Relationship between sialorrhea and dysphagia in Chinese patients with Parkinson′s disease / 中华神经科杂志

Objective To explore the prevalence of sialorrhea and its clinical correlation with dysphagia in Chinese patients with Parkinson′s disease ( PD ).Methods One hundred and sixteen consecutive patients with a clinical diagnosis of PD were selected.Demographic data included sex , age, years of education, age at onset of PD, clinical genotype, disease duration, treatment, Hoehn and Yahr (H&Y) stage.Sialorrhea was assessed using the Unified Parkinson′s Disease Rating Scale (UPDRS) Ⅱitem number 6.All patients were studied with videofluoroscopic study of swallowing ( VFSS).Results The prevalence rate of sialorrhea in PD was 59.5% (69/116, 95% CI 50.6%-68.4%).Males were more likely to develop sialorrhea than females (47/70 vs 22/46,χ2 =4.298, P=0.038).PD patients′sialorrhea correlated with oral dysphagia:with food leaking from the mouth ( liquid r=0.229, P=0.014; juice r=0.197, P=0.034;pudding viscosities r=0.231, P=0.013;solid food r=0.255, P=0.006), with more than 1 ml of oral food residues (liquid r=0.319, P<0.01;solid food r=0.185, P=0.047), with delay in food transfer to the root of the tongue (liquid r=0.279, P=0.002; juice r=0.209, P=0.024), and delayed swallow transfer ( pudding viscosities r=0.257, P=0.005).Sialorrhea score was not related to H&Y stage, clinical course and levodopa equivalent doses (LED).The prevalence rate of dysphagia in PD was 87.1%(95% CI 81.0% -93.2%).Liquid was more likely to cause pharyngeal dysphagia ( P=0.03).With the increase in H&Y stage , so did the oral and pharyngeal stages of dysphagia.Late and mid-course was more likely to develop oral and pharyngeal dysphagia than those with early clinical course .Conclusions Sialorrhea and dysphagia are common non-motor symptoms in PD patients.Sialorrhea is more prevalent in males and correlates with oral phase of dysphagia.Liquid is more likely to cause pharyngeal dysphagia.With increase in H&Y stage , so did oral and pharyngeal dysphagia.Even though late clinical course is more likely to develop oral and pharyngeal dysphagia than early clinical course , the comparison between late and intermediate clinical courses does not reach statistical significance .

Oropharyngeal Swallowing Disorders under Videofluoroscopic Swallowing Study / 中国康复理论与实践

@#Objective To explore oropharyngeal swallowing disorders with videofluoroscopic swallowing study (VFSS). Methods 16 patients with dysphagia accepted VFSS with 10 ml of thin barium meal (50% w/v), thick barium meal (270% w/v), biscuit coated with thick barium meal in single swallow. Their swallowing function was observed on the lateral and anterior/posterior planes, including: symmetry of pyriform sinuses, oral transit time, presence of pharyngeal delay, pharyngeal transit time, oral and pharyngeal residue, and presence of aspiration.Results 5 patients demonstrated oral swallowing disorder. 3 patients demonstrated pharyngeal swallowing disorders, that was pharyngeal delay which caused in aspiration after swallowing. 8 patients demonstrated oropharyngeal swallowing disorders, and 3 of them presented aspiration,2 patients were silent aspirators, 1 was aspiration before and 1 after swallowing. The aspiration time could not be judged from the videofluoroscopy in the other one. For 4 patients with aspiration, 3 were severe, with more than 25% of the bolus aspirated, and 1 aspirated less than 5%. Conclusion VFSS can be helpful to plan individual rehabilitation.

Effect of Treatment after Stimulation of Suprahyoid Muscle in Geriatric Patients with Pharyngeal Dysphagia

Electrical stimulation is recently rising as a treatment protocol of dysphagia. The mechanism is known to induce the pharyngeal reflex to stimulate the sensory nerve around the neck. However, elevation of the hyoid and pharynx to stimulate the suprahyoid muscles (esp. mylohyoid muscle) is thought to be more beneficial. We presented 3 cases to improve the dysphagia after stimulation of the suprahyoid muscles to elevate the hyoid and pharynx similar to the normal swallowing during 4 weeks.

The Comparison of Videofluoroscopic Findings between the Patients with Lateral Medullary Infarct and Middle Cerebral Artery Territorial Infarct

OBJECTIVE: To compare the videofluoroscopic findings between the patients with lateral medullary infarct and middle cerebral artery infarct and to investigate specific findings relevant to lateral medullary infarct. METHOD: Among patients with stroke taking videofluoroscopic study for swallowing problems, thirteen patients had a lesion in lateral medulla in imaging study and twenty-six patients in middle cerebral arterial territory. The findings of videofluoroscopic study on two groups were analyzed and compared. RESULTS: In oral phase, the ability of mastication and bolus formation were better in lateral medullary group. In pharyngeal phase, lateral medullary group revealed significantly impaired triggering of pharyngeal reflex, impaired laryngeal elevation, larger amount of residual materials, repeated swallow, delayed pharyngeal transit time, weaker pharyngeal muscle contraction, and poorer upper esophageal sphincter relaxation. Inadequate relaxation of upper esophageal sphincter was most significant factor in indicating the possibility of lateral medullary infarct (positive predictability 90.0%). Inadequate triggering of pharyngeal swallow indicated least possibility of lateral medullary infarct (negative predictability 92.3%). CONCLUSION: Lateral medullary group has the characteristics of more impaired pharyngeal function and better oral function during swallowing than middle cerebral artery group in videofluoroscopic study. Inadequate upper esophageal relaxation and triggering of pharyngeal swallow are the most predictive for lateral medullary infarct.

The Functional Dysphagia Scale Using Videofluoroscopic Swallowing Study in Stroke Patients

OBJECTIVE: Early detection and identification of the aspiration in stroke patients are essential for the prevention of respiratory complications. The purpose of this study is to develop a simple, easy-to-use, quantifiable functional dysphagia scale for stroke patients using videofluoroscopic swallowing study findings. METHOD: Oral and pharyngeal videofluoroscopic swallowing study findings of a consecutive series of 103 stroke patients were analysed. Items of the functional dysphagia scale were determined by the polychotomous linear logistic regression analysis between videofluoroscopic findings and aspiration. The sensitivity and specificity of the scale, and correlation between the total score of the scale and aspiration grade were measured. RESULTS: The final scale included the following eleven items; The score of lip closure, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, pharyngeal transit time. The sensitivity and specificity of the scale for detecting supraglottic penetration and subglottic aspiration were 81.0%, 70.7% and 78.1%, 77.9% respectively. The total score of the scale was significantly correlated with the severity of aspiration. (Spermann correlation coefficient r=0.58943, p=0.00001). CONCLUSION: We developed functional dysphagia scale using videofluoroscopic swallowing study in stroke patients, which could be used as a simple, easy-to-use, quantifiable method to evaluate the severity of the dysphagia.