyngeal dysphagia defined as hypopharyngeal sensory deficit with mild to moderate vallecular residues after swallowing solid consistencies. Analysis of the Substance P level in saliva of the 20 included PD patients was performed in the clinical on state condition by ELISA-type immunoassay. Significant differences were calculated by using the Mann-Whitney test. Results: Twenty PD patients with a mean age of 69.5 ± 12.5 years (8 female) were included in the study. No significant differences were found regarding gender, age, UPDRS III, Hoehn and Yahr stage, disease duration, and Levodopa equivalent dose between the non-dysphagic and dysphagic subjects. Dysphagia was mainly characterized by unrecognized residues in the valleculae without any aspiration risk for all of the tested consistencies in FEES and was thereby scored as mild in all cases. Saliva SP concentrations were significantly lower in PD patients with pharyngeal dysphagia compared to those with a normal pharyngeal swallowing function (9,644 vs. 17,591 pg/mL; p = 0.001). Conclusion: Reduced saliva SP concentrations may predict early pharyngeal swallowing dysfunction in PD patients. This finding supports the hypothesis that an impaired SP mediated neurotransmission has a significant impact for the development of dysphagia in PD patients. Larger studies are needed to confirm SP as a clinical useful biomarker for early detection of PD-related dysphagia.
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Affiliation(s)
| | - Thomas Marian
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Münster, Germany
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The Modified Barium Swallow Impairment Profile as a Predictor of Clinical Outcomes of Admission for Pneumonia or Choking in Dysphagic Patients with Parkinson’s Disease. Dysphagia 2019; 34:896-903. [DOI: 10.1007/s00455-019-09986-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 02/06/2019] [Indexed: 11/26/2022]
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Xie T, Bloom L, Padmanaban M, Bertacchi B, Kang W, MacCracken E, Dachman A, Vigil J, Satzer D, Zadikoff C, Markopoulou K, Warnke P, Kang UJ. Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD. J Neurol Neurosurg Psychiatry 2018; 89:989-994. [PMID: 29654112 DOI: 10.1136/jnnp-2018-318060] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/01/2018] [Accepted: 03/24/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the long-term effect of 60 Hz stimulation of the subthalamic nucleus (STN) on dysphagia, freezing of gait (FOG) and other motor symptoms in patients with Parkinson's disease (PD) who have FOG at the usual 130 Hz stimulation. METHODS This is a prospective, sequence randomised, crossover, double-blind study. PD patients with medication refractory FOG at 130 Hz stimulation of the STN were randomised to the sequences of 130 Hz, 60 Hz or deep brain stimulation off to assess swallowing function (videofluoroscopic evaluation and swallowing questionnaire), FOG severity (stand-walk-sit test and FOG questionnaire) and motor function (Unified PD Rating Scale, Part III motor examination (UPDRS-III)) at initial visit (V1) and follow-up visit (V2, after being on 60 Hz stimulation for an average of 14.5 months), in their usual medications on state. The frequency of aspiration events, perceived swallowing difficulty and FOG severity at 60 Hz compared with 130 Hz stimulation at V2, and their corresponding changes at V2 compared with V1 at 60 Hz were set as primary outcomes, with similar comparisons in UPDRS-III and its subscores as secondary outcomes. RESULTS All 11 enrolled participants completed V1 and 10 completed V2. We found the benefits of 60 Hz stimulation compared with 130 Hz in reducing aspiration frequency, perceived swallowing difficulty, FOG severity, bradykinesia and overall axial and motor symptoms at V1 and persistent benefits on all of them except dysphagia at V2, with overall decreasing efficacy when comparing V2 to V1. CONCLUSIONS The 60 Hz stimulation, when compared with 130 Hz, has long-term benefits on reducing FOG, bradykinesia and overall axial and motor symptoms except dysphagia, although the overall benefits decrease with long-term use. CLINICAL TRIAL REGISTRATION NCT02549859; Pre-results.
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Affiliation(s)
- Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Lisa Bloom
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Breanna Bertacchi
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Wenjun Kang
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
| | - Ellen MacCracken
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Abraham Dachman
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julie Vigil
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Satzer
- Department of Neurosurgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Katerina Markopoulou
- Department of Neurology, NorthShore University HealthSystem, Glenview, Illinois, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Un Jung Kang
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
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Tomita S, Oeda T, Umemura A, Kohsaka M, Park K, Yamamoto K, Sugiyama H, Sawada H. Video-fluoroscopic swallowing study scale for predicting aspiration pneumonia in Parkinson's disease. PLoS One 2018; 13:e0197608. [PMID: 29874285 PMCID: PMC5991364 DOI: 10.1371/journal.pone.0197608] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction A number of video-fluoroscopic swallowing study (VFSS) abnormalities have been reported in patients with Parkinson’s disease (PD). However, the most crucial finding of subsequent aspiration pneumonia has not been validated fully. We conducted a retrospective and case-control study to determine the clinically significant VFSS findings in this population, and to propose a practical scale for predicting aspiration pneumonia in patients with PD. Methods We enrolled 184 PD patients who underwent VFSS because of suspected dysphagia. The patients who developed aspiration pneumonia within six months of the VFSS were assigned as cases and the patients without aspiration pneumonia at six months were designated as controls. Logistic regression analysis was performed to determine the prognostic VFSS features based on the data of swallowing 3 mL of jelly, which were used to make a PD VFSS scale (PDVFS). The validity of the new PDVFS was evaluated by ROC analysis. Additionally, we used the survival time analysis to compare time to death between groups, stratified by the PDVFS score. Results Twenty-five patients developed aspiration pneumonia. Among the previously-proposed VFSS features, mastication, lingual motility prior to transfer, aspiration, and total swallow time were identified as significant prognostic factors. We combined these factors to form the PDVFS. The PDVFS score ranges from 0 to 12, with 12 being the worst. ROC analysis revealed 92% sensitivity and 82% specificity at a cutoff point of 3. The higher PDVFS group showed shorter time-to-death than the lower PDVFS group (log rank P = 0.001). Conclusion Our newly developed VFSS severity scale (based on jelly swallowing) for patients with PD was easy to rate and could predict subsequent aspiration pneumonia and poor prognosis in patients with PD.
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Affiliation(s)
- Satoshi Tomita
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Tomoko Oeda
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Atsushi Umemura
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Kwiyoung Park
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Kenji Yamamoto
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Hiroshi Sugiyama
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Hideyuki Sawada
- Clinical Research Center and Department of Neurology, Utano National Hospital, Kyoto, Japan
- * E-mail:
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Sato H, Yamamoto T, Sato M, Furusawa Y, Murata M. Dysphagia Causes Symptom Fluctuations after Oral L-DOPA Treatment in a Patient with Parkinson Disease. Case Rep Neurol 2018; 10:101-107. [PMID: 29681829 PMCID: PMC5903165 DOI: 10.1159/000488138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
Abstract
Objective The causes of “delayed-on” and “no-on” phenomena in Parkinson disease (PD) are thought to have some impact on the progress of L-DOPA from the time of ingestion until it reaches the brain and is converted to dopamine. Dysphagia can cause fluctuating symptom expression in L-DOPA therapy for PD. Case Description A 69-year-old man with PD presented with “delayed-on” and “no-on” phenomena. The patient developed a gait disorder at age 60 years, and he began coughing on his food during breakfast at age 64 years. Even though he was independent in daily life, he could not eat because of dysphagia in an “off” state. Videofluoroscopic examination of swallowing in an “off” state revealed bradykinesia of the tongue and the retention of tablets in the epiglottic vallecula. We trained him to keep his tongue in strong contact with the upper incisors before swallowing. After rehabilitation of dysphagia, the frequency of “delayed-on” and “no-on” phenomena decreased, and his peak L-DOPA plasma concentration was elevated. Additionally, transdermal rotigotine (RTG) was initiated at a maintenance dose of 9.0 mg. The patient reported improvement in swallowing, and the frequency of “no-on” phenomena decreased. Conclusion In PD patients, the “no-on” phenomenon can be caused by posterior contractile dysfunction of the tongue, and it can be improved with training of the tongue and transdermal RTG administration.
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Affiliation(s)
- Hiromasa Sato
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masako Sato
- Department of Rehabilitation Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshihiko Furusawa
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Murata
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Evidence of Oropharyngeal Dysfunction in Feeding in the Rat Rotenone Model of Parkinson's Disease. PARKINSONS DISEASE 2018; 2018:6537072. [PMID: 29713446 PMCID: PMC5866867 DOI: 10.1155/2018/6537072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 12/31/2022]
Abstract
Swallowing disorders in Parkinson's disease are not responsive to dopamine depletion therapy and contribute to morbidity. They are poorly understood owing to a lack of adequate models. We present the first evidence of oropharyngeal changes in a rotenone toxicity model of Parkinson's disease. Rats were recorded while feeding before and after daily rotenone injections at two different doses (2.75 mg/kg and 3 mg/kg). The higher dose had a much more severe parkinsonian phenotype than the low dose. Timing and amplitude of chewing changed, as did the coordination of chewing and swallowing. Dose-dependent effects were evident. These preliminary results indicate that future research in toxicological models of Parkinson's disease should incorporate the study of oropharyngeal dysfunction. A better understanding of nongenetic models of Parkinson's disease in feeding may open new avenues for research into the neurological and behavioral bases for swallowing dysfunction in Parkinson's disease.
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Yang KM, Blue KV, Mulholland HM, Kurup MP, Kelm-Nelson CA, Ciucci MR. Characterization of oromotor and limb motor dysfunction in the DJ1 -/- model of Parkinson disease. Behav Brain Res 2017; 339:47-56. [PMID: 29109055 DOI: 10.1016/j.bbr.2017.10.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
Abstract
Parkinson disease (PD) is devastating to sensorimotor function that includes cranial/oromotor and limb motor deficits. However, the onset, progression, and neural correlates of PD-related dysfunctions are poorly understood. To address this gap, we used a genetic rat model of PD, DJ1 -/-, and hypothesized that motor deficits would manifest early in the disease process, be progressive in nature, and be related to pathologies in brainstem structures associated with sensorimotor function. The present study compares homozygous DJ1 -/- male rats to age-matched wild type controls. Progressive cranial sensorimotor function (ultrasonic vocalizations and tongue motor performance) and limb motor function (tapered balance beam) was analyzed at 2, 4, 6, and 8 months of age. Additionally, tyrosine hydroxylase cell counts were performed in the locus coeruleus and correlated to behavioral measures. We found that compared to wild type controls, DJ1 -/- show deficits in ultrasonic vocalizations as well as oromotor (tongue) deficits that were progressive. Overtime, DJ1 -/- rats cross a tapered balance beam with significantly decreased speed of traversal. Additionally, in the DJ1 -/-, tyrosine hydroxylase positive cells in the locus coeruleus are significantly reduced and are negatively correlated to oromotor behaviors. Characterizing the DJ1 -/- model of PD provides important foundational work necessary to define behavioral and early-onset biomarkers that parallels early-stage PD pathology in humans.
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Affiliation(s)
- Katie M Yang
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Katherine V Blue
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Haleigh M Mulholland
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Meghna P Kurup
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Cynthia A Kelm-Nelson
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Michelle R Ciucci
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, 53706, USA.
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18
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Abstract
Apart from the typical motor symptoms, Parkinson's disease is characterized by a wide range of different non-motor symptoms, which are highly prevalent in all stages of the disease and have an incisive influence on quality of life. Moreover, their treatment continues to be challenging. In this review, we critically summarize the evidence for the impact of dopaminergic therapies on non-motor symptoms in Parkinson's disease. We performed a PubMed search to identify relevant clinical studies that investigated the response of non-motor symptoms to dopaminergic therapy. In the domain of neuropsychiatric disturbances, there is increasing evidence that dopamine agonists can ameliorate depression or anxiety. Other neuropsychiatric symptoms such as psychosis or impulse control disorders can also be worsened or even be induced by dopaminergic agents. For the treatment of sleep disturbances, it is essential to identify different subtypes of sleep pathologies. While there is for example profound evidence for the effectiveness of dopaminergic medication for the treatment of restless legs syndrome and sleep fragmentation, evidence for an improvement of rapid eye movement sleep behavior disorder is lacking. With regard to the broad spectrum of autonomic disturbances, response to dopaminergic treatment seems to differ largely, with on the one hand, some evidence for an improvement of sexual function or sweating with dopaminergic treatment, while on the other hand, constipation can be worsened. Finally, the analysis of sensory deficits reveals that some forms of pain, in particular fluctuation-dependent dystonic pain, can be well addressed by adapting the dopaminergic therapy, while no effect has been seen so far for hyposmia or visual deficits. Moreover, the occurrence of non-motor fluctuations is gaining increased attention, as they can be specifically addressed by a more continuous dopaminergic intake. Taken together, there is evidence of a good response of some (but not all) non-motor symptoms to dopaminergic therapy, which must be individually adapted to the special spectrum of symptoms.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany.
| | - Daniela Berg
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany
- Department of Neurodegeneration, Hertie-Institute of Clinical Brain Research, Tuebingen, Germany
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Jones CA, Ciucci MR. Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:197-208. [PMID: 26891176 DOI: 10.3233/jpd-150687] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parkinson disease (PD) has detrimental effects on swallowing function. Treatment options are largely behavioral; thus, patients would benefit from an earlier start to therapy. Early swallowing changes in PD are not well-known, so patients do not typically receive swallowing treatment until later in the progression of PD. OBJECTIVE We used predictive modeling to determine what quantitative swallowing variables best differentiate individuals with early to mid-stage PD from healthy controls. METHODS Participants included twenty-six individuals with early to mid-stage PD and 26 healthy, age- and sex-matched controls. Swallowing was evaluated by simultaneous high-resolution manometry and videofluoroscopy as well as the Sydney Swallow Questionnaire (SSQ). Binomial logistic regression was performed on 4 sets of data: 1) high-resolution manometry only; 2) videofluoroscopy only; 3) SSQ only; and 4) all data combined. RESULTS A model from a combined data set had the highest accuracy in differentiating individuals with PD from controls. The model included maximum pressure in the velopharynx (soft palate), pressure variability in the velopharynx, and the SSQ item concerning difficulty with swallowing saliva. No significant models could be generated using the videofluoroscopy data. CONCLUSIONS Individuals with PD show quantitative changes in pressure generation and are able to self-assess aspects of swallowing function in the early and mid-stages of PD, even in the absence of swallowing changes seen on videofluoroscopy. A multimodal approach for the assessment of swallowing may be more accurate for determining subtle swallowing changes that occur in the early stages of PD.
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Affiliation(s)
- Corinne A Jones
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
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Gastrointestinal Dysfunctions in Parkinson's Disease: Symptoms and Treatments. PARKINSONS DISEASE 2016; 2016:6762528. [PMID: 28050310 PMCID: PMC5168460 DOI: 10.1155/2016/6762528] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
A diagnosis of Parkinson's disease is classically established after the manifestation of motor symptoms such as rigidity, bradykinesia, and tremor. However, a growing body of evidence supports the hypothesis that nonmotor symptoms, especially gastrointestinal dysfunctions, could be considered as early biomarkers since they are ubiquitously found among confirmed patients and occur much earlier than their motor manifestations. According to Braak's hypothesis, the disease is postulated to originate in the intestine and then spread to the brain via the vagus nerve, a phenomenon that would involve other neuronal types than the well-established dopaminergic population. It has therefore been proposed that peripheral nondopaminergic impairments might precede the alteration of dopaminergic neurons in the central nervous system and, ultimately, the emergence of motor symptoms. Considering the growing interest in the gut-brain axis in Parkinson's disease, this review aims at providing a comprehensive picture of the multiple gastrointestinal features of the disease, along with the therapeutic approaches used to reduce their burden. Moreover, we highlight the importance of gastrointestinal symptoms with respect to the patients' responses towards medical treatments and discuss the various possible adverse interactions that can potentially occur, which are still poorly understood.
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Ali SA, Yin N, Rehman A, Justilien V. Parkinson Disease-Mediated Gastrointestinal Disorders and Rational for Combinatorial Therapies. Med Sci (Basel) 2016; 4:medsci4010001. [PMID: 29083365 PMCID: PMC5635767 DOI: 10.3390/medsci4010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/24/2015] [Accepted: 01/13/2016] [Indexed: 12/29/2022] Open
Abstract
A gradual loss of dopamine-producing nerve cells gives rise to a common neurodegenerative Parkinson’s disease (PD). This disease causes a neurotransmitter imbalance in the brain and initiates a cascade of complications in the rest of the body that appears as distressing symptoms which include gait problems, tremor, gastrointestinal (GI) disorders and cognitive decline. To aid dopamine deficiency, treatment in PD patients includes oral medications, in addition to other methods such as deep brain stimulation and surgical lesioning. Scientists are extensively studying molecular and signaling mechanisms, particularly those involving phenotypic transcription factors and their co-regulatory proteins that are associated with neuronal stem cell (SC) fate determination, maintenance and disease state, and their role in the pathogenesis of PD. Advancement in scientific research and “personalized medicine” to augment current therapeutic intervention and minimize the side effects of chemotherapy may lead to the development of more effective therapeutic strategies in the near future. This review focuses on PD and associated GI complications and summarizes the current therapeutic modalities that include stem cell studies and combinatorial drug treatment.
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Affiliation(s)
- Syed A Ali
- Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, FL 32224, USA.
| | - Ning Yin
- Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, FL 32224, USA.
| | - Arkam Rehman
- Department of Pain Medicine, Baptist Medical Center, Jacksonville, FL 32258, USA.
| | - Verline Justilien
- Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, FL 32224, USA.
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Abstract
More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists, speech-language therapists, and other clinicians in their daily work with PD patients and associated swallowing difficulties. Furthermore areas with an urgent need for future clinical research are identified.
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Malloy JR, Valentin JC, Hands GL, Stevens CA, Langmore SE, Noordzij JP, Stepp CE. Visuomotor control of neck surface electromyography in Parkinson's disease. NeuroRehabilitation 2015; 35:795-803. [PMID: 25318778 DOI: 10.3233/nre-141169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare performance of individuals with Parkinson's disease (PD) and age-matched controls on a visuomotor tracking task controlled via surface electromyography (sEMG). METHODS Twenty-seven adults with PD and twenty-four older controls produced dry swallows and completed a visuomotor tracking task utilizing both static and dynamic targets. sEMG was recorded at the anterior neck and submental surface during both tasks. RESULTS There was no significant difference in visuomotor tracking ability between cohorts. Post hoc analyses indicated that there was no significant difference between participant groups in the strength or duration of swallows as measured by sEMG but that participants with PD showed a trend for decreased swallow durations at the anterior neck (padj = 0.067) whereas controls showed a trend for increased durations at the anterior neck (padj = 0.112), compared to the submental surface. However, there were no significant correlations between swallowing behavior and visuomotor tracking ability. CONCLUSION There were no significant differences in visuomotor tracking performance between individuals with PD and controls. Furthermore, there was no relationship between tracking ability and swallowing behavior. We conclude that sEMG-mediated biofeedback may have limited promise as a tool for treating PD-related dysphagia.
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Affiliation(s)
- Jessica R Malloy
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | - Juliana C Valentin
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | - Gabrielle L Hands
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | | | - Susan E Langmore
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA Otolaryngology - Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - J Pieter Noordzij
- Otolaryngology - Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Cara E Stepp
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA Biomedical Engineering, Boston University, Boston, MA, USA
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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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25
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Kim JS, Sung HY. Gastrointestinal Autonomic Dysfunction in Patients with Parkinson's Disease. J Mov Disord 2015; 8:76-82. [PMID: 26090079 PMCID: PMC4460543 DOI: 10.14802/jmd.15008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/03/2015] [Accepted: 04/07/2015] [Indexed: 12/20/2022] Open
Abstract
Currently, gastrointestinal dysfunctions in Parkinson’s disease (PD) are well-recognized problems and are known to be an initial symptom in the pathological process that eventually results in PD. Gastrointestinal symptoms may result from the involvement of either the central or enteric nervous systems, or these symptoms may be side effects of antiparkinsonian medications. Weight loss, excessive salivation, dysphagia, nausea/gastroparesis, constipation, and defecation dysfunction all may occur. Increased identification and early detection of these symptoms can result in a significant improvement in the quality of life for PD patients.
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Affiliation(s)
- Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye-Young Sung
- Department of Gastroenterology, The Neighborhood Christian Clinic, AZ, USA
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26
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Xie T, Vigil J, MacCracken E, Gasparaitis A, Young J, Kang W, Bernard J, Warnke P, Kang UJ. Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD. Neurology 2014; 84:415-20. [PMID: 25540305 DOI: 10.1212/wnl.0000000000001184] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To study whether 60-Hz stimulation, compared with routine 130 Hz, improves swallowing function and freezing of gait (FOG) in patients with Parkinson disease (PD) who undergo bilateral subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS We studied 7 patients with PD who experienced FOG that persisted despite routine 130-Hz stimulation and dopaminergic medication. Each patient received 3 modified barium swallow (MBS) studies in a single day under 3 DBS conditions in the medication-on state: 130 Hz, 60 Hz, or DBS off, in a randomized double-blind manner. The laryngeal penetration and aspiration events were cautiously assessed, and a swallowing questionnaire was completed. The Unified Parkinson's Disease Rating Scale, Part III motor score, axial subscore, tremor subscore, and FOG by a questionnaire and stand-walk-sit test were also assessed. The best DBS condition (60 Hz here) producing the least FOG was maintained for 3 to 8 weeks, and patients were assessed again. Changes in measurements between the 60 Hz and 130 Hz were analyzed using paired t test, with swallowing function as primary and the remainder as secondary outcomes. Changes between other DBS conditions were further explored with Bonferroni correction. RESULTS Compared with the routine 130 Hz, 60-Hz stimulation significantly reduced aspiration frequency by 57% on MBS study and perceived swallowing difficulty by 80% on questionnaire. It also significantly reduced FOG, and axial and parkinsonian symptoms. The benefits at 60-Hz stimulation persisted over the average 6-week assessment. CONCLUSIONS Compared with the routine 130 Hz, the 60-Hz stimulation significantly improved swallowing function, FOG, and axial and parkinsonian symptoms in patients with PD treated with bilateral STN-DBS, which persisted over the 6-week study period. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with PD who experience FOG, STN-DBS at 60 Hz decreases aspiration events observed during MBS compared with DBS at 130 Hz.
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Affiliation(s)
- Tao Xie
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY.
| | - Julie Vigil
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Ellen MacCracken
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Arunas Gasparaitis
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Joan Young
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Wenjun Kang
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Jacqueline Bernard
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Peter Warnke
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Un J Kang
- From the Departments of Neurology (T.X., J.Y., J.B.), Radiology (A.G.), and Neurosurgery (P.W.), and Speech and Swallowing Section, Department of Surgery (J.V., E.M.), University of Chicago Medicine, Chicago; Center for Research Informatics (W.K.), University of Chicago, Chicago, IL; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
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Tsai MJ, Fu YS, Lin YH, Huang YB, Wu PC. The effect of nanoemulsion as a carrier of hydrophilic compound for transdermal delivery. PLoS One 2014; 9:e102850. [PMID: 25068531 PMCID: PMC4113283 DOI: 10.1371/journal.pone.0102850] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
The purpose of the present study was to investigate the effect of nanoemulsions as a carrier vehicle of hydrophilic drug for transdermal delivery. The response surface methodology with a mixture design was used to evaluate the effect of ingredient levels of nanoemulsion formulations including cosurfactant (isopropyl alcohol, 20 ∼ 30%), surfactant (mixed of Brij 30 and Brij 35, 20 ∼ 30%), and distilled-water (34.5 ∼ 50.0%) on properties of the drug-loaded nanoemulsions including physicochemical characters and drug permeability through rat skin. The result showed that the hydrophilic drug in aqueous solution with or without penetration enhancer could not transport across rat skin after 12 h of application. Used nanoemulsions as carrier vehicle, the permeation rate of drug was significantly increased from 0 to 63.23 µg/cm2/h and the lag time was shortened from more than 12 h to about 2.7 ∼ 4.0 h. Moreover, the drug-loaded nanoemulsion formulation also showed physicochemical stability after 3 month storage at 25°C and 40°C.
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Affiliation(s)
- Ming-Jun Tsai
- Department of Neurology, China Medical University Hospital, School of Medicine, Medical College, China Medical University, Taichung, Taiwan, ROC
- Department of Neurology, Tainan Municipal An-Nan Hospital, Tainan, Taiwan, ROC
| | - Yaw-Syan Fu
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yu-Hsuan Lin
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yaw-Bin Huang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Pao-Chu Wu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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28
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Simons JA, Fietzek UM, Waldmann A, Warnecke T, Schuster T, Ceballos-Baumann AO. Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease. Parkinsonism Relat Disord 2014; 20:992-8. [PMID: 25012695 DOI: 10.1016/j.parkreldis.2014.06.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/22/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dysphagia in patients with Parkinson's disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD. METHODS The two-phased project comprised the questionnaire, diagnostic scales construction (N = 105), and a validation study (N = 82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration. RESULTS The Munich Dysphagia Test - Parkinson's disease (MDT-PD) consists of 26 items that show high internal consistency (α = 0.91). For the validation study, 82 patients, aged 70.9 ± 8.7 (mean ± SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r = 0.70, p < 0.001). The MDT-PD sum score classified not noticeable dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively. CONCLUSIONS MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients.
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Affiliation(s)
- Janine A Simons
- Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany; Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany.
| | - Urban M Fietzek
- Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital of Muenster, Muenster, Germany
| | - Tibor Schuster
- Institute of Medical Statistics and Epidemiology, Technische Universität München (TUM), Munich, Germany
| | - Andrés O Ceballos-Baumann
- Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany
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29
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Grant LM, Richter F, Miller JE, White SA, Fox CM, Zhu C, Chesselet MF, Ciucci MR. Vocalization deficits in mice over-expressing alpha-synuclein, a model of pre-manifest Parkinson's disease. Behav Neurosci 2014; 128:110-21. [PMID: 24773432 PMCID: PMC4079049 DOI: 10.1037/a0035965] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Communication and swallowing deficits are common in Parkinson's disease (PD). Evidence indicates that voice and speech dysfunction manifest early, prior to motor deficits typically associated with striatal dopamine loss. Unlike deficits in the extremities, cranial sensorimotor deficits are refractory to standard dopamine-related pharmacological and surgical interventions, thus the mechanisms underlying vocal deficits are unclear. Although neurotoxin models have provided some insight, they typically model nigrostriatal dopamine depletion and are therefore limited. Widespread alpha-synuclein (aSyn) pathology is common to familial and sporadic PD, and transgenic mouse models based on aSyn overexpression present a unique opportunity to explore vocalization deficits in relation to extrastriatal, nondopaminergic pathologies. Specifically, mice overexpressing human wild-type aSyn under a broad neuronal promoter (Thy1-aSyn) present early, progressive motor and nonmotor deficits starting at 2-3 months, followed by parkinsonism with dopamine loss at 14 months. We recorded ultrasonic vocalizations from Thy1-aSyn mice and wild-type (WT) controls at 2-3, 6-7, and 9 months. Thy1-aSyn mice demonstrated early, progressive vocalization deficits compared with WT. Duration and intensity of calls were significantly reduced and call profile was altered in the Thy1-aSyn mice, particularly at 2-3 months. Call rate trended toward a more drastic decrease with age in the Thy1-aSyn mice compared with WT. Alpha-synuclein pathology is present in the periaqueductal gray and may underlie the manifestation of vocalization deficits. These results indicate that aSyn overexpression can induce vocalization deficits at an early age in mice and provides a new model for studying the mechanisms underlying cranial sensorimotor deficits and treatment interventions for PD.
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Affiliation(s)
- Laura M Grant
- Department of Surgery, Division of Otolaryngology- Head & Neck Surgery, University of Wisconsin
| | | | | | | | - Cynthia M Fox
- National Center for Voice and Speech, University of Colorado
| | - Chunni Zhu
- Department of Neurology, David Geffen School of Medicine at UCLA
| | | | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin
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30
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Ciucci MR, Grant LM, Rajamanickam ESP, Hilby BL, Blue KV, Jones CA, Kelm-Nelson CA. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang 2013; 34:185-202. [PMID: 24166192 DOI: 10.1055/s-0033-1358367] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Parkinson disease (PD) is a complex, progressive, neurodegenerative disorder that leads to a wide range of deficits including fine and gross sensorimotor impairment, autonomic dysfunction, mood disorders, and cognitive decline. Traditionally, the focus for diagnosis and treatment has been on sensorimotor impairment related to dopamine depletion. It is now widely recognized, however, that PD-related pathology affects multiple central nervous system neurotransmitters and pathways. Communication and swallowing functions can be impaired even in the early stages, significantly affecting health and quality of life. The purpose of this article is to review the literature on early intervention for communication and swallowing impairment in PD. Overarching themes were that (1) studies and interpretation of data from studies in early PD are limited; (2) best therapy practices have not been established, in part due to the heterogeneous nature of PD; and (3) as communication and swallowing problems are pervasive in PD, further treatment research is essential.
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Affiliation(s)
- Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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31
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Russell JA, Ciucci MR, Hammer MJ, Connor NP. Videofluorographic assessment of deglutitive behaviors in a rat model of aging and Parkinson disease. Dysphagia 2013; 28:95-104. [PMID: 22763806 PMCID: PMC3554861 DOI: 10.1007/s00455-012-9417-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
Dysphagia is commonly associated with aging and Parkinson disease and can have a significant impact on a person's quality of life. In some cases, dysphagia may be life-threatening. Animal models may be used to study underlying mechanisms of dysphagia, but paradigms that allow adequate imaging of the swallow in combination with measurement of physiological variables have not been forthcoming. To begin development of methods that allow this, we used videofluorography to record the deglutition behaviors of 22 Fisher 344/Brown Norway rats in young adult (9 months old), old (32 months old), and parkinsonian (unilateral lesion to the medial forebrain bundle) groups. We hypothesized that the old and parkinsonian rats would manifest deficits in deglutition behaviors analogous to those found in human clinical populations. Our results supported our hypothesis in that the old group demonstrated reductions in bolus transport speeds and mastication rate while the parkinsonian rats showed impairments in oral processing. Interpretation of these results should consider the particular animal model, lesion type, and videofluorographic protocol used in this work. Future studies will link swallow imaging data of this kind with physiological and anatomical data in a manner not possible with human participants.
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Affiliation(s)
- John A Russell
- Otolaryngology Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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32
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Suntrup S, Teismann I, Bejer J, Suttrup I, Winkels M, Mehler D, Pantev C, Dziewas R, Warnecke T. Evidence for adaptive cortical changes in swallowing in Parkinson's disease. Brain 2013; 136:726-38. [PMID: 23412935 DOI: 10.1093/brain/awt004] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dysphagia is a relevant symptom in Parkinson's disease, whose pathophysiology is poorly understood. It is mainly attributed to degeneration of brainstem nuclei. However, alterations in the cortical contribution to deglutition control in the course of Parkinson's disease have not been investigated. Here, we sought to determine the patterns of cortical swallowing processing in patients with Parkinson's disease with and without dysphagia. Swallowing function in patients was objectively assessed with fiberoptic endoscopic evaluation. Swallow-related cortical activation was measured using whole-head magnetoencephalography in 10 dysphagic and 10 non-dysphagic patients with Parkinson's disease and a healthy control group during self-paced swallowing. Data were analysed applying synthetic aperture magnetometry, and group analyses were done using a permutation test. Compared with healthy subjects, a strong decrease of cortical swallowing activation was found in all patients. It was most prominent in participants with manifest dysphagia. Non-dysphagic patients with Parkinson's disease showed a pronounced shift of peak activation towards lateral parts of the premotor, motor and inferolateral parietal cortex with reduced activation of the supplementary motor area. This pattern was not found in dysphagic patients with Parkinson's disease. We conclude that in Parkinson's disease, not only brainstem and basal ganglia circuits, but also cortical areas modulate swallowing function in a clinically relevant way. Our results point towards adaptive cerebral changes in swallowing to compensate for deficient motor pathways. Recruitment of better preserved parallel motor loops driven by sensory afferent input seems to maintain swallowing function until progressing neurodegeneration exceeds beyond the means of this adaptive strategy, resulting in manifestation of dysphagia.
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Affiliation(s)
- Sonja Suntrup
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Malmedyweg 15, 48149 Muenster, Germany.
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33
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Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG. Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 2013; 72:119-29. [PMID: 23334595 PMCID: PMC3552335 DOI: 10.1097/nen.0b013e3182801cde] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parkinson disease (PD) is a neurodegenerative disease primarily characterized by cardinal motor manifestations and CNS pathology. Current drug therapies can often stabilize these cardinal motor symptoms, and attention has shifted to the other motor and nonmotor symptoms of PD that are resistant to drug therapy. Dysphagia in PD is perhaps the most important drug-resistant symptom because it leads to aspiration and pneumonia, the leading cause of death. Here, we present direct evidence for degeneration of the pharyngeal motor nerves in PD. We examined the cervical vagal nerve (cranial nerve X), pharyngeal branch of nerve X, and pharyngeal plexus innervating the pharyngeal muscles in 14 postmortem specimens, that is, from 10 patients with PD and 4 age-matched control subjects. Synucleinopathy in the pharyngeal nerves was detected using an immunohistochemical method for phosphorylated α-synuclein. Alpha-synuclein aggregates were revealed in nerve X and the pharyngeal branch of nerve X, and immunoreactive intramuscular nerve twigs and axon terminals within the neuromuscular junctions were identified in all of the PD patients but in none of the controls. These findings indicate that the motor nervous system of the pharynx is involved in the pathologic process of PD. Notably, PD patients who have had dysphagia had a higher density of α-synuclein aggregates in the pharyngeal nerves than those without dysphagia. These findings indicate that motor involvement of the pharynx in PD is one of the factors leading to oropharyngeal dysphagia commonly seen in PD patients.
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Affiliation(s)
- Liancai Mu
- Upper Airway Research Laboratory, Department of Research, Hackensack University Medical Center, New Jersey 07601, USA.
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34
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Sutton JP. Dysphagia in Parkinson's disease is responsive to levodopa. Parkinsonism Relat Disord 2013; 19:282-4. [PMID: 23333537 DOI: 10.1016/j.parkreldis.2012.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/12/2012] [Indexed: 12/16/2022]
Abstract
The role of levodopa in the treatment of dysphagia in Parkinson's disease (PD) has recently been questioned. There are good reasons, however, to "question the question." In this essay, evidence from published literature and clinical experience is presented, as well as a critical review of the first meta-analysis to explore this issue. The evidence presented supports the traditional view that PD dysphagia is responsive to levodopa.
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Affiliation(s)
- James P Sutton
- Pacific Neuroscience Medical Group, Oxnard, CA 93030, United States.
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35
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Melo A, Monteiro L. Swallowing improvement after levodopa treatment in idiopathic Parkinson's disease: lack of evidence. Parkinsonism Relat Disord 2012; 19:279-81. [PMID: 23231973 DOI: 10.1016/j.parkreldis.2012.11.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/12/2012] [Indexed: 02/07/2023]
Abstract
Swallowing impairment is the main cause of pulmonary infection and death in Parkinson's disease (PD). To date, there is no established effective treatment to restore swallowing function among these subjects. Levodopa is considered the gold standard treatment for motor symptoms in PD but its efficacy in improving oropharyngeal and esophageal dysphagia remains controversial.
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Affiliation(s)
- Ailton Melo
- Division of Neurology and Epidemiology, Federal University of Bahia, Salvador-Bahia, Brazil
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36
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Manor Y, Mootanah R, Freud D, Giladi N, Cohen JT. Video-assisted swallowing therapy for patients with Parkinson's disease. Parkinsonism Relat Disord 2012; 19:207-11. [PMID: 23131836 DOI: 10.1016/j.parkreldis.2012.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/07/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conventional swallowing therapy for patients with Parkinson's disease (PD) and swallowing difficulties has poor carryover to everyday life. Herein, we test the effectiveness of visual information while treating swallowing disturbances in patients with PD. METHODS Forty two non-demented PD patients with swallowing disturbances were randomly divided into two groups. An experimental group received video-assisted swallowing therapy (VAST) and a control group (n = 21) was given conventional therapy. Both groups were given 6 interventional sessions by the same speech and swallowing therapist. Patients in the VAST group were exposed to video of the swallowing process in general as well as of their own, as part of all therapy sessions. Swallowing function was assessed before and post-intervention by fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life, quality of care and the degree of pleasure from eating were also assessed by questioners pre and post-intervention. RESULTS There was a significant improvement in swallowing functions following both interventions. The FEESs demonstrated a significantly greater reduction in food residues in the pharynx in the VAST group compared to the conventional treatment group. There were significant group improvement in some parameters of the quality of life, quality of care and pleasure of eating scales. CONCLUSION In cognitively intact patients with PD with swallowing disturbances VAST was associated with improved swallowing related QOL and less food residues in the pharynx.
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Affiliation(s)
- Yael Manor
- Movement Disorders Unit, Dept of Neurology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sundstedt S, Olofsson K, van Doorn J, Linder J, Nordh E, Blomstedt P. Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation. Acta Neurol Scand 2012; 126:350-6. [PMID: 22384826 DOI: 10.1111/j.1600-0404.2012.01658.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the present study was to examine whether there was a negative effect of caudal Zona Incerta deep brain stimulation (cZI DBS) on pharyngeal swallowing function in Parkinson's patients (PD). There are no former reports including swallowing and cZI DBS. METHODS Eight patients (aged 49-71 years; median 62) were evaluated pre- and post-operatively, at 6 and 12 months after DBS surgery. Evaluation tools were fiberoptic endoscopic evaluation of swallowing examinations and patients' self-assessments of their swallowing function including a visual analog scale and quality-of-life-related questions. The swallowing protocol included Rosenbek's Penetration-Aspiration Scale, Secretion Severity Scale and parameters for preswallow spillage, pharyngeal residue, and pharyngeal clearance. RESULTS There was no clear-cut effect of neurostimulation post-operatively at 6 and 12 months on any of the swallowing parameters except for the preswallow spillage that was slightly worsened in the stimulation on condition 12 months post-operatively. The answers to the self assessment questions did not vary significantly. CONCLUSIONS The effect of the stimulation on the swallowing function varied among individuals, but the overall outcome was that cZI DBS did not seem to have a negative influence on swallowing function in the eight patients studied.
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Affiliation(s)
- S. Sundstedt
- Division of Speech and Language Pathology; Department of Clinical Sciences; Umeå University; Umeå; Sweden
| | - K. Olofsson
- Division of Otorhinolaryngology; Department of Clinical Sciences; Umeå University; Umeå; Sweden
| | - J. van Doorn
- Division of Speech and Language Pathology; Department of Clinical Sciences; Umeå University; Umeå; Sweden
| | - J. Linder
- Division of Neurology; Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå; Sweden
| | - E. Nordh
- Division of Clinical Neurophysiology; Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå; Sweden
| | - P. Blomstedt
- Division of Neurosurgery; Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå; Sweden
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Abstract
Dysphagia (impaired swallowing) is common in patients with Parkinson disease (PD) and is related to aspiration pneumonia, the primary cause of death in PD. Therapies that ameliorate the limb motor symptoms of PD are ineffective for dysphagia. This suggests that the pathophysiology of PD dysphagia may differ from that affecting limb muscles, but little is known about potential neuromuscular abnormalities in the swallowing muscles in PD. This study examined the fiber histochemistry of pharyngeal constrictor and cricopharyngeal sphincter muscles in postmortem specimens from 8 subjects with PD and 4 age-matched control subjects. Pharyngeal muscles in subjects with PD exhibited many atrophic fibers, fiber type grouping, and fast-to-slow myosin heavy chain transformation. These alterations indicate that the pharyngeal muscles experienced neural degeneration and regeneration over the course of PD. Notably, subjects with PD with dysphagia had a higher percentage of atrophic myofibers versus with those without dysphagia and controls. The fast-to-slow fiber-type transition is consistent with abnormalities in swallowing, slow movement of food, and increased tone in the cricopharyngeal sphincter in subjects with PD. The alterations in the pharyngeal muscles may play a pathogenic role in the development of dysphagia in subjects with PD.
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Nuckolls AL, Worley C, Leto C, Zhang H, Morris JK, Stanford JA. Tongue force and tongue motility are differently affected by unilateral vs bilateral nigrostriatal dopamine depletion in rats. Behav Brain Res 2012; 234:343-8. [PMID: 22796604 DOI: 10.1016/j.bbr.2012.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 01/05/2023]
Abstract
In addition to its cardinal symptoms of bradykinesia, muscle rigidity, resting tremor and postural disturbances, Parkinson's disease (PD) also affects orolingual motor function. Orolingual motor deficits can contribute to dysphagia, which increases morbidity and mortality in this population. Previous preclinical studies describing orolingual motor deficits in animal models of PD have focused on unilateral nigrostriatal dopamine (DA) depletion. In this study we compared the effects of unilateral vs bilateral 6-hydroxydopamine (6-OHDA)-induced DA depletion in rats trained to lick water from an isometric force-sensing disc. Rats received either unilateral or bilateral 6-OHDA into the medial forebrain bundle and were tested for four weeks post-lesion. Dependent variables included task engagement (the number of licks per session), tongue force (mean and maximum), and tongue motility (the number of licks per second). While both lesion groups exhibited decreased tongue force output, tongue motility deficits were present in only the group that received unilateral nigrostriatal DA depletion. Task engagement was not significantly diminished by 6-OHDA. Analysis of striatal DA tissue content revealed that DA depletion was ∼97% in the unilateral group and ∼90% in the bilateral group. These results suggest that while nigrostriatal DA depletion affects tongue force output, deficits in tongue motility may instead result from a functional imbalance in neural pathways affecting this midline structure.
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Affiliation(s)
- Andrea L Nuckolls
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, United States
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Smith SK, Roddam H, Sheldrick H. Rehabilitation or compensation: time for a fresh perspective on speech and language therapy for dysphagia and Parkinson's disease? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:351-364. [PMID: 22788222 DOI: 10.1111/j.1460-6984.2011.00093.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Dysphagia is a common symptom of Parkinson's disease and can have negative consequences for physical health and quality of life. A variety of treatment options are available to clinicians working with people who have dysphagia and Parkinson's disease. These options can be broadly categorized as being compensatory or rehabilitative in nature. AIMS To explore the evidence behind treatment options available to clinicians working with dysphagia and Parkinson's disease and to draw conclusions about whether compensatory or rehabilitative approaches are likely to provide the best outcomes for our patients. METHODS & PROCEDURES A critical literature review of compensatory and rehabilitative interventions for dysphagia in Parkinson's disease was undertaken. Relevant studies were analysed for their robustness and potential clinical applications. General conclusions were drawn based on the evidence base identified in this review. MAIN CONTRIBUTION This review outlines the lack of evidence supporting both compensatory and rehabilitative methods of treating dysphagia in Parkinson's disease. It directs clinicians and researchers towards areas that require further investigation. CONCLUSIONS & IMPLICATIONS To date, compensatory methods of treating dysphagia in Parkinson's disease have received more research attention than rehabilitative methods and yet neither approach has a strong evidence base. This review argues that rehabilitative methods could possibly have greater potential to increase swallowing safety and improve quality of life in the long-term than compensatory methods alone. However, at present there is a lack of research in this area.
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Affiliation(s)
- Sarah K Smith
- Division of Physiotherapy and Sports Therapy, SSTO Greenbank Building 161, University of Central Lancashire, PRESTON PR1 2HE, UK
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Fleming SM, Schallert T, Ciucci MR. Cranial and related sensorimotor impairments in rodent models of Parkinson's disease. Behav Brain Res 2012; 231:317-22. [PMID: 22394540 DOI: 10.1016/j.bbr.2012.02.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/17/2012] [Accepted: 02/20/2012] [Indexed: 12/21/2022]
Abstract
In Parkinson's disease both limb and cranial sensorimotor functions are impaired, leading to a profound diminished quality of life for many patients. Toxin and genetic animal models of Parkinson's disease are likely essential for understanding the pathology associated with these impairments as well as for the development and testing of potential therapeutics. Here we describe useful novel and established behavioral outcome measures for assessing limb and cranial sensorimotor functions in toxin and genetic models of parkinsonism in rats and mice.
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Affiliation(s)
- Sheila M Fleming
- Departments of Psychology and Neurology, University of Cincinnati, Cincinnati, OH 45221-0376, USA.
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Heijnen BJ, Speyer R, Baijens LWJ, Bogaardt HCA. Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia: effects on quality of life. Dysphagia 2011; 27:336-45. [PMID: 22081122 PMCID: PMC3417093 DOI: 10.1007/s00455-011-9371-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 10/04/2011] [Indexed: 12/14/2022]
Abstract
This study compares the effects of traditional logopedic dysphagia treatment with those of neuromuscular electrical stimulation (NMES) as adjunct to therapy on the quality of life in patients with Parkinson’s disease and oropharyngeal dysphagia. Eighty-eight patients were randomized over three treatment groups. Traditional logopedic dysphagia treatment and traditional logopedic dysphagia treatment combined with NMES at sensor or motor level stimulation were compared. At three times (pretreatment, post-treatment, and 3 months following treatment), two quality-of-life questionnaires (SWAL-QOL and MD Anderson Dysphagia Inventory) and a single-item Dysphagia Severity Scale were scored. The Functional Oral Intake Scale was used to assess the dietary intake. After therapy, all groups showed significant improvement on the Dysphagia Severity Scale and restricted positive effects on quality of life. Minimal group differences were found. These effects remained unchanged 3 months following treatment. No significant correlations were found between dietary intake and quality of life. Logopedic dysphagia treatment results in a restricted increased quality of life in patients with Parkinson’s disease. In this randomized controlled trial, all groups showed significant therapy effects on the Dysphagia Severity Scale and restricted improvements on the SWAL-QOL and the MDADI. However, only slight nonsignificant differences between groups were found.
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Affiliation(s)
- B J Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Gastrointestinal (GI) symptoms are among the most common nonmotor manifestations of Parkinson's disease (PD), and they have many important ramifications for patients. The purpose of this review is to raise awareness of the full spectrum of GI symptoms in PD which include weight loss, sialorrhea, dysphagia, nausea, constipation, and defecatory dysfunction. We will discuss their practical significance, and outline a clear approach to their evaluation and management. A brief discussion about the impacts of commonly used medical and surgical PD therapies on GI symptom manifestation is also included.
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Swallowing in Parkinson Patients versus Healthy Controls: Reliability of Measurements in Videofluoroscopy. Gastroenterol Res Pract 2011; 2011:380682. [PMID: 21977026 PMCID: PMC3185253 DOI: 10.1155/2011/380682] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/09/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. To determine and describe the pathophysiological aspects of oropharyngeal swallowing in patients with Parkinson's disease more accurately, a pilot study of qualitative as well as quantitative parameters of swallowing was performed using videofluoroscopy (VFS). Methods. Ten patients with a diagnosis of idiopathic Parkinson's disease having dysphagic complaints and ten healthy age- and gender-matched control subjects underwent a standardized videofluoroscopic swallowing protocol. Information on the swallowing function was derived from temporal, spatial, and descriptive visuoperceptual parameters. Intra- and interrater reliability was calculated. Results. No significant differences were found between Parkinson patients and healthy control subjects for the majority of the reliable variables. Conclusions. It was concluded that swallowing function seemed to be preserved in the early stages of Parkinson's disease. Furthermore, the reliability of many quantitative as well as qualitative swallowing parameters proved insufficient, raising questions about the interpretation of study outcomes in videofluoroscopy.
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Kane JR, Ciucci MR, Jacobs AN, Tews N, Russell JA, Ahrens AM, Ma ST, Britt JM, Cormack LK, Schallert T. Assessing the role of dopamine in limb and cranial-oromotor control in a rat model of Parkinson's disease. JOURNAL OF COMMUNICATION DISORDERS 2011; 44:529-37. [PMID: 21820129 PMCID: PMC3278988 DOI: 10.1016/j.jcomdis.2011.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Parkinson's disease (PD) is a neurodegenerative disorder primarily characterized by sensorimotor dysfunction. The neuropathology of PD includes a loss of dopamine (DA) neurons of the nigrostriatal pathway. Classic signs of the disease include rigidity, bradykinesia, and postural instability. However, as many as 90% of patients also experience significant deficits in speech, swallowing (including mastication), and respiratory control. Oromotor deficits such as these are underappreciated, frequently emerging during the early, often hemi-Parkinson, stage of the disease. In this paper, we review tests commonly used in our labs to model early and hemi-Parkinson deficits in rodents. We have recently expanded our tests to include sensitive models of oromotor deficits. This paper discusses the most commonly used tests in our lab to model both limb and oromotor deficits, including tests of forelimb-use asymmetry, postural instability, vibrissae-evoked forelimb placing, single limb akinesia, dry pasta handling, sunflower seed shelling, and acoustic analyses of ultrasonic vocalizations and pasta biting strength. In particular, we lay new groundwork for developing methods for measuring abnormalities in the acoustic patterns during eating that indicate decreased biting strength and irregular intervals between bites in the hemi-Parkinson rat. Similar to limb motor deficits, oromotor deficits, at least to some degree, appear to be modulated by nigrostriatal DA. Finally, we briefly review the literature on targeted motor rehabilitation effects in PD models. LEARNING OUTCOMES Readers will: (a) understand how a unilateral lesion to the nigrostriatal pathway affects limb use, (b) understand how a unilateral lesion to the nigrostriatal pathway affects oromotor function, and (c) gain an understanding of how limb motor deficits and oromotor deficits appear to involve dopamine and are modulated by training.
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Affiliation(s)
- Jacqueline R Kane
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Ebihara S, Ebihara T. Cough in the elderly: A novel strategy for preventing aspiration pneumonia. Pulm Pharmacol Ther 2011; 24:318-23. [DOI: 10.1016/j.pupt.2010.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/21/2010] [Accepted: 10/02/2010] [Indexed: 02/04/2023]
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Ciucci MR, Russell JA, Schaser AJ, Doll EJ, Vinney LM, Connor NP. Tongue force and timing deficits in a rat model of Parkinson disease. Behav Brain Res 2011; 222:315-20. [PMID: 21459116 DOI: 10.1016/j.bbr.2011.03.057] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 03/24/2011] [Accepted: 03/27/2011] [Indexed: 11/16/2022]
Abstract
Deficits in tongue function in conjunction with airway compromise can contribute to dysphagia associated with Parkinson disease (PD). However, it is unknown if these deficits are related to the primary disease pathology in PD, nigrostriatal dopamine depletion. To directly study the impact of striatal dopamine depletion on tongue function, we used unilateral infusion of the neurotoxin 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle and measured tongue force and timing parameters during a complex tongue protrusion task for a water reward. Maximal and average forces were significantly diminished and average press time was significantly longer after neurotoxin administration, reflecting aspects of bradykinesia and hypokinesia associated with PD. Our findings suggest that even unilateral deficits to the nigrostriatal dopamine system may be contributing to some of the lingual sensorimotor deficits seen in PD. Because previous research in rat models of PD has shown that targeted training of the limb can rescue behavioral deficits and spare striatal dopamine neurons, early intervention for cranial sensorimotor deficits may also be indicated.
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Affiliation(s)
- Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin, 1300 University Avenue, Madison, WI 53706, USA.
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Clinical review of treatment options for select nonmotor symptoms of Parkinson's disease. ACTA ACUST UNITED AC 2010; 8:294-315. [PMID: 20869620 DOI: 10.1016/j.amjopharm.2010.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is associated with a host of nonmotor symptoms, including psychosis, cognitive impairment, depression, sleep disturbance, swallowing disorders, gastrointestinal symptoms, and autonomic dysfunction. The nonmotor symptoms of PD have the potential to be more debilitating than the motor features of the disorder. OBJECTIVE The aim of this article was to review treatment options for the nonmotor manifestations of PD, including pharmacologic and nonpharmacologic interventions. METHODS The PubMed and MEDLINE databases were searched for articles published in English between January 1966 and April 2010, using the terms Parkinson's disease, nonmotor, psychosis, hallucination, antipsychotic, cognitive impairment, dementia, depression, sleep disturbance, sleepiness, REM (rapid eye movement) sleep behavior disorder, dysphagia, swallowing disorder, sialorrhea, gastrointestinal, constipation, autonomic dysfunction, orthostatic hypotension, gastroparesis, erectile dysfunction, sexual dysfunction, and urinary dysfunction. Articles were selected for review if they were randomized controlled trials (RCTs), meta-analyses, or evidence-based reviews of treatment of patients with PD, and/or expert opinion regarding the treatment of nonmotor symptoms of PD. RESULTS A total of 148 articles, including RCTs, meta-analyses, and evidence-based reviews, were included in this review. The treatment of hallucinations or psychosis in PD should include a stepwise reduction in medications for motor symptoms, followed by the use of quetiapine or clozapine. Dementia may be treated with acetylcholinesterase inhibitors. Evidence is lacking concerning the optimal pharmacologic treatment for depression in PD, with expert opinions indicating selective serotonin reuptake inhibitors as the antidepressants of choice. However, the largest study to date found nortriptyline therapy to be efficacious compared with placebo, whereas paroxetine controlled release was not. A variety of sleep disturbances may plague a person with PD, and treatment must be individualized to the patient's specific sleep disturbance pattern and contributing factors. Swallowing disorders may lead to aspiration and pneumonia, and patients with dysphagia should be referred to a speech therapist for further evaluation and treatment. Orthostasis may be treated with nonpharmacologic interventions as well as pharmacologic treatments (eg, fludrocortisone, midodrine, indomethacin). Other autonomic symptoms are managed in a manner similar to that in patients without PD, although careful attention must be aimed at avoiding dopamine-blocking therapies in the treatment of gastrointestinal dysfunction and gastroparesis. CONCLUSIONS Various pharmacologic and nonpharmacologic strategies are available for the management of the nonmotor symptoms of PD. The challenges associated with nonmotor symptoms must not be forgotten in light of the motor symptoms of PD, and treatment of nonmotor symptoms should be encouraged.
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Impaired Food Transportation in Parkinson’s Disease Related to Lingual Bradykinesia. Dysphagia 2010; 26:250-5. [DOI: 10.1007/s00455-010-9296-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 08/06/2010] [Indexed: 11/27/2022]
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Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2010; 26:218-24. [PMID: 20623304 DOI: 10.1007/s00455-010-9289-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine if individuals with Parkinson's disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A ≤ 2; Group 2 = P-A ≥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.
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