Abstract
PurposeDysphagia is thought to be prevalent and a leading cause of morbidity and mortality in people with Parkinson disease (PwPD). The aim of this study was to compare the frequencies of atypical and extreme values for measures of swallowing physiology in PwPD and in an age- and sex-matched cohort of healthy adults. Atypical and extreme values were defined, respectively, as values falling in the 25% and 5% tails of the reference distribution for healthy adults under age 60 years.MethodA standard videofluoroscopy (VF) protocol was performed in 17 adults with mild PD and 17 age- and sex-matched healthy adults using 20% w/v liquid barium ranging from thin to extremely thick consistency. Blinded VF analysis was performed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Frequencies for atypical and extreme values were tabulated by cohort and compared using odds ratios.ResultsIncreased frequencies of atypical values (> 25%) were seen in the PwPD for prolonged swallow reaction time, prolonged time-to-laryngeal-vestibule-closure (LVC), and poor pharyngeal constriction. However, these findings were also observed in the healthy controls. The PwPD showed significantly higher odds of atypical values for narrow upper esophageal sphincter (UES) diameter on thin liquids, a short hyoid-burst-to-UES-opening interval on extremely thick liquids, and prolonged time-to-LVC, LVC duration, and UES opening duration on multiple consistencies. The frequencies of extreme values failed to show any significant cohort differences for any parameter.ConclusionsIn this study, a group of people with mild PD did not show clear evidence of swallowing impairments distinct from the changes seen in a healthy age-matched control group when odds ratios were used to compare the frequencies of atypical values between PwPD and the control group; only a few parameters showed significant differences. These were findings of significantly higher frequencies in PwPD of prolonged LVC and UES opening duration.Supplemental Material https://doi.org/10.23641/asha.15032241
Highlights
Atypical values that were limited to specific consistencies were seen for penetration– aspiration on thin liquids, prolonged time-to-LVC on extremely thick liquids, prolonged LVC duration on thin and slightly thick liquids, prolonged UES opening duration on thin and slightly thick liquids, and larger UES opening diameter on slightly and extremely thick liquids
Taken together with the observations of prolonged UES opening, we propose that these atypically long LVC durations may reflect a compensatory mechanism in the PD group
Our findings suggest that the individuals in our PD cohort, who had mild disease, and who were studied in medication “on” state, did not show clear evidence of impairments in pharyngeal swallowing physiology
Summary
The aim of this study was to compare the frequencies of atypical and extreme values for measures of swallowing physiology in PwPD and in an age- and sex-matched cohort of healthy adults. We aimed to compare swallowing in PwPD to these reference data, defining values falling in the 25% tails and 5% of the reference distribution as “atypical” and “extreme,” respectively. Our goal was to identify differences in swallowing physiology that may be considered characteristic of PD, through use of a standard videofluoroscopy protocol and comparison of the frequencies of typical, atypical, and extreme values in samples of PwPD and healthy older controls
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