Abstract
BackgroundThe underlying pathophysiology of dysphagia is multifactorial and evidence clarifying the precise mechanisms are scarce. Dysfunction in dopamine-related and non-dopamine-related pathways, changes in cortical networks related with swallowing and peripheral mechanisms have been implicated in the pathogenesis of dysphagia. We aimed at investigating whether dysphagia is associated with presynaptic dopaminergic deficits, faster motor symptom progression and cognitive decline in a population of early drug-naïve patients with Parkinson’s disease.MethodsBy exploring the database of Parkinson’s Progression Markers Initiative we identified forty-nine early drug-naïve Parkinson’s disease patients with dysphagia. Dysphagia was identified with SCOPA-AUT question 1 (answer regularly) and was assessed with MDS-UPDRS Part-II, Item 2.3 (Chewing and Swallowing). We compared Parkinson’s disease patients with dysphagia to Parkinson’s disease patients without dysphagia, and investigated differences in striatal [123I]FP-CIT single photon emission computed tomography levels. Using Cox proportional hazards analyses, we also evaluated whether dysphagia can predict motor deterioration and cognitive dysfunction.ResultsParkinson’s disease patients with dysphagia, harbored a greater deterioration regarding motor and non-motor symptoms and decreased [123I]FP-CIT binding when compared with patients without dysphagia. Higher burden of dysphagia (MDS-UPDRS-II, item 2.3) was correlated with lower [123I]FP-CIT uptakes within the striatum (rs = −0.157; P = 0.002) and the caudate (rs = −0.156; P = 0.002). The presence of dysphagia was not a predictor of motor progression (Hazard ratio [HR]: 1.143, 95% confidence interval [CI]: 0.848–1.541; P = 0.379) or cognitive decline (HR: 1.294, 95% CI: 0.616–2.719; P = 0.496).ConclusionsDysphagia is associated with decreased presynaptic dopaminergic integrity within caudate and greater motor and non-motor symptoms burden in early drug-naïve PD.
Highlights
Swallowing and chewing difficulties, defined as dysphagia on ICD-10, are characterised by the inability to safely swallow fluids and /or solid food and are accounting for severe complications, commonly aspiration pneumonia that substantially increases mortality rates
Dysphagia is associated with decreased presynaptic dopaminergic integrity within caudate and greater motor and non-motor symptoms burden in early drug-naïve Parkinson’s disease (PD)
In this study we investigated the association of dysphagia and dopaminergic deficits using [123I]FP-CIT single photon emission computed tomography (SPECT)
Summary
Swallowing and chewing difficulties, defined as dysphagia on ICD-10, are characterised by the inability to safely swallow fluids and /or solid food and are accounting for severe complications, commonly aspiration pneumonia that substantially increases mortality rates. Between 70 to 100% of patients with PD have dysphagia throughout the disease progression. Aspiration pneumonia in the context of dysphagia is regarded one of the most important factors contributing to decreased life expectancy of PD patients [5]. Malnutrition, dehydration and medication intake complications are further consequences of dysphagia that contribute to significant decline in the quality of patients life [6]. The underlying pathophysiology of dysphagia is multifactorial and evidence clarifying the precise mechanisms are scarce. Dysfunction in dopamine-related and non-dopaminerelated pathways, changes in cortical networks related with swallowing and peripheral mechanisms have been implicated in the pathogenesis of dysphagia. We aimed at investigating whether dysphagia is associated with presynaptic dopaminergic deficits, faster motor symptom progression and cognitive decline in a population of early drug-naïve patients with Parkinson’s disease
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