Swallowing Disturbance Questionnaire Research Articles

Evaluation of dysphagia in different phenotypes of early and idiopathic Parkinsonism

BackgroundParkinsonism (PD) is a common neurodegenerative disorders into which dysphagia occurs mainly in the late stage and to a lesser extent in an early stage. Diagnosis of dysphagia particularly in early idiopathic Parkinson’s disease (IPD) is important as dysphagia affects the quality of life of patients and most of the patients are unaware of this important symptom.MethodFifty-four patients were enrolled in this study presented with early IPD attending to the outpatient clinic of Sohag University Hospital. All PD patients were assessed by using Unified Parkinson’s Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale. IPD patients were classified into tremor dominant (TD) and postural instability/gait disorder (PIGD) phenotypes. Swallowing disturbance questionnaire (SDQ) and fiberoptic endoscopic evaluation of swallowing (FEES) were used to evaluate dysphagia.ResultsThirty-five percent of patients experienced dysphagia when the patients were questioned, and this percent rises to 40% on using FEES. The results of SDQ were significantly correlated to the results of more accurate FEES. The percentage of dysphagia was higher in patients with PIGD than TD phenotype. Dysphagia was significantly associated with the mean of the Mini-Mental State Examination (MMSE), UPDRS, and modified Hoehn and Yahr scale.ConclusionsDysphagia is a prevalent symptom in early IPD and significantly correlated with Parkinsonism phenotype, UPDRS, and modified Hoehn and Yahr scale.

Swallowing difficulties among healthy elderly: prevalence and aetiology

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Dysphagia is a common problem among elderly individuals. Very few studies have been done to know the prevalence of dysphagia among healthy elderly individuals. So a study was done to assess the prevalence of swallowing difficulties among healthy elderly individuals and to find out the various causes for it in them. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">259 elderly individuals were screened using the swallowing disturbance questionnaire to assess the prevalence of swallowing disorders. Those individuals with swallowing disorders were further subjected to modified Barium swallow to know the aetiology. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Of the 259 elderly individuals screened, 85 were females and 174 were males. The mean age and standard deviation was 66.16±6.233. The prevalence of swallowing difficulties was 20.1%, with no significant difference in the gender wise distribution or age wise distribution. Among the various aetiologies diagnosed, idiopathic cause is the commonest, followed by oesophageal neoplasm (21.1%), and then the achalasia cardia (9.6%). Among oesophageal neoplasm, mid-thoracic esophageal neoplasm (9.6%) is the commonest. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Considering the time and cost involved, it is not feasible to subject all elderly for instrumental swallowing evaluation like videofluoroscopy. Hence it would be beneficial to screen the elderly individuals for dysphagia and educate them regarding its importance, as dysphagia can also be associated with serious underlying pathology and complications such as aspiration.</span></p><p class="abstract"> </p>

Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases

ABSTRACT Introduction Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both extent of symptoms and effect on quality of life. These should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aim To develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India) and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending n in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders) (n = 63) attending the ear, nose, and throat (ENT); neurology; and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference, indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients has been found to be reliable and valid for use. We recommend it as a screening tool in the neurology outpatient department (OPD). How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to Assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(2):78-82.

Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases

ABSTRACT Background Swallowing problems have significant subjective component. Their evaluation necessitates the use of questionnaires to know both the extent of symptoms and the effect on quality of life. Questionnaires should be designed to get maximum information with minimum trouble to the patient. Parkinson's disease (PD) involves swallowing disorder as a symptom, often unreported. Hence, this needs to be assessed separately. Aims This study aims to develop a questionnaire, in the vernacular, to check for the presence of swallowing problems in PD patients, and to study its reliability and validity. Materials and methods We developed an 11-item questionnaire in English, modeled on the Tel Aviv swallowing disturbance questionnaire (SDQ), chosen for its brevity. This was translated into the vernacular (Malayalam, native tongue of the state of Kerala in India), and administered to patients (n = 106) attending the weekly PD clinic of a tertiary care center, in consultation with the attending neurologist in charge of movement disorder patients. The same questionnaire was also administered to age-matched controls (patients without any swallowing disorders; n = 63), attending the ENT, neurology, and geriatric clinics. The scores were documented and statistical analysis done, to check for internal reliability and validity. Results Comparison of mean total scores between cases (2.89) and controls (1.51) showed a statistically significant difference indicating statistical validity (p = 0.009). Guttman's split-half correlation showed fairly good reliability for both cases (0.812) and controls (0.851). Conclusion The present questionnaire to assess dysphagia in PD patients was found to be reliable and valid for use. We recommend it as a screening tool in the neurology OPD. How to cite this article Menon U, Radhakrishnan SK, Sundaram KR. Reliability and Validity of a Questionnaire to assess Swallowing Disorders in Parkinson's Disease Cases. Int J Phonosurg Laryngol 2016;6(1):35-39.

Central cholinergic dysfunction could be associated with oropharyngeal dysphagia in early Parkinson's disease.

Dysphagia is an important issue in the prognosis of Parkinson's disease (PD). Although several studies have reported that oropharyngeal dysphagia may be associated with cognitive dysfunction, the exact relationship between cortical function and swallowing function in PD patients is unclear. Therefore, we investigated the association between an electrophysiological marker of central cholinergic function, which reflected cognitive function, and swallowing function, as measured by videofluoroscopic studies (VFSS). We enrolled 29 early PD patients. Using the Swallowing Disturbance Questionnaire (SDQ), we divided the enrolled patients into two groups: PD with dysphagia and PD without dysphagia. The videofluoroscopic dysphagia scale (VDS) was applied to explore the nature of the dysphagia. To assess central cholinergic dysfunction, short latency afferent inhibition (SAI) was evaluated. We analyzed the relationship between central cholinergic dysfunction and oropharyngeal dysphagia and investigated the characteristics of the dysphagia. The SAI values were significantly different between the two groups. The comparison of each VFSS component between the PD with dysphagia group and the PD without dysphagia group showed statistical significance for most of the oral phase components and for a single pharyngeal phase component. The total score on the VDS was higher in the PD with dysphagia group than in the PD without dysphagia group. The Mini-Mental State Examination and SAI values showed significant correlations with the total score of the oral phase components. According to binary logistic regression analysis, SAI value independently contributed to the presence of dysphagia in PD patients. Our findings suggest that cholinergic dysfunction is associated with dysphagia in early PD and that an abnormal SAI value is a good biomarker for predicting the risk of dysphagia in PD patients.

The Huntington's Disease Dysphagia Scale.

Little is known about the swallowing disturbances of patients with Huntington's disease; therefore, we developed the Huntington's Disease Dysphagia Scale. The scale was developed in four stages: (1) item generation, (2) comprehension testing, (3) evaluation of reliability, (4) item reduction and validity testing. The questionnaire was presented twice to 50 Huntington's disease patients and their caregivers. The Kruskal-Wallis test was used to evaluate whether the severity of swallowing difficulties increased with advancing disease. Pearson's correlation coefficient was used to examine the construct validity with the Swallowing Disturbance Questionnaire. The final version contained 11 items with five response options and exhibited a Cronbach's alpha coefficient of 0.728. The severity of swallowing difficulties was significantly higher in more advanced Huntington's disease. The correlation with the Swallowing Disturbance Questionnaire was 0.734. We developed a valid and reliable 11-item scale to measure the severity of dysphagia in Huntington's disease.

Validation of the persian translation of the swallowing disturbance questionnaire in Parkinson's disease patients.

Dysphagia, as a common finding in Parkinson's disease (PD) patients, was estimated to be present in 80–95% of this population during different stages of the disease. The Swallowing Disturbance Questionnaire (SDQ) was created as a self-rated dysphagia screening tool in PD. According to the guidelines for cross-cultural adaptation, Persian version of this questionnaire (SDQ-P) was developed. 59 Persian patients (39 men and 20 women) participated in the study. They responded to the SDQ-P and underwent videofluoroscopic swallowing study (VFSS). Aspiration during VFSS was compared with questionnaire results for each individual. Cronbach's alpha coefficient for the questionnaire was 0.86 and based on SDQ-P 15 patients (25.4%) were dysphagic, while 10 patients (16.9%) showed aspiration during VFSS. SDQ-P sensitivity and specificity in predicting aspiration were 96.7 and 91.2%; therefore, the SDQ-P could be a prognostic tool for aspiration. The positive predictive value (PPV), the negative predictive value (NPV), and the pre- and posttest probabilities of aspiration were 0.67, 1, 16.9%, and 66.7%, respectively. In summary, this study demonstrated the reliability and also the feasibility of SDQ-P for screening of aspiration in Iranian patients with PD. Further evaluation of SDQ-P in larger subject population would be suggested.

OC-034 Cortical and Brainstem Neurophysiological Mechanisms underlying Dysphagia in Parkinson’S Disease: A Transcranial Magnetic Stimulation Study’ ‘On’ and ‘Off’ Levodopa

IntroductionDysphagia in Parkinson’s disease (PD) patients, persisting despite dopaminergic medication, affects nutritional and drug intake with reduced quality-of-life (Michou & Hamdy, Exp Rev Neurother 2010). Here we explore the potential...

Management of Dysphagia and Drooling in Patients With Parkinson’s Disease

SUMMARY Dysphagia and drooling are frequently reported consequences of Parkinson’s disease (PD) and this article aims to review their management. Several PD-specific and validated instruments are available for the screening and evaluation of dysphagia and drooling, including the Swallowing Disturbance Questionnaire (SDQ), Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD), Radboud Oral Motor Inventory for Parkinson’s Disease (ROMP), subscales for swallowing and saliva, and non-motor questionnaires that include items on dysphagia and drooling (e.g., Scales for Outcomes in Parkinson’s disease-Autonomic [SCOPA-AUT]; Non-motor Symptoms Questionnaire for Parkinson’s disease [PD-NMSQuest]; and Non-motor Symptoms Assessment Scale for Parkinson’s disease [NMSS]). For the behavioral treatment of dysphagia traditional techniques are helpful, however, exercise training might be more effective. Dysphagia appears to be resistant to drug treatment, but dysphagic patients may benefit from deep brain stimulation. For the treatment of drooling, swallow compensations should be tried, but when saliva reduction is required, botulinum-toxin injections are currently the best option. Overall, there is an urgent need for new approaches to treat dysphagia and drooling in PD.

Validation of the Japanese translation of the Swallowing Disturbance Questionnaire in Parkinson’s disease patients

The Swallowing Disturbance Questionnaire (SDQ) was developed as a self-rated screening tool for dysphagia in patients with Parkinson's disease (PD). We developed the Japanese version of this questionnaire (SDQ-J), according to the cross-cultural adaptation guidelines, and examined its reliability. Subjects were 61 Japanese patients with PD (mean age, 67.0 ± 9.2 years) who answered the SDQ-J before undergoing videofluoroscopic examination of swallowing (VF). We compared the findings of the questionnaire with the patients' aspiration status during VF. Cronbach's alpha coefficient for the 15 questions of the SDQ-J was 0.84. According to the SDQ-J, 15 patients (24.6%) were diagnosed with dysphagia, while 9 patients (14.8%) aspirated liquid during VF. The sensitivity and specificity of the SDQ-J in predicting aspiration were 77.8 and 84.6%, respectively; therefore, the SDQ-J significantly predicted aspiration during VF (P < 0.01). The positive predictive value (PPV) and negative predictive value (NPV) for the SDQ-J were 0.46 and 0.96, respectively. The SDQ-J appears to be a reliable and useful screening tool for Japanese PD patients with aspiration. As the NPV was higher than the PPV in the SDQ-J, this questionnaire could potentially be used for early identification of severe dysphagia in patients with PD.

Swallowing disturbance questionnaire for detecting dysphagia

To assess the accuracy of the swallowing disturbance questionnaire (SDQ) that had originally been designed and validated for detecting swallowing problems among patients with Parkinson's disease and was now applied for identifying patients with dysphagia associated with various other etiologies. Prospective. One-hundred patients with the complaint of swallowing disturbances who underwent a full swallowing survey at the Tel-Aviv Voice and Swallowing Disorder Clinic participated. They all filled in the SDQ. The collected data included patient characteristics, medical history, and the results of an oromotor examination and a fiberoptic endoscopic evaluation of swallowing (FEES). The SDQ results were compared to the FEES and oromotor examination findings. The responses to the questions in the SDQ were highly correlated with the findings of the oral part of the oromotor examination (85.71% sensitivity, 87.6% specificity). Items on the laryngopharyngeal phase reliably assessed dysphagia symptoms in correlation to the FEES examination (67.3% sensitivity, 76.7% specificity). The total SDQ score correlated with the total oromotor and the FEES scores (79.7% sensitivity, 73% specificity). The SDQ is a sensitive and accurate tool for identifying patients with true swallowing disturbances arising from different etiologies and for indicating the need for more in-depth instrumental swallowing evaluations.

Dysautonomia rating scales in Parkinson's disease: Sialorrhea, dysphagia, and constipation—Critique and recommendations by movement disorders task force on rating scales for Parkinson's disease

Upper and lower gastrointestinal dysautonomia symptoms (GIDS)--sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met "Recommended" criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically.

Anxiety, depression and swallowing disorders in patients with Parkinson's disease

Swallowing disturbances (SDs), anxiety and depression are commonly present in Parkinson's disease (PD) patients. We hypothesized that there is an association between the presence of SDs and the PD affective state. Sixty-nine PD patients were assessed for the presence of SDs by undergoing cognitive screening with the Mini Mental State Examination (MMSE), completing three inventories: a swallowing disturbance questionnaire (SDQ), the Spielberger manual for the trait anxiety and Beck depression inventories. All patients underwent clinical swallowing evaluations by a speech and language pathologist (SLP). Patients diagnosed with SDs were also assessed by fiberoptic endoscopic evaluation of swallowing (FEES) performed by an ENT and SLP. Thirty-eight patients experienced SDs, the other 31 did not. The clinical characteristics of the two groups were matched. Patients with SDs experienced increased anxiety and depression compared to patients without SDs. Comparisons between patients who scored in the two opposite ends of the anxiety and depression ranges demonstrated that the most anxious and depressed patients reported more swallowing difficulties (SDQ scores) compared with the least anxious and depressed ones. In addition, the most anxious patients had significantly increased disease severity and decreased MMSE scores compared with the least anxious patients. Disease severity was also increased in the most depressed patients compared with the least depressed ones. Advanced disease emerged as being associated with high anxiety levels and greater numbers of SDs. The contribution of anxiety or depression to the development or worsening of SDs and their role in treatment strategy warrant further investigation.

Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease

Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 +/- 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients.