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Videofluoroscopic Predictors of Penetration–Aspiration in Parkinson’s Disease Patients

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Abstract

Parkinson’s disease (PD) patients show a high prevalence of swallowing disorders and tracheal aspiration of food. The videofluoroscopic study of swallowing (VFSS) allows clinicians to visualize the visuoperceptual and temporal parameters associated with swallowing disorders in an attempt to predict aspiration risk. However, this subject remains understudied in PD populations. Our aim was to identify the predictors of penetration–aspiration in PD patients using the VFSS. Consecutive patients were evaluated using VFSS with different consistencies and volumes of food. A speech-language pathologist measured the type of intra-oral bolus organization, loss of bolus control, bolus location at the initiation of the pharyngeal swallow, the presence of multiple swallows, piecemeal deglutition, bolus residue in the pharyngeal recesses and temporal measures. Scores ≥3 on the penetration–aspiration scale (PAS) indicated the occurrence of penetration–aspiration. Using logistic marginal regression, we found that residue in the vallecula, residue in the upper esophageal sphincter and piecemeal deglutition were associated with penetration–aspiration (odds ratio (OR) = 4.09, 2.87 and 3.83; P = 0.0040, 0.0071 and 0.0009, respectively). Penetration/aspiration occurred only with fluids (both of thin and thick consistency), and no significant differences were observed between fluid types or food volumes. The mechanisms underlying dysphagia and penetration/aspiration in PD patients and indications for further studies are discussed.

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References

  1. Kalf JG, de Swart BJM, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–5. doi:10.1016/j.parkreldis.2011.11.006.

    Article  CAS  PubMed  Google Scholar 

  2. Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res JSLHR. 2008;51(1):173–83. doi:10.1044/1092-4388(2008/013).

    Article  PubMed  Google Scholar 

  3. Wang X, You G, Chen H, Cai X. Clinical course and cause of death in elderly patients with idiopathic Parkinson’s disease. Chin Med J (Engl). 2002;115(9):1409–11.

    PubMed  Google Scholar 

  4. Nobrega A, Rodrigues B, Melo A. Is silent aspiration a risk factor for respiratory infection in Parkinson’s disease patients? Parkinsonism Relat Disord. 2008;14(8):646–8. doi:10.1016/j.parkreldis.2007.12.007.

    Article  PubMed  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(2):383–92. doi:10.1053/gast.1996.v110.pm8566584.

    Article  CAS  PubMed  Google Scholar 

  6. Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12(1):11–20. doi:10.1007/PL00009512.

    Article  CAS  PubMed  Google Scholar 

  7. Nilsson H, Ekberg O, Olsson R, Hindfelt B. Quantitative assessment of oral and pharyngeal function in Parkinson’s disease. Dysphagia. 1996;11(2):144–50. doi:10.1007/BF00417900.

    Article  CAS  PubMed  Google Scholar 

  8. 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(3):218–24. doi:10.1007/s00455-010-9289-x.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Rodrigues B, Nóbrega AC, Sampaio M, Argolo N, Melo A. Silent saliva aspiration in Parkinson’s disease. Mov Disord. 2011;26(1):138–41. doi:10.1002/mds.23301.

    Article  PubMed  Google Scholar 

  10. Nagaya M, Kachi T, Yamada T, Igata A. Videofluorographic study of swallowing in Parkinson’s disease. Dysphagia. 1998;13(2):95–100. doi:10.1007/PL00009562.

    Article  CAS  PubMed  Google Scholar 

  11. Molfenter SM, Steele CM. Temporal variability in the deglutition literature. Dysphagia. 2012;27(2):162–77. doi:10.1007/s00455-012-9397-x.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9(2):90–5. doi:10.1007/BF00714593.

    Article  CAS  PubMed  Google Scholar 

  13. Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol. 2002;178(2):393–8. doi:10.2214/ajr.178.2.1780393.

    Article  PubMed  Google Scholar 

  14. Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28(4):494–500. doi:10.1007/s00455-013-9459-8.

    Article  PubMed  Google Scholar 

  15. Steele CM, Cichero JAY. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29(3):295–304. doi:10.1007/s00455-014-9516-y.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1988;51(6):745–52. doi:10.1136/jnnp.51.6.745.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Yamada EK, de Siqueira KO, Xerez D, Koch HA, Costa MMB. The influence of oral and pharyngeal phases on the swallowing dynamic. Arq Gastroenterol. 2004;41(1):18–23.

    Article  PubMed  Google Scholar 

  18. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration–aspiration scale. Dysphagia. 1996;11(2):93–8. doi:10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  19. Ertekin C, Aydogdu I, Yüceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosurg Psychiatry. 1996;61:491–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration–aspiration scale. Dysphagia. 1999;14:228–32.

    Article  CAS  PubMed  Google Scholar 

  21. Van Lieshout PHHM, Steele CM, Lang AE. Tongue control for swallowing in Parkinson’s disease: effects of age, rate, and stimulus consistency. Mov Disord. 2011;26(9):1725–9. doi:10.1002/mds.23690.

    Article  PubMed  Google Scholar 

  22. Leopold NA, Kagel MC. Prepharyngeal dysphagia in Parkinson’s disease. Dysphagia. 1996;11(1):14–22. doi:10.1007/BF00385794.

    Article  CAS  PubMed  Google Scholar 

  23. Ertekin C, Tarlaci S, Aydogdu I, Kiylioglu N, Yuceyar N, Turman AB, et al. Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson’s disease. Mov Disord. 2002;17(5):942–9. doi:10.1002/mds.10240.

    Article  PubMed  Google Scholar 

  24. Perlman AL, Grayhack JP, Booth BM. The relationship of vallecular residue to oral involvement, reduced hyoid elevation, and epiglottic function. J Speech Hear Res. 1992;35(4):734–41. doi:10.1044/jshr.3504.734.

    Article  CAS  PubMed  Google Scholar 

  25. Ebihara S. Impaired efficacy of cough in patients with parkinson disease. Chest. 2003;124(3):1009–15. doi:10.1378/chest.124.3.1009.

    Article  PubMed  Google Scholar 

  26. Pitts T, Bolser D, Rosenbek J, Troche M, Sapienza C. Voluntary cough production and swallow dysfunction in Parkinson’s disease. Dysphagia. 2008;23(3):297–301. doi:10.1007/s00455-007-9144-x.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Adnerhill I, Ekberg O, Groher ME. Determining normal bolus size for thin liquids. Dysphagia. 1989;4(1):1–3. doi:10.1007/BF02407395.

    Article  CAS  PubMed  Google Scholar 

  28. Butler SG, Stuart A, Case LD, Rees C, Vitolins M, Kritchevsky SB. Effects of liquid type, delivery method, and bolus volume on penetration–aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2011;120(5):288–95.

    Article  PubMed  Google Scholar 

  29. Michou E, Hamdy S, Harris M, Vania A, Dick J, Kellett M, et al. Characterization of corticobulbar pharyngeal neurophysiology in dysphagic patients with Parkinson’s disease. Clin Gastroenterol Hepatol. 2014;12(12):2037–45. doi:10.1016/j.cgh.2014.03.020.

    Article  PubMed  Google Scholar 

  30. Stephen JR, Taves DH, Smith RC, Martin RE. Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia. 2005;20(4):266–72. doi:10.1007/s00455-005-0023-z.

    Article  PubMed  Google Scholar 

  31. Lin C-W, Chang Y-C, Chen W-S, Chang K, Chang H-Y, Wang T-G. Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia. Arch Phys Med Rehabil. 2012;93(11):2080–4. doi:10.1016/j.apmr.2012.07.010.

    Article  PubMed  Google Scholar 

  32. Reimers-Neils L, Logemann J, Larson C. Viscosity effects on EMG activity in normal swallow. Dysphagia. 1994;9(2):101–6. doi:10.1007/BF00714596.

    Article  CAS  PubMed  Google Scholar 

  33. Butler SG, Stuart A, Leng LX, Rees C, Williamson J, Kritchevsky SB. Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope. 2010;120(11):2147–52. doi:10.1002/lary.21116.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neurology and Epidemiology, Federal University of Bahia, Rua Padre Feijó, 29 (4° floor) – Canela, Salvador, Bahia, 40.110-170, Brazil

    Natalie Argolo, Marília Sampaio, Patrícia Pinho, Ailton Melo & Ana Caline Nóbrega

  2. Department of Speech-Language Pathology, Health Sciences Institute, Federal University of Bahia, Salvador, Bahia, Brazil

    Marília Sampaio & Ana Caline Nóbrega

Authors
  1. Natalie Argolo
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  2. Marília Sampaio
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  3. Patrícia Pinho
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  4. Ailton Melo
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  5. Ana Caline Nóbrega
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Correspondence to Natalie Argolo.

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Argolo, N., Sampaio, M., Pinho, P. et al. Videofluoroscopic Predictors of Penetration–Aspiration in Parkinson’s Disease Patients. Dysphagia 30, 751–758 (2015). https://doi.org/10.1007/s00455-015-9653-y

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  • DOI: https://doi.org/10.1007/s00455-015-9653-y

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