Abstract
Introduction: Although patients with Parkinson's disease (PD) often suffer from oropharyngeal dysphagia, knowledge about the underlying pathophysiological mechanisms is limited. Substance P (SP) is a localization-independent neurotransmitter of the entire nervous system. Reduced levels of SP were found in saliva of patients with impaired cough reflex and in advanced stages of PD. The aim of the study was to investigate SP in PD patients in order to gain further insights into the underlying pathophysiology of PD-related dysphagia and to evaluate the potential of SP as a biomarker for early dysphagia.Methods: Flexible endoscopic evaluation of swallowing (FEES) was used to objectively assess pharyngeal swallowing function. From a cohort of 105 consecutive PD patients 20 subjects were recruited: in 10 of them pharyngeal dysphagia was excluded by FEES, the other 10 subjects showed signs of early pharyngeal dysphagia defined as hypopharyngeal sensory deficit with mild to moderate vallecular residues after swallowing solid consistencies. Analysis of the Substance P level in saliva of the 20 included PD patients was performed in the clinical on state condition by ELISA-type immunoassay. Significant differences were calculated by using the Mann-Whitney test.Results: Twenty PD patients with a mean age of 69.5 ± 12.5 years (8 female) were included in the study. No significant differences were found regarding gender, age, UPDRS III, Hoehn and Yahr stage, disease duration, and Levodopa equivalent dose between the non-dysphagic and dysphagic subjects. Dysphagia was mainly characterized by unrecognized residues in the valleculae without any aspiration risk for all of the tested consistencies in FEES and was thereby scored as mild in all cases. Saliva SP concentrations were significantly lower in PD patients with pharyngeal dysphagia compared to those with a normal pharyngeal swallowing function (9,644 vs. 17,591 pg/mL; p = 0.001).Conclusion: Reduced saliva SP concentrations may predict early pharyngeal swallowing dysfunction in PD patients. This finding supports the hypothesis that an impaired SP mediated neurotransmission has a significant impact for the development of dysphagia in PD patients. Larger studies are needed to confirm SP as a clinical useful biomarker for early detection of PD-related dysphagia.
Highlights
Patients with Parkinson’s disease (PD) often suffer from oropharyngeal dysphagia, knowledge about the underlying pathophysiological mechanisms is limited
Oropharyngeal dysphagia is a clinically relevant symptom in affected patients as the majority of PD patients will suffer from neurogenic dysphagia during the course of their disease [3,4,5,6]
flexible endoscopic evaluation of swallowing (FEES) was successfully performed in all 20 subjects (12 male, 8 female, mean age 68.6 ± 12.5 years), presenting with either no (n = 10) or early pharyngeal dysphagia (n = 10)
Summary
Patients with Parkinson’s disease (PD) often suffer from oropharyngeal dysphagia, knowledge about the underlying pathophysiological mechanisms is limited. Oropharyngeal dysphagia is a clinically relevant symptom in affected patients as the majority of PD patients will suffer from neurogenic dysphagia during the course of their disease [3,4,5,6]. In addition to consecutive malnutrition, dehydration and insufficient medication intake, neurogenic dysphagia leads to loss of quality of life for affected patients and aspiration pneumonia, which is the leading cause of death in Parkinson’s patients [4, 7,8,9]. In early disease stages affected patients are usually unaware of their swallowing dysfunction and do not report spontaneously about swallowing problems [10, 11]. Access to FEES and VFSS is limited in many institutions
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