Swallowing physiology in Parkinson disease (Gandhi et al., 2021)

Purpose: Dysphagia 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.Method: A 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.Results: Increased 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.Conclusions: In 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 S1. This supplement contains descriptive statistics for measures of swallowing based on duplicated blinded review of videofluoroscopies, performed according to the ASPEKT Method. Gandhi, P., Mancopes, R., Sutton, D., Plowman, E. K., & Steele, C. M. (2021). The frequency of atypical and extreme values for pharyngeal phase swallowing measures in mild Parkinson disease compared to healthy aging. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2021_JSLHR-21-00084

目的：吞咽困难被认为在帕金森病患者（PwPD）中普遍存在，且是导致其发病率与死亡率的首要原因。本研究旨在比较帕金森病患者及与年龄和性别相匹配的健康成人群体中吞咽生理学指标异常值和极端值的频率。异常值和极端值分别定义为低于60岁以下健康成人参考分布25%和5%尾部的值。方法：对17例轻度帕金森病患者和17例年龄和性别相匹配的健康成人进行了标准视频荧光检查（VF），使用20% w/v的液体钡剂，从稀到极稠的浓度范围。根据《吞咽生理学分析：事件、运动学和时间方法》进行了盲法VF分析。按群体统计了异常值和极端值的频率，并使用优势比进行比较。结果：帕金森病患者在吞咽反应时间延长、喉咽闭合时间延长和咽部收缩不良方面的异常值频率增加（>25%），但这些发现也见于健康对照组。帕金森病患者在狭窄上食管括约肌（UES）直径、极稠液体中的短舌骨爆发至UES开放间隔、多浓度下的喉咽闭合时间、喉咽闭合持续时间以及UES开放持续时间等方面显示出显著更高的异常值优势比。极端值的频率在所有参数上均未显示出任何显著的群体差异。结论：在本研究中，当使用优势比比较帕金森病患者和对照组之间异常值频率时，轻度帕金森病组并未显示出与健康年龄匹配对照组吞咽障碍的明确差异；仅少数参数显示出显著差异。这些差异体现在帕金森病患者中喉咽闭合和UES开放持续时间显著更高的频率。补充材料S1：本补充材料包含基于视频荧光检查的吞咽指标描述性统计数据，检查按照ASPEKT方法进行，并进行了重复的盲法审查。Gandhi, P., Mancopes, R., Sutton, D., Plowman, E. K., & Steele, C. M. (2021). 与健康老龄化相比，轻度帕金森病患者咽部吞咽阶段异常值和极端值频率的频率。言语、语言和听力研究杂志。在线预发表。https://doi.org/10.1044/2021_JSLHR-21-00084