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Clinical nutrition

Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients

European Journal of Clinical Nutrition volume 72, pages 82–86 (2018)Cite this article

Subjects

Abstract

Background/objectives:

Dysphagia is relatively common in patients with Parkinson disease (PD) and can have a negative impact on their quality of life; therefore, it is imperative that its prevalence in PD patients is studied. The aim of this study was to explore the prevalence and clinical correlation of dysphagia in Chinese PD patients.

Subjects/methods:

We recruited 116 Chinese PD patients. A videofluoroscopic study of swallowing (VFSS) was used to identify dysphagia. Assessments, including water drinking test, relative motor symptoms, non-motor symptoms (NMS) and quality of life, were performed to analyze the risks of dysphagia.

Results:

The prevalence of dysphagia was 87.1%. The comparison of demographic and clinical features between patients with and without dysphagia included sex, education level, disease course, Mini-mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Question 6, 7 of the Unified Parkinson Disease Rating Scale (UPDRS Part II), Hoehn-Yahr stage (H&Y), water drinking test, 39-item Parkinson Disease Questionnaire (PDQ-39) and Non-Motor Symptoms Quest (NMSQ). We found significant correlations between dysphagia and age. Using age, disease course, and H&Y stage as the independent variable in our regression analysis for assessing the risk factors of dysphagia in PD patients, age and H&Y stage displayed a strong correlation as the risk factors. The risk of dysphagia in elderly PD patients is 1.078 times greater than that of younger PD patients. Also, the risk of dysphagia in PD patients of a greater H&Y staging is 3.260 times greater than that of lower staging PD patients.

Conclusions:

Our results suggest that dysphagia is common in Chinese PD patients. Older patients or those in higher H&Y stages are more likely to experience dysphagia. There is no correlation between dysphagia and PD duration.

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References

  1. Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM . Respiratory-swallowing coordination and swallowing safety in patients with Parkinson’s disease. Dysphagia 2011; 26: 218–224.

    Article  Google Scholar 

  2. Mehanna R, Jankovic J . Respiratory problems in neurologic movement disorders. Parkinsonism Relat Disord 2010; 16: 628–638.

    Article  Google Scholar 

  3. Kalf JG, de Swart BJ, Bloem BR, Munneke M . Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 2012; 18: 311–315.

    Article  CAS  Google Scholar 

  4. Yamamoto T . Validation of the Japanese translation of the Swallowing Disturbance Questionnaire in Parkinson's disease patients. Qual Life Res 2012; 21: 1299–1303.

    Article  Google Scholar 

  5. Ali GN, Wallace KL, Schwartz R, DeCarle DJ, Zagami AS, Cook IJ . Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease. Gastroenterology 1996; 110: 383–392.

    Article  CAS  Google Scholar 

  6. Costa MM . Videofluoroscopy : the gold standard exam for studying swallowing and its dysfunction. Arq Gastroenterol 2010; 47: 327–328.

    Article  Google Scholar 

  7. Logemann JA . Manual for the Videofluorographic Study of Swallowing, 2nd edition. Pro-ed: Austin, TX, USA 1993; pp 115–117.

    Google Scholar 

  8. Nascimento WV, Cassiani RA, Santos CM, Dantas RO . Effect of bolus volume and consistency on swallowing events duration in healthy subjects. J Neurogastroenterol Motil 2015; 21: 78–82.

    Article  Google Scholar 

  9. Terré R, Panadés A, Mearin F . Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke. Neurogastroenterol Motil 2013; 25: 896–e702.

    Article  Google Scholar 

  10. Allen JE, White CJ, Leonard RJ, Belafsky PC . Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia. Otolaryngol Head Neck Surg 2010; 142: 208–213.

    Article  Google Scholar 

  11. Hsiao IT, Weng YH, Hsieh CJ, Lin WY, Wey SP, Kung MP et al. Correlation of Parkinson disease severity and 18 F-DTBZ positron emission tomography. JAMA Neurol 2014; 71: 758–766.

    Article  Google Scholar 

  12. Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P et al. The metric properties of a novel non-motor symptoms scale for Parkinson's disease: results from an international pilot study. Mov Disord 2007; 22: 1901–1911.

    Article  Google Scholar 

  13. Folstein MF, Folstein SE, Mchugh PR . 'Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

    Article  CAS  Google Scholar 

  14. Hamilton M . Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–296.

    Article  CAS  Google Scholar 

  15. Clark DB, Donovan JE . Reliability and validity of the Hamilton anxiety rating scale in an adolescent sample. J Am Acad Child Adolesc Psychiatry 1994; 33: 354–360.

    Article  CAS  Google Scholar 

  16. Han TR, Paik NJ, Park JW . Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil 2001; 82: 677–682.

    Article  CAS  Google Scholar 

  17. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Fahn S et al. The Unified Parkinson’s Disease Rating Scale (UPDRS): Status and recommendations. Mov Disord 2003; 18: 738–750.

    Article  Google Scholar 

  18. Luo W, Gui XH, Wang B, Zhang WY, Ouyang ZY, Guo Y et al. Validity and reliability testing of the Chinese (mainland) version of the 39-item Parkinson's Disease Questionnaire (PDQ-39). J Zhejiang Univ Sci B 2010; 11: 531–538.

    Article  Google Scholar 

  19. Walker RW, Dunn JR, Gray WK . Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease. Dysphagia 2011; 26: 92–96.

    Article  Google Scholar 

  20. Clarke CE, Gullaksen E, Macdonald S, Lowe F . Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson's disease. Acta Neurol Scand 1998; 97: 27–35.

    Article  CAS  Google Scholar 

  21. Volonte′ MA, Porta M, Comi G . Clinical assessment of dysphagia inearly phases of Parkinson’s disease. Neurol Sci 2002; 23: 121–122.

    Article  Google Scholar 

  22. Fuh JL, Lee RC, Wang SJ, Lin CH, Wang PN, Chiang JH et al. Swallowing difficulty in Parkinson’s disease. Clin Neurol Neurosurg 1997; 99: 106–112.

    Article  CAS  Google Scholar 

  23. Sura L, Madhavan A, Carnaby G, Crary MA . Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging 2011; 7: 287–298.

    Google Scholar 

  24. Belo LR, Lins SC, Cunha DAD, Lins O, Amorim CF et al. Eletromiografia de superfície da musculatura supra-hióidea durante a deglutição de idosos sem doenças neurológicas e idosos com Parkinson. Revista Cefac 2009; 11: 268–280.

    Article  Google Scholar 

  25. Miller N, Noble E, Jones D, Burn D . Hard to swallow: dysphagia in Parkinson's disease. Age Ageing 2006; 35: 614–618.

    Article  Google Scholar 

  26. Steele CM, Miller AJ . Sensory input pathways and mechanisms in swallowing: a review. Dysphagia 2010; 25: 323–333.

    Article  Google Scholar 

  27. McNaught KS, Perl DP, Brownell AL, Olanow CW . Systemic exposure to proteasome inhibitors causes a progressive model of Parkinson's disease. Ann Neurol 2004; 56: 149–162.

    Article  CAS  Google Scholar 

  28. Levandis G, Balestra B, Siani F, Rizzo V, Ghezzi C, Ambrosi G et al. Response of colonic motility to dopaminergic stimulation is subverted in rats with nigrostriatal lesion: relevance to gastrointestinal dysfunctions in Parkinson's disease. Neurogastroenterol Motil 2015; 27: 1783–1795.

    Article  CAS  Google Scholar 

  29. Liu M, Choi DY, Hunter RL, Pandya JD, Cass WA, Sullivan PG et al. Trichloroethylene induces dopaminergic neurodegeneration in Fisher 344 rats. J Neurochem 2010; 112: 773–783.

    Article  CAS  Google Scholar 

  30. Johnston BT, Colcher A, Li Q, Gideon RM, Castell JA, Castell DO . Repetitive proximal esophageal contractions, a new manometric finding and a possible further link between Parkinson's disease and achalasia. Dysphagia 2001; 16: 186–189.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank all the PD patients and their families who participated in our research. This work was supported by the natural science foundation of Zhejiang Province (No: LY12H09006), the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No: 2012BAI10B00) and the Program for Zhejiang Leading Team of Science and Technology Innovation (No: 2012R10049-04).

Author contributions

XD designed the study, performed neurological evaluations, VFSS data acquisition and statistical analyses and wrote the first draft. JG conducted neurological evaluations. CX conducted neurological evaluations, VFSS data acquisition. BX participated in VFSS data acquisition, and the review and critique of the manuscript. SW conducted neurological evaluations. ZC conducted neurological evaluations. YL conducted neurological evaluations, and the review and critique of the manuscript. DL conducted neurological evaluations. FX performed image preprocessing and statistical analyses. Wei Luo conceived of and organized the research project, participated in the neurological evaluations, and the review and critique of the manuscript.

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Authors and Affiliations

  1. Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    X Ding, J Gao, C Xie, B Xiong, S Wu, Z Cen, Y Lou, D Lou, F Xie & W Luo

  2. Department of Neurology, People’s Hospital of Haining, Haining, Zhejiang, China

    X Ding

  3. Department of Neurology, People’s Hospital of Beilun, Ningbo, China

    C Xie

  4. Department of Physiotherapy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    B Xiong

  5. Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    Z Cen & Y Lou

  6. Department of Neurology, the people's Liberation Army 117 hospital, Hangzhou, Zhejiang, China

    D Lou

  7. Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    F Xie

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  1. X Ding
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Correspondence to W Luo.

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Ding, X., Gao, J., Xie, C. et al. Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Eur J Clin Nutr 72, 82–86 (2018). https://doi.org/10.1038/ejcn.2017.100

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