bireme- resumos-parkinson

[PMID]:22086428[Au] Autor:Bayés-Rusiñol À; Forjaz MJ; Ayala A; Crespo Mde L; Prats A; Valles E; Petit C; Casanovas M;

Garolera-Freixa M[Ad] Endereço:Unidad de Parkinson, Fundación Teknon, Barcelona, España. [email protected]

[Ti] Título:[Awareness of dysphagia in Parkinson's disease].[Ti] Título:Consciencia de disfagia en la enfermedad de Parkinson..

[So] Source:Rev Neurol;53(11):664-72, 2011 Dec 1.[Is] ISSN:1576-6578

[Cp] País de publicação:Spain[La] Idioma:spa

[Ab] Resumo:INTRODUCTION AND AIM: In order to be able to assess the level of awareness of swallowing disorders in Parkinson's disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. PATIENTS AND METHODS: A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. RESULTS: The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well. The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. CONCLUSIONS: The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis. A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.

[PMID]:20803220[Au] Autor:Umemoto G; Tsuboi Y; Kitashima A; Furuya H; Kikuta T

[Ad] Endereço:Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. [email protected]

[Ti] Título:Impaired food transportation in Parkinson's disease related to lingual bradykinesia.[So] Source:Dysphagia;26(3):250-5, 2011 Sep.

[Is] ISSN:1432-0460[Cp] País de publicação:United States

[La] Idioma:eng[Ab] Resumo:This study aimed to analyze quantitatively videofluoroscopic (VF) images of patients with

Parkinson's disease (PD), to evaluate if the predicted factors of the oral phase of swallowing deteriorated with PD progression, and to demonstrate a relationship between the abnormal movements of the tongue and food transportation. Thirty PD patients were recruited and divided into mild/moderate (Hoehn & Yahr stages II and III) and advanced (stages IV and V) groups. They underwent measurement of tongue strength and VF using 5 ml of barium gelatin jelly as a test food. We measured the speed of bolus movement and the range of tongue and mandible movements during oropharyngeal transit time. The maximum tongue pressure of the mild/moderate group was significantly larger than that of advanced group (p = 0.047). The oropharyngeal transit time of the mild/moderate group was significantly shorter than that of the advanced group (p = 0.045). There was a significant negative correlation between the speed of tongue movement and the oropharyngeal transit time (p = 0.003, R = -0.527). Prolonged mealtimes and the ejection of insufficiently masticated food from the oral cavity into oropharynx were associated with PD progression. These results indicate the importance of the oral phase of swallowing in PD patients.

[PMID]:20623304[Au] Autor:Troche MS; Huebner I; Rosenbek JC; Okun MS; Sapienza CM

[Ad] Endereço:University of Florida, P.O. Box 117420, Gainesville, FL 32611, USA. [email protected][Ti] Título:Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease.

[So] Source:Dysphagia;26(3):218-24, 2011 Sep.[Is] ISSN:1432-0460

[Cp] País de publicação:United States[La] Idioma:eng

[Ab] Resumo: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 â‰¤ 2; Group 2 = P-A â‰¥ 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.

[PMID]:21819188[Au] Autor:Fagbami OY; Donato AA

[Ad] Endereço:Department of Internal Medicine, The Reading Hospital and Medical Center, West Reading, Pennsylvania 19612, USA. [email protected]

[Ti] Título:Stridor and dysphagia associated with subthalamic nucleus stimulation in Parkinson disease.[So] Source:J Neurosurg;115(5):1005-6, 2011 Nov.


[La] Idioma:eng[Ab] Resumo:Refractory symptoms in Parkinson disease show good response to deep brain stimulation (DBS).

This procedure improves United Parkinson's Disease Rating Scale scores and reduces dyskinesias, whereas speech and swallowing dysfunction typically do not improve and may even worsen. Rarely, DBS can cause idiosyncratic dystonias of muscle groups, including those of the neck and throat. The authors describe a patient experiencing stridor and dysphagia with confirmed pulmonary restriction and aspiration following subthalamic nucleus deep brain stimulator adjustment, with a resolution of symptoms and signs when the stimulator was switched off.

[PMID]:21542018[Au] Autor:Van Lieshout PH; Steele CM; Lang AE

[Ad] Endereço:Department of Speech-Language Pathology, University of Toronto, and Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. [email protected]

[Ti] Título:Tongue control for swallowing in Parkinson's disease: effects of age, rate, and stimulus consistency.

[So] Source:Mov Disord;26(9):1725-9, 2011 Aug 1.[Is] ISSN:1531-8257


[Ab] Resumo:BACKGROUND: Patients with Parkinson's disease often suffer from swallowing problems, especially at more advanced stages of the disease. Efficient swallows require well-coordinated tongue movements during bolus flow, but little is known about such movements in Parkinson's disease. METHODS: The current study presents data on tongue movements for patients with mild to moderate Parkinson's disease (n=10), age-matched adults (n=13), and younger healthy adults (n=15). RESULTS: Participants with Parkinson's disease showed smaller and more variable movements in the horizontal movement plane, indicating that tongue movements are affected in early stages of Parkinson's disease. CONCLUSIONS: The small and more variable movements in the horizontal plane of Patients with Parkinson's disease may pose challenges for swallowing liquids efficiently and safely.

[PMID]:21704797[Au] Autor:Kalf JG; Borm GF; de Swart BJ; Bloem BR; Zwarts MJ; Munneke M

[Ad] Endereço:Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. [email protected]

[Ti] Título:Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson's disease.

[So] Source:Arch Phys Med Rehabil;92(7):1152-8, 2011 Jul.[Is] ISSN:1532-821X


[Ab] Resumo:OBJECTIVE: To report on the development and psychometric evaluation of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP), a newly developed patient-rated assessment of speech, swallowing, and saliva control in patients with Parkinson's disease (PD). DESIGN: Reliability and validity study. SETTING: Tertiary-care Parkinson center for multidisciplinary assessment. PARTICIPANTS: Consecutive community-dwelling patients with PD (n=129) or atypical parkinsonism (AP; n=49; mean ± SD age, 64±9.8y; mean ± SD disease duration, 7y; median Hoehn and Yahr [HY] stage, 2.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To evaluate reproducibility, 60 patients completed the ROMP twice within a mean of 24±12 days. To study validity, another cohort of 118 patients who had completed the ROMP was assessed by both a neurologist (HY stage, Unified Parkinson's Disease Rating Scale III) and speech-language pathologist (severity of dysarthria, dysphagia, drooling) who were blinded to ROMP scores. RESULTS: Confirmatory factor analysis identified the 3 a priori-designed ROMP domains of speech, swallowing, and saliva control. Internal consistency was .95 for the total ROMP and .87 to .94 for the 3 domains or subscales. Intraclass correlation coefficients for reproducibility were .94 and .83 to .92 for the subscales. Construct validity was substantial to good with correlations ranging from .36 to .82. The ROMP differentiated significantly (P<.001) between patients indicated for speech therapy (based on independent assessment) and those who were not and between mild, moderate, and severe PD according to HY stage. CONCLUSIONS: The ROMP provides a reliable and valid instrument to evaluate patient-perceived problems with speech, swallowing, and saliva control in patients with PD or AP.

[PMID]:21111672

[Au] Autor:Aydogdu I; Tanriverdi Z; Ertekin C

[Ad] Endereço:Department of Neurology, Ege University Medical School Hospital, Bornova, Izmir 35100, Turkey. [email protected]

[Ti] Título:Dysfunction of bulbar central pattern generator in ALS patients with dysphagia during sequential deglutition.

[So] Source:Clin Neurophysiol;122(6):1219-28, 2011 Jun.

[Is] ISSN:1872-8952

[Cp] País de publicação:Netherlands

[La] Idioma:eng

[Ab] Resumo:OBJECTIVE: The aim of this study is to investigate a probable dysfunction of the central pattern generator (CPG) in dysphagic patients with ALS. METHODS: We investigated 58 patients with ALS, 23 patients with PD, and 33 normal subjects. The laryngeal movements and EMG of the submental muscles were recorded during sequential water swallowing (SWS) of 100ml of water. The coordination of SWS and respiration was also studied in some normal cases and ALS patients. RESULTS: Normal subjects could complete the SWS optimally within 10s using 7 swallows, while in dysphagic ALS patients, the total duration and the number of swallows were significantly increased. The novel finding was that the regularity and rhythmicity of the swallowing pattern during SWS was disorganized to irregular and arhythmic pattern in 43% of the ALS patients. The duration and speed of swallowing were the most sensitive parameters for the disturbed oropharyngeal motility during SWS. CONCLUSIONS: The corticobulbar control of swallowing is insufficient in ALS, and the swallowing CPG cannot work very well to produce segmental muscle activation and sequential swallowing. CPG dysfunction can result in irregular and arhythmical sequential swallowing in ALS patients with bulbar plus pseudobulbar types. SIGNIFICANCE: The arhythmical SWS pattern can be considered as a kind of dysfunction of CPG in human ALS cases with dysphagia.

[PMID]:21127909

[Au] Autor:Walker RW; Dunn JR; Gray WK

[Ti] Título:Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease.

[So] Source:Dysphagia;26(1):92-6, 2011 Mar.

[Is] ISSN:1432-0460

[Cp] País de publicação:United States

[La] Idioma:eng

[Ab] Resumo:Many people with Parkinson's disease (PD) experience dysphagia; however, the prevalence of dysphagia in people with PD is unknown. We studied a prevalent population of PD cases. All of those who consented to participate were assessed for anxiety, depression, cognitive function, and quality of life using standard rating scales. Anyone who answered "yes" to either one of the two questions: Do you have difficulty swallowing food/liquid or tablets? and Do you cough after eating/drinking? was considered to have dysphagia. Question 7 of the Unified Parkinson's Disease Rating Scale (UPDRS) was also used to identify dysphagia. Of 106 prevalent PD cases, 75 (38 males) patients consented to examination and assessment. The prevalence of dysphagia was 32.0% (n=24; 11 males). Using the response to UPDRS Question 7 as an indicator of the impact of swallowing problems on the patient, there were significant correlations with cognitive function, anxiety, depression, quality of life, and UPDRS-reported gait disturbance, postural instability and problems with falling. There was no correlation with disease duration, age, or gender. Almost one third of the participants reported dysphagia. There was a strong correlation between dysphagia and gross motor skills; patients reporting such problems should be screened for swallowing problems.

[PMID]:21322025[Au] Autor:Rodrigues B; Nóbrega AC; Sampaio M; Argolo N; Melo A

[Ad] Endereço:Division of Neurology and Epidemiology, Federal University of Bahia, Salvador, Bahia, Brazil.[Ti] Título:Silent saliva aspiration in Parkinson's disease.

[So] Source:Mov Disord;26(1):138-41, 2011 Jan.[Is] ISSN:1531-8257


[Ab] Resumo:BACKGROUND: Silent laryngeal penetration and silent aspiration (SLP/SA) are common manifestations in Parkinson's disease (PD) patients and are frequently associated with dysphagia. However, little is known about saliva aspiration in this population. OBJECTIVE: We investigated the frequency and characteristics of saliva SLP/SA in PD patients with daily drooling (Group A) and in individuals without PD or daily drooling (Group B). METHOD: Both groups were evaluated by fiberoptic endoscopic evaluation of swallowing (FEES) after dyeing the oral cavity with blue dye. The oropharynx was assessed for the presence of the stasis of saliva, and sensitivity was tested by direct tactile stimuli. RESULTS: PD patients (n = 28) and controls (n = 18) were evaluated. We observed silent aspiration of saliva in 10.7% and silent laryngeal penetration of saliva near the vocal folds in 28.6% of Group A; however, none of these events was observed in Group B. Sensitivity in the epiglottis and posterior wall of the hypopharynx was decreased in 89.2% of Group A and in 33.3% of Group B, whereas in the aryepiglottic folds and interarytenoid area, a decrease in sensitivity was observed in 92.8% and in 44.4% of Groups A and B, respectively. CONCLUSION: Silent aspiration and laryngeal penetration of saliva are common features in PD patients with daily drooling. The presence of hypoesthesia of the laryngeal structures and the lack of protective reflexes in such patients may play a major role in the mechanisms of SLP/SA.

[PMID]:21244508[Au] Autor:Bakke M; Larsen SL; Lautrup C; Karlsborg M

[Ad] Endereço:Department of Oral Medicine, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen N, Denmark. [email protected]

[Ti] Título:Orofacial function and oral health in patients with Parkinson's disease.[So] Source:Eur J Oral Sci;119(1):27-32, 2011 Feb.

[Is] ISSN:1600-0722[Cp] País de publicação:Denmark

[La] Idioma:eng[Ab] Resumo:No comprehensive study has previously been published on orofacial function in patients with well-

defined Parkinson's disease (PD). Therefore, the aim of this study was to perform an overall assessment of orofacial function and oral health in patients, and to compare the findings with matched control subjects. Fifteen outpatients (nine women and six men, 61-82 yr of age; Hoehn & Yahr Stages 2-4; and with motor impairment ranging from 17 to 61 according to the Unified Parkinson's Disease Rating Scale, Objective Motor Part III) were examined in their 'on' state together with 15 age- and gender-matched controls. Orofacial function and oral health were assessed using the Nordic Orofacial Test, masticatory ability, performance and efficiency, oral stereognosis, jaw opening, jaw muscle tenderness, the Oral Health Impact Profile-49, number of natural teeth, and oral hygiene. Orofacial dysfunction was more prevalent, mastication and jaw opening poorer, and impact of oral health on daily life more negative, in patients with PD than in controls. The results indicate that mastication and orofacial function are impaired in moderate to advanced PD, and with progression of the disease both orofacial and dental problems become more marked. It is suggested that greater awareness of the special needs in PD patients and frequent dental visits are desirable to prevent dental diseases and decay and to support masticatory function.

[PMID]:20705802[Au] Autor:Pitts T; Troche M; Mann G; Rosenbek J; Okun MS; Sapienza C

[Ad] Endereço:Department of Physiological Sciences, Movement Disorders Center, Malcom Randall Veterans Administration Medical Center, Gainesville, FL 32610-0144, USA. [email protected]

[Ti] Título:Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease.

[So] Source:Chest;138(6):1426-31, 2010 Dec.[Is] ISSN:1931-3543


[Ab] Resumo:BACKGROUND: Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia. METHODS: Fifty-eight consecutive patients (Hoehn and Yahr stage II-III; average age 72.3) were enrolled in the study. Measures of airflow during voluntary cough production and the degree of penetration/aspiration on a 3-oz oropharyngeal swallow task, derived from videofluorographic images, were examined. RESULTS: To detect at-risk people (those with penetration and/or aspiration on the 3-oz swallow task), four objective measures of voluntary cough (compression phase duration [CPD], expiratory phase rise time [EPRT], expiratory phase peak flow [EPPF], and cough volume acceleration [CVA)]) were collected. CPD, EPRT, EPPF, and CVA measurements produced significant area under the curve (AUC) analyses and likelihood ratios equal to 0.83:2.72, 0.71:2.68, 0.69:1.75, and 0.78:18.42, respectively. CPD, EPRT, EPPF, and CVA measurements demonstrated sensitivities of 95.83%, 70.83%, 87.50%, and 84.53%, and specificities of 64.71%, 73.53%, 50.01%, and 97.06%, respectively. For detection of aspiration, EPPF was significantly associated with an AUC = 0.88 and with an EPPF < 5.24, which had a sensitivity of 57.15% and a specificity of 100%. CONCLUSIONS: The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.

[PMID]:19707818[Au] Autor:Regan J; Walshe M; Tobin WO

[Ad] Endereço:SLT Department, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. [email protected]

[Ti] Título:Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic Parkinson's disease.



[Ab] Resumo:Oropharyngeal dysphagia frequently presents in people with idiopathic Parkinson's disease (IPD). Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the

latter of which is the leading cause of hospital admissions and death in IPD. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The effects of TTS on swallowing have not yet been investigated in IPD. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). TTS did not significantly alter median oral transit time on either fluid or paste consistency. TTS significantly reduced temporal measures of the pharyngeal phase of swallowing in the IPD population. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. It is still unclear whether these findings will translate into a clinically beneficial effect.

[PMID]:19680723[Au] Autor:Leow LP; Huckabee ML; Anderson T; Beckert L

[Ad] Endereço:Department of Speech Therapy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. [email protected]

[Ti] Título:The impact of dysphagia on quality of life in ageing and Parkinson's disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire.



[Ab] Resumo:This prospective, cross-sectional study evaluated the impact of dysphagia on quality of life in healthy ageing and in subjects with Parkinson's disease (PD) using the Swallowing Quality of Life (SWAL-QOL) questionnaire. Sixteen healthy young adults (8 males, mean age = 25.1 years) and 16 healthy elders (8 males, mean age = 72.8 years) were recruited. Thirty-two subjects with idiopathic PD (mean age = 68.5 years) were recruited from a movement disorders clinic. The severity of PD was staged using the Hoehn and Yahr scale. Results revealed that elders experienced symptoms of dysphagia more frequently than young adults but the overall SWAL-QOL scores were not significantly different. Subjects with PD who experienced dysphagia reported greatly reduced QOL, and significant differences were found in all but one subsection of the SWAL-QOL. Disease progression detrimentally impacts QOL, with subjects in later-stage PD experiencing further reduction in the desire to eat, difficulty with food selection, and prolonged eating duration. These features, which increase with disease severity, are likely to impact negatively upon nutritional status, which is already under threat from PD-related dysphagia.

[PMID]:20518603[Au] Autor:Michou E; Hamdy S

[Ad] Endereço:University of Manchester, Salford, UK.[Ti] Título:Dysphagia in Parkinson's disease: a therapeutic challenge?

[So] Source:Expert Rev Neurother;10(6):875-8, 2010 Jun.[Is] ISSN:1744-8360

[Cp] País de publicação:England[La] Idioma:eng

[Ab] Resumo:This article focuses on the current status and research directions on swallowing disorders (dysphagia) in patients with Parkinson's disease (PD). Although epidemiological data are scarce, increased incidence of dysphagia in patients with PD leads to increased risk of mortality, secondary to aspiration pneumonia. Although studies show that aspiration pneumonia is a common cause of death in this group of patients, clinical practice lacks an evidence base and there is an increased need for randomized clinical trials. Importantly, the underlying mechanisms accounting for the progression of dysphagia in PD are still unclear. Furthermore, evidence shows that dopaminergic medication does not affect swallowing performance. Future research in the field is urgently needed and may result in improved management of dysphagia in patients with PD.

[PMID]:20518382[Au] Autor:Olofsson K; Van Doorn J; Kulneff L; Linder J; Nordh E; Blomstedt P

[Ad] Endereço:Foniatriska sektionen, öron-, näs- och halskliniken, Centrum för rekonstruktiv kirurgi, Norrlands universitetssjukhus, Umeå. [email protected]

[Ti] Título:[Deep brain stimulation in dysphagia among patients with Parkinson disease. The self-evaluated swallowing function improved in a pilot study].

[Ti] Título:Djup hjärnstimulering vid dysfagi hos parkinsonpatienter. Den självskattade sväljningsfunktionen förbättrades i pilotstudie..

[So] Source:Lakartidningen;107(17):1150-2, 1154, 2010 Apr 28-May 4.[Is] ISSN:0023-7205

[Cp] País de publicação:Sweden[La] Idioma:swe

[PMID]:20205142[Au] Autor:González-Fernández J; Prieto-Albin R; Velasco-Palacios L; Jorge-Roldán S; Cubo-Delgado E

[Ad] Endereço:Hospital General Yagüe, Burgos, España.[Ti] Título:[Digestive disorders in Parkinson's disease: dysphagia and sialorrhea].[Ti] Título:Trastornos digestivos en la enfermedad de Parkinson: disfagia y sialorrea..

[So] Source:Rev Neurol;50 Suppl 2:S51-4, 2010 Feb 8.[Is] ISSN:1576-6578

[Cp] País de publicação:Spain[La] Idioma:spa

[Ab] Resumo:INTRODUCTION: The non-motor symptoms of Parkinson's disease are a frequent and often under-diagnosed disorder. Two of the most significant non-motor symptoms are perhaps dysphagia and sialorrhea (which are relatively common in advanced stages of the disease) owing to their important functional repercussions and to the associated comorbidity. DEVELOPMENT AND CONCLUSIONS: In recent years, different evaluation scales have been developed for clinical use and in screening the aforementioned symptoms. Of the different therapeutic options available, botulinum toxin represents the preferred treatment for sialorrhea. In contrast, speech therapy and an optimisation of the antiparkinsonian therapy are generally useful measures to treat dysphagia, percutaneous endoscopic gastrostomy being reserved for patients suffering from Parkinson who have severe dysphagia.

[PMID]:20175800[Au] Autor:Menezes C; Melo A

[Ad] Endereço:Federal University of Bahia, Bahia, Brazil.[Ti] Título:Does levodopa improve swallowing dysfunction in Parkinson's disease patients?

[So] Source:J Clin Pharm Ther;34(6):673-6, 2009 Dec.[Is] ISSN:1365-2710

[Cp] País de publicação:England[La] Idioma:eng

[Ab] Resumo:OBJECTIVE: To assess the influence of levodopa on swallowing dysfunction in Parkinson's disease patients. METHODS: A systematic review of the literature and a meta-analysis were performed. All studies referring to levodopa and swallowing dysfunction that provided direct data or data that could be transformed into mean +/- standard deviation were considered for analysis. The primary efficacy variables were Oral Transit Time (OTT), Pharyngeal Transit Time (PTT) for both thin fluids and solids, and aspiration. RESULTS: Seven studies describing swallowing functions in PD patients using levodopa were found, and five of these matched the inclusion criteria. No clinically meaningful improvement after levodopa intake was noted. Adverse effects were not reported by the authors. CONCLUSION: This meta-analysis shows that levodopa intake was not associated with an improvement of swallowing dysfunction in Parkinson's disease patients.

[PMID]:19028764[Au] Autor:Miller N; Allcock L; Hildreth AJ; Jones D; Noble E; Burn DJ

[Ad] Endereço:Institute of Health and Society, Speech and Language Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK. [email protected]

[Ti] Título:Swallowing problems in Parkinson disease: frequency and clinical correlates.[So] Source:J Neurol Neurosurg Psychiatry;80(9):1047-9, 2009 Sep.

[Is] ISSN:1468-330X[Cp] País de publicação:England

[La] Idioma:eng[Ab] Resumo:BACKGROUND: Changes to the efficiency and integrity of swallowing mechanisms are inevitable

in Parkinson disease (PD); however, it remains unclear how many people with PD are at risk of dysphagia. The aim of this study was to establish the frequency of impaired swallowing in people with PD and the relationship between swallowing performance and indicators of disease progression. METHODS: A community-based and hospital-based cohort of 137 individuals with PD were asked to drink 150 ml of water as quickly as possible while in an 'off drug' state. RESULTS: Thirty-one (23%) patients could not completely drink the full 150 ml. Swallowing rate (ml/sec) fell to more than 1 SD below published norms for 115 (84%) patients and to more than 2SD below for 44 (32%) individuals. There were moderate correlations between rate of swallowing and disease severity, depression and cognition, but not between swallowing speed and disease duration. There was poor correlation between subjective reports of dysphagia and performance on the water swallow test. CONCLUSIONS: Swallowing problems are frequent in PD. Self-report of 'no difficulty' is not a reliable indicator of swallowing ability. Studies employing more-objective assessment of aspiration risk to compare with water swallow test performance are advocated.

[PMID]:18953607[Au] Autor:Hind JA; Gensler G; Brandt DK; Gardner PJ; Blumenthal L; Gramigna GD; Kosek S; Lundy D;

McGarvey-Toler S; Rockafellow S; Sullivan PA; Villa M; Gill GD; Lindblad AS; Logemann JA; Robbins J

[Ad] Endereço:School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA. [email protected]

[Ti] Título:Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial.

[So] Source:Dysphagia;24(2):211-7, 2009 Jun.[Is] ISSN:1432-0460


[Ab] Resumo:Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin-down posture with thin liquids and head-neutral posture with thickened liquids (nectar-thick and honey-thick consistencies). The subject population included patients with Parkinson's disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all kappa > 0.86) and variable accuracy (range = 69-76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale.

[PMID]:19205066[Au] Autor:Evatt ML; Chaudhuri KR; Chou KL; Cubo E; Hinson V; Kompoliti K; Yang C; Poewe W; Rascol O;

Sampaio C; Stebbins GT; Goetz CG[Ad] Endereço:Section of Movement Disorders, Department of Neurology, Emory University School of Medicine,

Atlanta, Georgia 30329, USA. [email protected][Ti] Título:Dysautonomia rating scales in Parkinson's disease: sialorrhea, dysphagia, and constipation--

critique and recommendations by movement disorders task force on rating scales for Parkinson's disease.

[So] Source:Mov Disord;24(5):635-46, 2009 Apr 15.[Is] ISSN:1531-8257


[Ab] Resumo:Upper and lower gastrointestinal dysautonomia symptoms (GIDS)--sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms

and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met "Recommended" criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically.

[PMID]:18931877[Au] Autor:Baijens LW; Speyer R

[Ad] Endereço:Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands. [email protected]

[Ti] Título:Effects of therapy for dysphagia in Parkinson's disease: systematic review.[So] Source:Dysphagia;24(1):91-102, 2009 Mar.


[La] Idioma:eng[Ab] Resumo:This systematic review explores the effects of dysphagia treatment for Parkinson's disease. The

review includes rehabilitative, surgical, pharmacologic, and other treatments. Only oropharyngeal dysphagia is selected for this literature search, excluding dysphagia due to esophageal or gastric disorders. The effects of deep brain stimulation on dysphagia are not included. In general, the literature concerning dysphagia treatment in Parkinson's disease is rather limited. Most effect studies show diverse methodologic problems. Multiple case studies and trials are identified by searching biomedical literature databases PubMed and Embase, and by hand-searching reference lists. The conclusions of most studies cannot be compared with one another because of heterogeneous therapy methods and outcome measures. Further research based on randomized controlled trials to determine the effectiveness of different therapies for dysphagia in Parkinson's disease is required.

PMID]:18925327[Au] Autor:Felix VN; Corrêa SM; Soares RJ

[Ad] Endereço:Gastroenterology Department, Surgical Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. [email protected]

[Ti] Título:A therapeutic maneuver for oropharyngeal dysphagia in patients with Parkinson's disease.[So] Source:Clinics (Sao Paulo);63(5):661-6, 2008 Oct.

[Is] ISSN:1980-5322[Cp] País de publicação:Brazil

[La] Idioma:eng[Ab] Resumo:OBJECTIVE: This study investigates resources to provide better conditions for oropharyngeal

swallowing for improvement in the quality of life of Parkinson's disease patients. METHOD: Three men and one woman with an average age of 70.25 years had been afflicted with Parkinson's disease for an average of 9.25 years. The patients were submitted to a rehabilitation program for oropharyngeal dysphagia after a clinical evaluation of swallowing. The rehabilitation program consisted of daily sessions for two consecutive weeks during which a biofeedback resource

adapted especially for this study was used. The patients were then reevaluated for swallowing ability at follow-up. RESULTS: The patients presenting difficulties with swallowing water displayed no such problems after rehabilitation. Only one patient exhibited slow oral transit of food and other discrete oropharyngeal food remnants when swallowing a biscuit. The sample variance was used to analyze the pressure measurements, demonstrating a numerical similarity of the results obtained with the swallowing of saliva or of biscuits (VAR = 4.41). A statistical difference was observed between the swallowing of saliva and biscuits, showing a significant pressure increase at the end of the rehabilitation program (p < 0.001). CONCLUSION: The effortful swallow maneuver reinforced by using biofeedback appears to be a therapeutic resource in the rehabilitation of oropharyngeal dysphagia in Parkinson's disease patients.

[PMID]:18483823[Au] Autor:Pitts T; Bolser D; Rosenbek J; Troche M; Sapienza C

[Ad] Endereço:Department of Communication Sciences and Disorders, University of Florida, Gainesville, Florida 32610, USA. [email protected]

[Ti] Título:Voluntary cough production and swallow dysfunction in Parkinson's disease.[So] Source:Dysphagia;23(3):297-301, 2008 Sep.

[Is] ISSN:0179-051X[Cp] País de publicação:United States

[La] Idioma:eng[Ab] Resumo:Cough is important for airway clearance, particularly if penetration/aspiration of foreign material

occurs during swallow. Measures of voluntary cough production from ten male participants with stage II-III Parkinson's disease (PD) who showed no videofluorographic evidence of penetration/aspiration (Group 1) were examined and compared with those of ten male participants with stage II-III PD who showed videofluorographic evidence of penetration/aspiration (Group 2). The degree of penetration/aspiration was expertly judged from the videofluorographic examinations of the participants' sequential swallow of a thin, 30-cc bolus. Measured cough parameters included inspiratory phase duration, inspiratory peak flow, compression phase duration, expiratory peak flow, expiratory rise time, and cough volume acceleration. Results indicated significant group differences for the majority of cough measures, except for inspiratory phase duration and inspiratory peak flow. A modest relationship existed between voluntary cough parameters and penetration/aspiration scores. Decreased ability to adequately clear material from the airway with voluntary cough may exacerbate symptoms resulting from penetration/aspiration, particularly for those with neurodegenerative disease. Measurement of voluntary cough may be useful for the evaluation of airway clearance ability.

[PMID]:18027027[Au] Autor:Gross RD; Atwood CW; Ross SB; Eichhorn KA; Olszewski JW; Doyle PJ

[Ad] Endereço:Division of Otolaryngology, University of Pittsburgh, Eye & Ear Institute, Suite 500, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA. [email protected]

[Ti] Título:The coordination of breathing and swallowing in Parkinson's disease.[So] Source:Dysphagia;23(2):136-45, 2008 Jun.


[La] Idioma:eng[Ab] Resumo:Multiple investigations have determined that healthy adults swallow most often during exhalation

and that exhalation regularly follows the swallow, even when a swallow occurs during inhalation. We hypothesized that persons with idiopathic Parkinson's disease would demonstrate impaired breathing and swallowing coordination during spontaneous eating. Twenty-five healthy volunteers and 25 Parkinson's disease patients spontaneously swallowed calibrated pudding and cookie portions while simultaneous nasal airflow and respiratory inductance plethysmography were used to track spontaneous breathing. Surface EMG was used to record the timing of each swallow within the respiratory cycle. When compared to the healthy control group, those with Parkinson's disease swallowed significantly more often during inhalation and at low tidal volumes. The Parkinson's participants also exhibited significantly more postswallow inhalation for both consistencies. Only the healthy subjects exhibited significantly longer deglutitive apnea when swallows that occurred during inhalation were compared with those that occurred during exhalation. The high incidence of oropharyngeal dysphagia and risk of aspiration pneumonia found in Parkinson's disease patients may be partially attributable to impaired coordination of breathing and swallowing.

[PMID]:18475072[Au] Autor:Sapir S; Ramig L; Fox C

[Ad] Endereço:Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. [email protected]

[Ti] Título:Speech and swallowing disorders in Parkinson disease.[So] Source:Curr Opin Otolaryngol Head Neck Surg;16(3):205-10, 2008 Jun.


[La] Idioma:eng[Ab] Resumo:PURPOSE OF REVIEW: To review recent research and clinical studies pertaining to the nature,

diagnosis, and treatment of speech and swallowing disorders in Parkinson disease. RECENT FINDINGS: Although some studies indicate improvement in voice and speech with dopamine therapy and deep brain stimulation of the subthalamic nucleus, others show minimal or adverse effects. Repetitive transcranial magnetic stimulation of the mouth motor cortex and injection of collagen in the vocal folds have preliminary data supporting improvement in phonation in people with Parkinson disease. Treatments focusing on vocal loudness, specifically LSVT LOUD (Lee Silverman Voice Treatment), have been effective for the treatment of speech disorders in Parkinson disease. Changes in brain activity due to LSVT LOUD provide preliminary evidence for neural plasticity. Computer-based technology makes the Lee Silverman Voice Treatment available to a large number of users. A rat model for studying neuropharmacologic effects on vocalization in Parkinson disease has been developed. New diagnostic methods of speech and swallowing are also available as the result of recent studies. SUMMARY: Speech rehabilitation with the LSVT LOUD is highly efficacious and scientifically tested. There is a need for more studies to improve understanding, diagnosis, prevention, and treatment of speech and swallowing disorders in Parkinson disease.

26/32[PMID]:18163451

[Au] Autor:Ciucci MR; Barkmeier-Kraemer JM; Sherman SJ[Ad] Endereço:Department of Speech, Language, Hearing Sciences, University of Arizona,

Tucson, Arizona, USA. [email protected][Ti] Título:Subthalamic nucleus deep brain stimulation improves deglutition in Parkinson's

disease.[So] Source:Mov Disord;23(5):676-83, 2008 Apr 15.

[Is] ISSN:1531-8257[Cp] País de publicação:United States[La] Idioma:eng

[Ab] Resumo:Relatively little is known about the role of the basal ganglia in human deglutition. Deep brain stimulation (DBS) affords us a model for examining deglutition in humans with known impairment of the basal ganglia. The purpose of this study was to examine the effects of subthalamic nuclei (STN) DBS on the oral and pharyngeal stages of deglutition in individuals with Parkinson's Disease (PD). It was hypothesized that DBS would be associated with improved deglutition. Within participant, comparisons were made between DBS in the ON and OFF conditions using the dependent variables: pharyngeal transit time, maximal hyoid bone excursion, oral total composite score, and pharyngeal total composite score. Significant improvement occurred for the pharyngeal composite score and pharyngeal transit time in the DBS ON condition compared with DBS OFF. Stimulation of the STN may excite thalamocortical or brainstem targets to sufficiently overcome the bradykinesia/hypokinesia associated with PD and return some pharyngeal stage motor patterns to performance levels approximating those of "normal" deglutition. However, the degree of hyoid bone excursion and oral stage measures did not improve, suggesting that these motor acts may be under the control of different sensorimotor pathways within the basal ganglia.

[PMID]:17602261[Au] Autor:Lim A; Leow L; Huckabee ML; Frampton C; Anderson T

[Ad] Endereço:Department of Medicine, Christchurch School of Medicine, Christchurch, New Zealand.

[Ti] Título:A pilot study of respiration and swallowing integration in Parkinson's disease: "on" and "off" levodopa.

[So] Source:Dysphagia;23(1):76-81, 2008 Mar.[Is] ISSN:0179-051X


[Ab] Resumo:Parkinson's disease is associated with both swallowing and respiratory dysfunction, increasing the risk of aspiration and pneumonia. Previous studies have shown improvements in measurements of swallowing and respiration with levodopa; however, the studies are small and some studies show conflicting reports. The aim of this study was to further investigate the effect of levodopa on respiration. Ten patients with Parkinson's disease were tested "On" and "Off" levodopa. Assessments included Unified Parkinson's Disease Rating Scale (UPDRS), coordination of swallowing and respiration, timed-test of swallowing, lung function testing, and, qualitative assessment of swallowing. There was a nonsignificant trend to lower volume per swallow when "On" levodopa, significant reduction in lung function when "On" levodopa, but no difference in coordination of swallowing and respiration or qualitative assessment of swallowing. There was a significant increase in motor examination score of the UPDRS when "Off" levodopa compared to "On." There may be a reduction in efficiency of swallowing with levodopa medication without any apparent increase in risk of aspiration. These pilot data suggest that further evaluation with larger numbers of participants is justified.

[PMID]:17551793[Au] Autor:Troche MS; Sapienza CM; Rosenbek JC

[Ad] Endereço:Department of Communication Sciences and Disorders, University of Florida, Gainesville, PO Box 117420, Florida 32611, USA. [email protected]

[Ti] Título:Effects of bolus consistency on timing and safety of swallow in patients with Parkinson's disease.[So] Source:Dysphagia;23(1):26-32, 2008 Mar.


[La] Idioma:eng[Ab] Resumo:Aspiration pneumonia is the leading cause of death in Parkinson's disease (PD) patients. In

clinical practice, the videofluoroscopic examination (VFE) is the most common method for evaluation of swallowing disorders. One of the variables manipulated during the VFE is consistency of the bolus. The results of this examination greatly influence the recommendations made by speech-language pathologists regarding swallow therapy and/or intervention. The primary aim of this study was to investigate the effects of bolus consistency on penetration-aspiration (P-A) score and timing of swallow of persons with PD. The videoradiographic images of ten participants with PD swallowing six thin and six pudding-thick boluses were analyzed. Swallow timing and P-A were measured. (i.e., oral transit time, pharyngeal transit time, number of tongue pumps, and P-A score). The results demonstrated various significant differences and relationships among the dependent variables. Implications for further research and clinical practice are discussed.

[PMID]:18230864[Au] Autor:Logemann JA; Gensler G; Robbins J; Lindblad AS; Brandt D; Hind JA; Kosek S; Dikeman K;

Kazandjian M; Gramigna GD; Lundy D; McGarvey-Toler S; Miller Gardner PJ[Ad] Endereço:Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus

Drive, #3-358, Evanston, IL 60208, USA. [email protected][Ti] Título:A randomized study of three interventions for aspiration of thin liquids in patients with dementia or

Parkinson's disease.[So] Source:J Speech Lang Hear Res;51(1):173-83, 2008 Feb.


[La] Idioma:eng[Ab] Resumo:PURPOSE: This study was designed to identify which of 3 treatments for aspiration on thin

liquids-chin-down posture, nectar-thickened liquids, or honey-thickened liquids-results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease. METHOD: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study. RESULTS: Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids. CONCLUSION: To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson's disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient's management plan.

The longer-term impact of short-term prevention of aspiration requires further study.

[PMID]:17588237[Au] Autor:Manor Y; Giladi N; Cohen A; Fliss DM; Cohen JT

[Ad] Endereço:Department of Neurology, Movement Disorders Unit, Parkinson Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. [email protected]

[Ti] Título:Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease.

[So] Source:Mov Disord;22(13):1917-21, 2007 Oct 15.[Is] ISSN:0885-3185


[Ab] Resumo:Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 +/- 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients.

[Mh] Termos MeSH primário:Transtornos de Deglutição/diagnóstico

[PMID]:17266075[Au] Autor:Lam K; Lam FK; Lau KK; Chan YK; Kan EY; Woo J; Wong FK; Ko A

[Ad] Endereço:Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong. [email protected]

[Ti] Título:Simple clinical tests may predict severe oropharyngeal dysphagia in Parkinson's disease.[So] Source:Mov Disord;22(5):640-4, 2007 Apr 15.


[La] Idioma:eng[Ab] Resumo:OBJECTIVE: To determine if simple screening tests can predict severe oropharyngeal dysphagia

in subjects with Parkinson's disease. METHODOLOGY: Forty-five subjects (26 females) of average age 75 (range: 65-94) who were classified as Modified Hoehn and Yahr stages 2 to 5 were enrolled. The presence of oropharyngeal dysphagia was assessed by a symptom questionnaire, 50 ml water swallowing test and videofluroscopic swallowing study. RESULTS: Six of the subjects had severe oropharyngeal dysphagia in videofluroscopic swallowing study. Subsequent multivariate analysis showed that 3 factors could independently predict severe oropharyngeal dysphagia. These included higher Modified Hoehn and Yahr stage (P = 0.042), low Body mass index (P = 0.014), and increased difficulty in keeping food or drink in the mouth (P = 0.047). The regression model had a positive predictive power of 96% (sensitivity: 83.3%, specificity: 97.4%). CONCLUSION: A combination of 3 simple clinical parameters may be useful for screening for severe oropharyngeal dysphagia as shown radiologically in subjects with Parkinson's disease.

[Au] Autor:Alfonsi E; Versino M; Merlo IM; Pacchetti C; Martignoni E; Bertino G; Moglia A; Tassorelli C; Nappi G

[Ad] Endereço:Spinal and Cranial Reflexes Laboratory, Department of Neurological Sciences, Università di Pavia, Pavia, Italy. [email protected]

[Ti] Título:Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes.[So] Source:Neurology;68(8):583-9, 2007 Feb 20.


[La] Idioma:eng

[Ab] Resumo:OBJECTIVES: To assess the presence, severity, and differences in dysphagia in Parkinson disease (PD), Parkinson variant of multiple system atrophy (MSA-P), and progressive supranuclear palsy (PSP), and to study the pathophysiology of swallowing abnormalities in these disorders. METHODS: We applied an electrophysiologic method to evaluate oral-pharyngeal swallowing. We analyzed the following measures: duration of EMG activity of suprahyoid/submental muscles (SHEMG-D); duration of laryngeal-pharyngeal mechanogram (LPM-D); duration of the inhibition of the cricopharyngeal muscle activity (CPEMG-ID); interval between onset of EMG activity of suprahyoid/submental muscles and onset of laryngeal-pharyngeal mechanogram (I-SHEMG-LPM); and swallowing reaction time (SRT). RESULTS: The prolongation of I-SHEMG-LPM was more typical in PD, whereas the most distinctive finding both in patients with PSP and MSA-P was the reduction or the absence of CPEMG-ID early in the course of the disease. CONCLUSIONS: Involvement of the peduncolo-pontine tegmental nucleus, with subsequent dysfunction of basal ganglia and of the medullary central pattern generator of swallowing, may account for the abnormalities detected in these parkinsonian syndromes. The method described was able to identify swallowing abnormalities also in patients without symptoms of dysphagia and to evaluate dysphagia severity in all patients.

Date post:	24-Oct-2014
Category:	Documents
Upload:	antero-eduardo
View:	116 times
Download:	5 times

bireme- resumos-parkinson

Documents