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研究背景：吞咽障碍（Dysphagia）被认为在帕金森病患者（PwPD）中高发，且是该人群主要的致病及致死原因。本研究旨在对比帕金森病患者与年龄、性别匹配的健康成人队列的吞咽生理学各项指标的非典型值与极端值出现频率。其中，非典型值与极端值分别定义为：落入60岁以下健康成人参考分布的25%与5%尾部区间的数值。 研究方法：本研究纳入17名轻度帕金森病患者与17名年龄、性别匹配的健康成人，采用标准视频透视吞咽检查（videofluoroscopy, VF）方案开展检测，检测过程中使用浓度覆盖从稀薄到极稠的20%重量体积比（w/v）液态钡剂。采用盲法对视频透视结果进行分析，分析依据《吞咽生理学分析：事件、运动学与时序方法》（Analysis of Swallowing Physiology: Events, Kinematics and Timing Method）执行。按研究队列统计非典型值与极端值的出现频率，并通过优势比（odds ratios）进行组间比较。 研究结果：帕金森病患者在吞咽反应时延长、喉前庭闭合（Laryngeal-Vestibule-Closure, LVC）时长延长以及咽部收缩功能欠佳这几项指标上，非典型值出现频率（>25%）更高。但此类表现在健康对照组中同样存在。帕金森病患者在稀薄钡剂下的食管上括约肌（upper esophageal sphincter, UES）直径偏窄、极稠钡剂下的舌骨爆发至食管上括约肌开放间隔过短，以及多种钡剂浓度下的LVC时长延长、LVC持续时间与UES开放持续时间延长等指标上，出现非典型值的优势比显著更高。而极端值的出现频率在两组间的所有指标均未表现出显著组间差异。 研究结论：本研究结果显示，当通过优势比对比帕金森病患者与健康年龄匹配对照组的非典型值出现频率时，轻度帕金森病患者并未表现出与健康对照组存在显著差异的明确吞咽功能受损证据；仅少数指标存在组间差异，即帕金森病患者的LVC时长延长与UES开放持续时间延长的出现频率显著更高。 补充材料S1：本补充内容包含基于重复盲法视频透视检查的吞咽指标描述性统计结果，该分析依据ASPEKT方法完成。 Gandhi, P., Mancopes, R., Sutton, D., Plowman, E. K., & Steele, C. M. (2021). 轻度帕金森病患者咽期吞咽指标的非典型值与极端值出现频率对比健康衰老人群. 《言语、语言与听力研究杂志》, 预在线发表. https://doi.org/10.1044/2021_JSLHR-21-00084