A pilot study of respiration and swallowing integration in Parkinson's disease: "on" and "off" levodopa

Facing and dealing with emotional turbulence: Living with newly diagnosed Parkinson's disease

INTRODUCTION

The experiences of living with Parkinson's disease (PD) from the perspective of newly diagnosed persons with PD (PwPD) have not been previously described.

AIM

This study aimed to gain a better understanding of the impact of living with the early stages of PD.

METHODS

A qualitative interview study was conducted among nine persons, seven men and two women, from southern Sweden. Participants had a median age of 71 (min-max, 64-77) years and had been diagnosed with PD for a median of 5 (min-max, 2-12) months. Interviews were recorded and analysed using systematic text condensation.

RESULTS

The analysis resulted in one core category, Facing and dealing with emotional turbulence, and four categories with 2-3 subcategories each: Something is wrong (Vague signs of change; Losing control); The going gets tough (Recalling; Lack of motivation); Losing direction (Uncertainties; Frightened of disease progression) and Dealing with life (Avoiding social situations; Hope and despair; Ease worries).

CONCLUSION

Newly diagnosed PwPD face emotional turbulence with increasing challenges in managing everyday basic needs. Impaired functioning affects self-esteem and identity, which calls for strategies to overcome emotional reactions of embarrassment, frustration and worry. A sense of lost control and direction increased as the future became more uncertain. The participants' emotional burden and struggle to find a reason to go on or some solution to their new situation left them with both hope and despair. Our results suggest that a person-centred needs-based approach may help newly diagnosed PwPD deal with their new life situation.

A systematic review and meta-analysis of acupuncture in Parkinson's disease with dysphagia

Objective

The systematic review and meta-analysis aimed to comprehensively evaluate acupuncture's efficacy and safety in treating dysphagia in Parkinson's disease (PD).

Methods

We searched PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Infrastructure (CNKI), China Science Journal Database (VIP), Wan-fang Database, and the China Biomedical Literature Service System (CBM) for randomized controlled trials (RCTs) comparing the efficacy of acupuncture alone or in combination with control treatment in improving dysphagia by October 2022. The degree of dysphagia was the primary outcome indicator, with secondary outcomes including serum albumin (ALB) and hemoglobin (Hb) levels, the incidence of pneumonia, and adverse events. Two investigators independently extracted information according to the inclusion and exclusion criteria. Data synthesis was calculated by RevMan (V.5.4.1) software.

Results

This study included ten randomized controlled trials with 724 patients. Most RCTs have a high or uncertain risk of bias due to the lack of a blinded design. Meta-analysis showed that acupuncture combined with control treatment was superior to control treatment alone in improving Videofluoroscopic Swallowing Study (VFSS) scores (MD: 1.48; 95% CI: 1.16, 1.81; P < 0.00001) and reducing Standardized Swallowing Assessment (SSA) scores (MD: -3.08; 95% CI: -4.01, -2.15; P < 0.00001). Acupuncture combined with control therapy has a more significant benefit in improving the clinical efficiency of dysphagia in PD (RR: 1.40; 95%CI: 1.25, 1.58; P < 0.00001). Compared to the control group without acupuncture, acupuncture improved the nutritional status of patients and increased their serum ALB (MD: 3.38, 95%CI: 1.83, 4.92, P < 0.00001) and Hb levels (MD: 7.66; 95%CI: 5.57, 9.75; P < 0.00001). Three RCTs reported that the rate of pulmonary infections in the acupuncture group was lower than without acupuncture intervention (RR: 0.29, 95% CI: 0.14, 0.63; P = 0.001).

Conclusion

Acupuncture could be recommended as an adjunctive treatment for dysphagia in PD. However, due to the high risk of bias in the included studies, more high-quality evidence is needed to confirm the efficacy and safety of acupuncture for dysphagia in PD.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022370221.

Respiratory-Swallow Coordination in Individuals with Parkinson's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Swallowing impairment, including altered physiology and aspiration, occur across the progression of Parkinson's disease (PD). The phase of respiration during which a swallow is initiated has been linked to swallowing impairment and aspiration in cohorts with dysphagia following stroke and head and neck cancer treatment, but has been understudied in PD. If similar findings are shown in individuals with PD, the implications for swallowing assessment and treatment are significant.

OBJECTIVE

The aim of this systematic review and meta-analysis of literature was to examine respiratory-swallow coordination measures and potential implications on swallowing physiology in individuals with PD.

METHODS

An extensive search of 7 databases (PubMed, EMBASE, Central, Web of Science, ProQuest Dissertations & Theses, Scopus, and CINAHL) with predetermined search terms was conducted. Inclusion criteria were individuals with PD and the use of objective evaluations of respiratory-swallow coordination.

RESULTS

Of the 13,760 articles identified, 11 met the inclusion criteria. This review supports the presence of atypical respiratory swallow patterning, respiratory pause duration and lung volume at swallow initiation in individuals with PD. The meta-analysis estimated an occurrence of 60% of non-expiration-expiration and 40% of expiration-expiration respiratory phase patterns surrounding swallowing.

CONCLUSION

Although this systematic review supports the occurrence of atypical respiratory-swallow coordination in individuals with PD, the evidence is limited by the variability in the methods of data acquisition, analysis, and reporting. Future research examining the impact of respiratory swallow coordination on swallowing impairment and airway protection using consistent, comparable, and reproducible methods and metrics in individuals with PD is warranted.

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

PURPOSE OF REVIEW

Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice.

RECENT FINDINGS

The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues.

SUMMARY

Screening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing.

Gastrointestinal Dysfunction in Parkinson’s Disease: Current and Potential Therapeutics

Abnormalities in the gastrointestinal (GI) tract of Parkinson’s disease (PD) sufferers were first reported over 200 years ago; however, the extent and role of GI dysfunction in PD disease progression is still unknown. GI dysfunctions, including dysphagia, gastroparesis, and constipation, are amongst the most prevalent non-motor symptoms in PD. These symptoms not only impact patient quality of life, but also complicate disease management. Conventional treatment pathways for GI dysfunctions (i.e., constipation), such as increasing fibre and fluid intake, and the use of over-the-counter laxatives, are generally ineffective in PD patients, and approved compounds such as guanylate cyclase C agonists and selective 5-hyroxytryptamine 4 receptor agonists have demonstrated limited efficacy. Thus, identification of potential targets for novel therapies to alleviate PD-induced GI dysfunctions are essential to improve clinical outcomes and quality of life in people with PD. Unlike the central nervous system (CNS), where PD pathology and the mechanisms involved in CNS damage are relatively well characterised, the effect of PD at the cellular and tissue level in the enteric nervous system (ENS) remains unclear, making it difficult to alleviate or reverse GI symptoms. However, the resurgence of interest in understanding how the GI tract is involved in various disease states, such as PD, has resulted in the identification of novel therapeutic avenues. This review focuses on common PD-related GI symptoms, and summarizes the current treatments available and their limitations. We propose that by targeting the intestinal barrier, ENS, and/or the gut microbiome, may prove successful in alleviating PD-related GI symptoms, and discuss emerging therapies and potential drugs that could be repurposed to target these areas.

Consensus on the treatment of dysphagia in Parkinson's disease

BACKGROUND

Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD.

OBJECTIVE

To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management.

METHODS

A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.

RESULTS

The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed.

CONCLUSIONS

The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.

A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value

Background

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD.

Objective

To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients.

Methods

A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.

Results

Eighty-five papers were used to inform the Panel’s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions.

Conclusions

The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00415-021-10739-8.

Respiratory Dysfunctions in Parkinson's Disease Patients

Respiratory dysfunctions have been associated with Parkinson's disease since the first observations of the disease in 1817. Patients with Parkinson's disease frequently present respiratory disorders with obstructive ventilatory patterns and restrictive modifications, as well as limitations in respiratory volumes. In addition, respiratory impairments are observed due to the rigidity and kyphosis that Parkinson's disease patients experience. Subsidiary pulmonary complications can also appear as side effects of medication. Silent aspiration can be the cause of pneumonia in Parkinson's disease. Pulmonary dysfunction is one of the main factors that leads to the morbidity and mortality of patients with Parkinson's disease. Here, we performed a narrative review of the literature and reviewed studies on dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders, and subsidiary speech and swallow impairments related to pulmonary dysfunction in patients with Parkinson's disease.

Effectiveness of pharmacologic treatment for dysphagia in Parkinson's disease: a narrative review

BACKGROUND

The effectiveness of pharmacological treatment on dysphagia in Parkinson's disease (PD) is debatable. We reviewed the literature for analyzing the effect of pharmacological treatment on the improvement of dysphagia in PD patients.

METHODS

We searched the PubMed database for papers published before June 21, 2020, that evaluated the effect of pharmacologic treatments for improving dysphagia in patients with PD. The following inclusion criteria were applied for the selection of articles: 1) studies performed on patients with dysphagia due to PD, 2) studies where pharmacologic treatment was applied for improvement of dysphagia, and 3) those where follow-up evaluation was performed after the treatment.

RESULTS

The primary literature search yielded 415 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included nine studies in this review. In five previous studies, the positive effects of dopaminergic drugs on dysphagia were reported, whereas two showed no significant positive results. The remaining two studies showed equivocal results.

CONCLUSION

We found that dopaminergic drugs have some potential to improve dysphagia in patients with PD. However, studies with high-quality evidence are lacking. For the clear elucidation of the effect of dopaminergic drugs on dysphagia in patients with PD, randomized controlled trials with large cohorts and detailed analyses should be conducted in the future.

Respiratory dysfunction in Parkinson's disease: a narrative review

The presence of respiratory symptoms in Parkinson's disease (PD) has been known since the first description of the disease, even though the prevalence and incidence of these disturbances are not well defined. Several causes have been reported, comprising obstructive and restrictive pulmonary disease and changes in the central ventilatory control, and different pathogenetic mechanisms have been postulated accordingly. In our review, we encompass the current knowledge about respiratory abnormalities in PD, as well as the impact of anti-Parkinsonian drugs as either risk or protective factors. A description of putative pathogenetic mechanisms is also provided, and possible treatments are discussed, focusing on the importance of recognising and treating respiratory symptoms as a key manifestation of the disease itself. A brief description of respiratory dysfunctions in atypical Parkinsonism, especially α-synucleinopathies, is also provided.

This review addresses current knowledge about respiratory dysfunctions in Parkinson's disease, from the aetiopathology to pharmacological and invasive treatments, describing the different clinical phenotypeshttps://bit.ly/2X7OLtN

Pathophysiology of Swallowing Dysfunction in Parkinson Disease and Lack of Dopaminergic Impact on the Swallow Function and on the Effect of Thickening Agents

(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson's disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.

A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration

INTRODUCTION

Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia.

AREAS COVERED

This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD.

EXPERT OPINION

A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options.

Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders

Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.

Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management

PURPOSE

Individuals with Parkinson disease (PD) present with complex and variable symptoms, with recent findings suggesting that the etiology of PD extends beyond the involvement of just the basal ganglia. These symptoms include significant impairments in the speech and swallowing domains, which can greatly affect quality of life and therefore require therapeutic attention. This research-based update reviews the neurophysiological basis for swallowing and speech changes in PD, the effectiveness of various types of treatments, and implications for symptom evaluation and management.

CONCLUSION

The mechanisms responsible for swallowing and speech symptoms in PD remain largely unknown. Dopaminergic medication and deep-brain-stimulation do not provide consistent benefits for these symptoms suggesting a non-dopaminergic network is involved. Importantly, evidence suggests that symptoms of dysphagia and hypokinetic dysarthria may be early indications of PD, so it is critical to investigate the cause of these changes.

Oro-Pharyngeal Dysphagia in Parkinson's Disease and Related Movement Disorders

Oro-pharyngeal dysphagia is a common symptom in patients with Parkinson’s disease (PD) and related disorders, even in their early stage of diseases. Dysphagia in these patients has been underdiagnosed, probably due to poor the self-awareness of the conditions and the underuse of validated tools and objective instruments for assessment. The early detection and intervention of dysphagia are closely related to improving the quality of life and decreasing the mortality rate in these patients. The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. The management of dysphagia and future research directions related to these disorders are also discussed.

Respiratory muscle strength and lung function in the stages of Parkinson's disease

Objective:

To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson’s disease (PD), as well as to determine their correlation with motor function and quality of life.

Methods:

This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test.

Results:

The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV₁, and FEF_25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV₁, PEF, and MEP.

Conclusions:

Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

Effects of the rotigotine transdermal patch versus oral levodopa on swallowing in patients with Parkinson's disease

OBJECTIVES

Abnormal swallowing or dysphagia is a potentially fatal symptom in Parkinson's disease (PD) and is characterized by frequent silent aspiration, which is an unrecognized risk for aspiration pneumonia. While the effects of oral levodopa on swallowing functions remain controversial, several small-scale studies have reported that rotigotine transdermal patch seems effective. The different effects between levodopa and rotigotine may be attributed to continuous dopaminergic stimulation (CDS), however, the absence of direct comparative evidence precludes conclusion.

METHODS

In the present retrospective open-label study of 50 patients with PD, swallowing functions were assessed via videofluoroscopic (VF) examination before and after treatment. Treatment included 2 mg/day rotigotine transdermal patch (N = 29) or 200 mg/day oral levodopa with carbidopa (N = 21) in drug-naïve and add-on groups of patients.

RESULTS

Rotigotine more consistently improved all measures assessed via VF examination. Such effects were similar to those in the drug-naïve and add-on groups. Improvement and responder rates of certain measures were significantly higher in the rotigotine group than in the levodopa group.

CONCLUSIONS

Our finding that rotigotine (levodopa equivalent dose = 60 mg) was more consistently effective than 200 mg/day oral levodopa suggests that CDS is more important in improving swallowing functions.

A Stage-Based Approach to Therapy in Parkinson's Disease

Parkinson’s disease (PD) is a neurodegenerative disorder that features progressive, disabling motor symptoms, such as bradykinesia, rigidity, and resting tremor. Nevertheless, some non-motor symptoms, including depression, REM sleep behavior disorder, and olfactive impairment, are even earlier features of PD. At later stages, apathy, impulse control disorder, neuropsychiatric disturbances, and cognitive impairment can present, and they often become a heavy burden for both patients and caregivers. Indeed, PD increasingly compromises activities of daily life, even though a high variability in clinical presentation can be observed among people affected. Nowadays, symptomatic drugs and non-pharmaceutical treatments represent the best therapeutic options to improve quality of life in PD patients. The aim of the present review is to provide a practical, stage-based guide to pharmacological management of both motor and non-motor symptoms of PD. Furthermore, warning about drug side effects, contraindications, as well as dosage and methods of administration, are highlighted here, to help the physician in yielding the best therapeutic strategies for each symptom and condition in patients with PD.

The Impact of Living with Parkinson's Disease: Balancing within a Web of Needs and Demands

This study explores the impact of living with Parkinson's disease (PD). Nineteen persons (11 women) aged 55–84 diagnosed with PD 3–27 years ago participated. Data were collected through semistructured interviews, which were recorded, transcribed verbatim, and analysed by qualitative content analysis. Four categories represented the impact of living with PD: “Changed prerequisites for managing day-to-day demands,” “Loss of identity and dignity,” “Compromised social participation,” and “The use of practical and psychological strategies.” There was a shift from an internal to an external locus of control in managing, control, competence, relatedness, and autonomy. According to self-determination theory, a shift towards extrinsically motivated behaviours may occur when these basic needs are thwarted, leading to compensatory strategies or needs substitutes with negative consequences on health and well-being. We suggest a needs-based approach as an important starting point to better understand the consequences of living with PD and to explore the means for people with PD to acquire an improved quality of life on their own terms. In conclusion, our findings suggest for a shift in focus, from a biomedical to a needs-based approach to understand the impact of living with PD and facilitate more person-centred care and person-centred outcome measurement.

Respiratory dysfunction in Parkinson's disease

Respiratory dysfunction has been associated with Parkinson's disease since it was first described in 1817. The respiratory symptoms observed in Parkinson's disease patients vary greatly. Most patients remain asymptomatic, whereas others present with acute shortness of breath and even stridor. In August 2016, an electronic literature search was conducted using PubMed and Google Scholar. Results were screened and studies reporting on respiratory dysfunction associated with Parkinson's disease were included. Respiratory dysfunction is due to a combination of factors including restrictive changes, upper airway obstruction, abnormal ventilatory drive and response to medications. Much debate surrounds the mechanism underlying respiratory dysfunction in Parkinson's disease, its prevalence and the effect of levodopa on respiration. It is clear from this review that larger studies, comparing patients of similar disease duration and severity using the same pulmonary function parameters, are required to provide a better understanding of the pathophysiology underlying respiratory dysfunction in Parkinson's disease.

Neurochemical Systems of the Retina Involved in the Control of Movement

Recent studies have revealed that the retina may exert control over deep brain function and may be importantly involved in the etiology, progression, and treatment of disorders such as Parkinson's disease (PD). While such a concept is uncharted territory and even less is known about the mechanism by which this might be achieved, this study was undertaken to determine how retinal dopamine (DA), serotonin (5-HT), and melatonin (MEL) neurotransmitter systems might be involved in the control of movement in their own right. To explore these further, intravitreal (IVIT) injections of DA, 5-HT, and MEL were made 0.5 or 3 h prior to testing horizontal and vertical movement in the open field as well as assessment on three motor tests used routinely to evaluate movement as a preclinical model of PD. The doses of DA (2 µl of 25 and 75 µg/µl), 5-HT (2 µl of 5 and 15 µg/µl), and MEL (2 µl of 5 µg/µl) were chosen because of previous work demonstrating an anatomically precise effect of these transmitters after they were injected directly into the brain. The postinjection times of testing were also chosen on the basis of previous intracerebral and IVIT work intimating the importance of the circadian cycle in determining the efficacy of such effects. 0.5 h after IVIT injection of DA at the 25 and 75 µg/µl doses, significant inhibition of motor function was observed. While IVIT injection of 10 or 30 µg of 5-HT also inhibited motor performance, this was significantly less than that seen with DA. In fact, IVIT injection increases motor performance compared to vehicle injection on some parameters. The IVIT injection of 10 µg of MEL facilitated motor function on many parameters compared to DA, 5-HT, and vehicle injection. When rats were tested 3 h after IVIT injection, the inhibition of vertical movement was also observed compared to controls. The present results illustrate that specific retinal neurotransmitter systems participate in the normal control of bodily motor function. The possible involvement of these systems in movement disorders such as PD is the subject of ongoing research.

Are Upper-Body Axial Symptoms a Feature of Early Parkinson's Disease?

BACKGROUND

Axial disorders are considered to appear late in the course of Parkinson's disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.

OBJECTIVES

To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.

METHODS

We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.

RESULTS

The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).

CONCLUSION

Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.

Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease

OBJECTIVE

To examine relations between peak expiratory (cough) airflow rate and swallowing symptom severity in participants with Parkinson disease (PD).

DESIGN

Cross-sectional study.

SETTING

Outpatient radiology clinic at an acute care hospital.

PARTICIPANTS

Men and women with PD (N=68).

INTERVENTIONS

Participants were cued to cough into an analog peak flow meter then swallowed three 20-mL thin liquid barium boluses. Analyses were directed at detecting potential relations among disease severity, swallowing symptom severity, and peak expiratory (cough) airflow rate.

MAIN OUTCOME MEASURES

Peak expiratory (cough) airflow rate and swallow symptom severity.

RESULTS

Peak expiratory (cough) airflow rate varied significantly across swallowing severity classifications. Participants with more severe disease displayed a significant, linear decrease in peak expiratory (cough) airflow rate than those participants with earlier stage, less severe disease. Swallowing symptom severity varied significantly across groups when comparing participants with less severe PD with those with more severe PD. Participants with early stage PD demonstrated little to no swallowing symptoms and had the highest measures of peak expiratory (cough) airflow rate. In contrast, participants with the most severe swallowing symptoms also displayed the lowest measures of peak expiratory (cough) airflow rate.

CONCLUSIONS

Relations existed among PD severity, swallowing symptom severity, and peak expiratory (cough) airflow rate in participants with PD. Peak expiratory (cough) airflow rate may eventually stand as a noninvasive predictor of aspiration risk in those with PD, particularly those with later stage disease. Inclusion of peak expiratory (cough) airflow rates into existing clinical swallowing assessments may increase the sensitivity and predictive validity of these assessments.

Parkinson Disease-Mediated Gastrointestinal Disorders and Rational for Combinatorial Therapies

A gradual loss of dopamine-producing nerve cells gives rise to a common neurodegenerative Parkinson’s disease (PD). This disease causes a neurotransmitter imbalance in the brain and initiates a cascade of complications in the rest of the body that appears as distressing symptoms which include gait problems, tremor, gastrointestinal (GI) disorders and cognitive decline. To aid dopamine deficiency, treatment in PD patients includes oral medications, in addition to other methods such as deep brain stimulation and surgical lesioning. Scientists are extensively studying molecular and signaling mechanisms, particularly those involving phenotypic transcription factors and their co-regulatory proteins that are associated with neuronal stem cell (SC) fate determination, maintenance and disease state, and their role in the pathogenesis of PD. Advancement in scientific research and “personalized medicine” to augment current therapeutic intervention and minimize the side effects of chemotherapy may lead to the development of more effective therapeutic strategies in the near future. This review focuses on PD and associated GI complications and summarizes the current therapeutic modalities that include stem cell studies and combinatorial drug treatment.

Dysphagia in Parkinson's Disease

More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists, speech-language therapists, and other clinicians in their daily work with PD patients and associated swallowing difficulties. Furthermore areas with an urgent need for future clinical research are identified.

Visuomotor control of neck surface electromyography in Parkinson's disease

OBJECTIVE

To compare performance of individuals with Parkinson's disease (PD) and age-matched controls on a visuomotor tracking task controlled via surface electromyography (sEMG).

METHODS

Twenty-seven adults with PD and twenty-four older controls produced dry swallows and completed a visuomotor tracking task utilizing both static and dynamic targets. sEMG was recorded at the anterior neck and submental surface during both tasks.

RESULTS

There was no significant difference in visuomotor tracking ability between cohorts. Post hoc analyses indicated that there was no significant difference between participant groups in the strength or duration of swallows as measured by sEMG but that participants with PD showed a trend for decreased swallow durations at the anterior neck (padj = 0.067) whereas controls showed a trend for increased durations at the anterior neck (padj = 0.112), compared to the submental surface. However, there were no significant correlations between swallowing behavior and visuomotor tracking ability.

CONCLUSION

There were no significant differences in visuomotor tracking performance between individuals with PD and controls. Furthermore, there was no relationship between tracking ability and swallowing behavior. We conclude that sEMG-mediated biofeedback may have limited promise as a tool for treating PD-related dysphagia.

Gastrointestinal Autonomic Dysfunction in Patients with Parkinson's Disease

Currently, gastrointestinal dysfunctions in Parkinson’s disease (PD) are well-recognized problems and are known to be an initial symptom in the pathological process that eventually results in PD. Gastrointestinal symptoms may result from the involvement of either the central or enteric nervous systems, or these symptoms may be side effects of antiparkinsonian medications. Weight loss, excessive salivation, dysphagia, nausea/gastroparesis, constipation, and defecation dysfunction all may occur. Increased identification and early detection of these symptoms can result in a significant improvement in the quality of life for PD patients.

Clinical spectrum of levodopa-induced complications

The first years of Parkinson disease (PD) treatment are marked by good and sustained responses to dopaminergic therapy. With disease progression and longer exposure to levodopa (l-dopa), patients develop a range of l-dopa-induced complications that include motor and non-motor symptoms. Motor complications include motor fluctuations, characterized by periods of reduced benefit from the medication, and l-dopa-induced dyskinesia, characterized by emergence of hyperkinetic involuntary movements. Dyskinesia can occur at peak effect of l-dopa, at the beginning and end of dose, or between doses. These motor complications are often associated with fluctuations in non-motor symptoms, particularly fluctuations in neuropsychiatric, autonomic, and sensory symptoms. Recognizing such complications and understanding their relationship with the timing of l-dopa doses is essential for adequate diagnosis and management. Society.

Characterization of corticobulbar pharyngeal neurophysiology in dysphagic patients with Parkinson's disease

BACKGROUND & AIMS

Dysphagia in patients with Parkinson's disease, persisting despite dopaminergic treatment, affects intake of nutrients and medication, and reduces quality of life (QOL). We investigated the neurophysiologic mechanisms that contribute to dysphagia in these patients, on and off L-3,4-dihydroxyphenylalanine (levodopa), using transcranial magnetic stimulation.

METHODS

We studied 26 patients with Parkinson's disease (age, 65 ± 9 y; 10 men). Dysphagia and QOL were first assessed with qualitative questionnaires. Twelve hours after patients were taken off levodopa, they underwent cortical transcranial magnetic stimulation mapping of the pharyngeal musculature and trigeminal (bulbar) transcranial magnetic stimulation, as well as videofluoroscopy to examine swallowing. The analyses were repeated after administration of levodopa.

RESULTS

Eleven patients initially reported dysphagia and reduced QOL scores. Videofluoroscopy identified 10 patients with swallowing impairments on and off levodopa, and 6 patients with swallowing impairments only on levodopa; the remaining 10 subjects showed no swallowing impairments, on or off the drug. While patients were on levodopa, those with swallowing impairments had bilateral increases in pharyngeal cortical excitability compared with those with no swallowing impairment (P < .05). By contrast, with medication, amplitudes of brainstem reflexes were altered only in patients with swallowing impairments on levodopa; these were decreased compared with when the patients were off levodopa.

CONCLUSIONS

In patients with Parkinson's disease, dopaminergic medications such as levodopa can negatively affect swallowing. The increased cortical excitability observed in dysphagic patients after they begin taking levodopa likely results from compensatory mechanisms, perhaps secondary to subcortical disease, because we observed associated inhibition of brainstem reflexes in patients with affected swallowing on medication. UK clinical trials registration no., 9882.

Electrophysiological evaluation of oropharyngeal Dysphagia in Parkinson's disease

Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings.

Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia

A Doença de Parkinson apresenta grande incidência na população idosa, gerando comprometimento motor progressivo, que afeta várias funções, dentre as quais se destaca a deglutição. Esse trabalho teve como objetivo relacionar a disfagia na Doença de Parkinson aos efeitos imediatos e/ou tardios do tratamento medicamentoso, que de forma direta ou indireta interferirá no gerenciamento fonoaudiológico. Fizemos uma revisão de literatura nas bases de dados eletrônicas Lilacs, Scielo, Medline e Pubmed no período de 2001 a 2011, utilizando os termos livres “Doença de Parkinson”; (Parkinson Disease), “deglutição”; (deglutition), “disfagia”; (dysphagia), “preparações farmacêuticas”; (pharmaceutical preparations), “levodopa”;, “videofluoroscopia”; (videofluoroscopy), além de um documento governamental (OPAS, 2002), artigos relevantes e exemplares da literatura americana e brasileira sobre o tema. A literatura aponta a Levodopa como o principal tratamento farmacológico da doença de Parkinson. Contudo, a melhora dos sintomas motores deve ser ponderada em função da ocorrência de efeitos colaterais importantes, sejam imediatos ou tardios. Até o momento não há respostas consistentes a favor da melhora da disfagia como resultado do tratamento farmacológico, cujos efeitos podem interferir direta ou indiretamente sobre as manifestações disfágicas e de várias formas. Assim, torna-se fundamental o registro das medicações como parte da anamnese, considerando que tais dados possam auxiliar na orientação/reorientação da conduta fonoaudiológica, especialmente em contexto interdisciplinar. A despeito da possibilidade do doente de Parkinson responder de forma inconsistente à terapia farmacológica, vale ressaltar que o profissional deve estar atento à presença de efeitos colaterais como fatores modificadores do quadro de disfagia orofaríngea na Doença de Parkinson idiopática.

Relação entre disfagia e tipos clínicos na doença de Parkinson

A disfagia é um sintoma comum na doença de Parkinson, porém a causa e o mecanismo permanecem obscuros. Sabe-se que manifestações disfágicas podem provir de sintomas motores característicos da doença de Parkinson. Sendo assim, o estudo tem como objetivo investigar se a literatura indica a relação entre disfagia e os tipos clínicos (sintomas predominantes) na doença de Parkinson, e se a Levodopa influencia na deglutição desses pacientes. A busca foi realizada utilizando as bases de dados: portal da Bireme (Medline, Lilacs, Ibecs, Scielo, Biblioteca Cochrane, entre outros bancos desse portal) e portal Pubmed. Não houve restrição quanto ao ano de publicação e idioma. Os descritores utilizados foram: Parkinson or Parkinsonism and Deglutition or Swallowing or Swallow and Dysphagia and Levodopa. Foram encontrados 29 artigos, dos quais apenas 2 foram incluídos segundo os critérios de elegibilidade. Porém os artigos selecionados não fazem uma relação clara entre a disfagia e os sintomas clássicos da doença de Parkinson, entretanto demonstram resultados que apontam para uma melhora da deglutição após levodopa em alguns pacientes ou em pacientes com discinesia. São necessários novos estudos que possam esclarecer tal pergunta, contribuindo para norteamento de intervenções terapêuticas mais específicas e eficazes.

Qualidade de vida em disfagia na doença de Parkinson: uma revisão sistemática

A doença de Parkinson pode causar distúrbios da deglutição em qualquer fase da doença devido às disfunções dos movimentos. Apesar da diversidade de sintomas, normalmente as alterações iniciais na deglutição do parkinsoniano são despercebidas e podem ocasionar prejuízo na qualidade de vida. Contudo, instrumentos que avaliam a qualidade de vida em disfagia na doença de Parkinson não têm sido sistematicamente estudados. Esta revisão sistemática objetivou identificar a utilização do questionário de Qualidade de Vida em Disfagia para avaliação na doença de Parkinson. Foram incluídos artigos com sujeitos de ambos os sexos e com doença de Parkinson idiopática, e excluídos os artigos de avaliação de tratamento e que apresentaram indivíduos com outra forma de parkinsonismo. Após a busca realizada nos portais da Bireme, Pubmed e Banco de Teses da Capes, foram analisados 30 artigos, dos quais dois foram incluídos depois da aplicação da Escala de Jadad modificada. Os dois artigos evidenciaram que o questionário de Qualidade de Vida em Disfagia é um instrumento seguro e relevante para avaliar alterações da deglutição do parkinsoniano nos domínios do instrumento, exceto no sono. Além disso, o questionário pode indicar uma compreensão da qualidade de vida geral. Sendo assim, a utilização do questionário de Qualidade de Vida em Disfagia contribuiu para avaliação da qualidade de vida em disfagia de sujeitos com doença de Parkinson.

Targeted motor rehabilitation dissociates corticobulbar versus corticospinal dysfunction in an animal model of Parkinson's disease

BACKGROUND

Recent evidence suggests that motor training may be beneficial for slowing the onset of motor impairments in Parkinson's disease (PD).

OBJECTIVE

To examine the impact of targeted rehabilitation on limb motor and cranial motor function and the corresponding corticospinal and corticobulbar circuits in a rodent model of PD.

METHODS

Baseline performance of limb (reaching) and cranial (licking) motor function were established prior to and 6 weeks following unilateral intrastriatal 6-hydroxydopamine (6-OHDA) infusions. Animals then received 6 weeks of limb motor rehabilitation (LMR) or cranial motor rehabilitation (CMR), after which motor performance was reassessed. Intracortical microstimulation (ICMS) was used to generate motor maps of corresponding corticospinal (forelimb) and corticobulbar (tongue) movement representations within the motor cortex ipsilateral to the 6-OHDA infusion. Quantitative tyrosine hydroxylase (TH) immunohistochemistry was performed to determine levels of striatal TH depletion in 6-OHDA animals using near infrared densitometry.

RESULTS

(1) unilateral intrastriatal dopamine depletion impaired both reaching accuracy and lick force; (2) targeted LMR ameliorated impairments in reaching performance; however, CMR did not improve lick force impairments; (3) unilateral dopamine depletion significantly reduced forelimb but not tongue motor map topography; (4) LMR partially restored forelimb motor maps, whereas CMR did not alter tongue motor maps; and (5) significant correlations were observed between skilled reaching accuracy, forelimb motor map area, and TH depletion, but no relationships were revealed for cranial motor function, motor maps, or TH depletion.

CONCLUSIONS

These data demonstrate dissociation between striatal dopamine depletion, limb versus cranial motor function, and targeted motor rehabilitation in a rodent model of PD.

Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease

OBJECTIVE

To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD.

METHODS

For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made.

RESULTS AND CONCLUSIONS

For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.

Influência da levodopa sobre a fase oral da deglutição em pacientes com Doença de Parkinson

Este estudo objetiva realizar levantamento bibliográfico para verificar a possível influência da Levodopa sobre a fase oral da deglutição de indivíduos com Doença de Parkinson. Foi realizado levantamento bibliográfico em periódicos indexados no Science Direct, periódicos Capes, LILACS, SciELO, MedLine e Scopus e livros. Para busca foram utilizados os termos disfagia, medicamentos, levodopa, Parkinson, dysphagia, drugs, swallowing disorders, Parkinson's disease, disfagia, las drogas e enfermedad de parkinson. Foram identificados 16 artigos internacionais e 25 nacionais, após a leitura de todos os artigos identificados foram selecionados 32, utilizaram-se ainda quatro livros e um resumo de anais de congresso. Para tal seleção utilizou-se como critério de inclusão aqueles artigos que considerassem o comprometimento causado pela Doença de Parkinson, especialmente na fase oral da deglutição, bem como os efeitos da levodopa sobre a mesma, e como critério de exclusão a influência do fármaco na fase faríngea, pois geralmente ele parece ter maior efeito na fase oral. Existe discordância na literatura quanto aos possíveis efeitos da Levodopa na deglutição. Quando estes ocorrem, geralmente afetam a fase oral desta função, uma vez que as dificuldades que o portador da Doença de Parkinson já apresenta são maximizadas pela xerostomia decorrente da administração deste fármaco. Em virtude da grande diversidade dos resultados dos estudos encontrados, faz-se necessária a realização de estudos controlados para uma elucidação mais detalhada dos efeitos da Levodopa na deglutição.

Dysphagia in Parkinson's disease is responsive to levodopa

The role of levodopa in the treatment of dysphagia in Parkinson's disease (PD) has recently been questioned. There are good reasons, however, to "question the question." In this essay, evidence from published literature and clinical experience is presented, as well as a critical review of the first meta-analysis to explore this issue. The evidence presented supports the traditional view that PD dysphagia is responsive to levodopa.

Swallowing improvement after levodopa treatment in idiopathic Parkinson's disease: lack of evidence

Swallowing impairment is the main cause of pulmonary infection and death in Parkinson's disease (PD). To date, there is no established effective treatment to restore swallowing function among these subjects. Levodopa is considered the gold standard treatment for motor symptoms in PD but its efficacy in improving oropharyngeal and esophageal dysphagia remains controversial.

Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation

OBJECTIVE

The purpose of the present study was to examine whether there was a negative effect of caudal Zona Incerta deep brain stimulation (cZI DBS) on pharyngeal swallowing function in Parkinson's patients (PD). There are no former reports including swallowing and cZI DBS.

METHODS

Eight patients (aged 49-71 years; median 62) were evaluated pre- and post-operatively, at 6 and 12 months after DBS surgery. Evaluation tools were fiberoptic endoscopic evaluation of swallowing examinations and patients' self-assessments of their swallowing function including a visual analog scale and quality-of-life-related questions. The swallowing protocol included Rosenbek's Penetration-Aspiration Scale, Secretion Severity Scale and parameters for preswallow spillage, pharyngeal residue, and pharyngeal clearance.

RESULTS

There was no clear-cut effect of neurostimulation post-operatively at 6 and 12 months on any of the swallowing parameters except for the preswallow spillage that was slightly worsened in the stimulation on condition 12 months post-operatively. The answers to the self assessment questions did not vary significantly.

CONCLUSIONS

The effect of the stimulation on the swallowing function varied among individuals, but the overall outcome was that cZI DBS did not seem to have a negative influence on swallowing function in the eight patients studied.

Differential sensitivity of cranial and limb motor function to nigrostriatal dopamine depletion

The present study determined the differential effects of unilateral striatal dopamine depletion on cranial motor versus limb motor function. Forty male Long Evans rats were first trained on a comprehensive motor testing battery that dissociated cranial versus limb motor function and included: cylinder forepaw placement, single pellet reaching, vermicelli pasta handling; sunflower seed opening, pasta biting acoustics, and a licking task. Following baseline testing, animals were randomized to either a 6-hydroxydopamine (6-OHDA) (n=20) or control (n=20) group. Animals in the 6-OHDA group received unilateral intrastriatal 6-OHDA infusions to induce striatal dopamine depletion. Six-weeks following infusion, all animals were re-tested on the same battery of motor tests. Near infrared densitometry was performed on sections taken through the striatum that were immunohistochemically stained for tyrosine hydroxylase (TH). Animals in the 6-OHDA condition showed a mean reduction in TH staining of 88.27%. Although 6-OHDA animals were significantly impaired on all motor tasks, limb motor deficits were more severe than cranial motor impairments. Further, performance on limb motor tasks was correlated with degree of TH depletion while performance on cranial motor impairments showed no significant correlation. These results suggest that limb motor function may be more sensitive to striatal dopaminergic depletion than cranial motor function and is consistent with the clinical observation that therapies targeting the nigrostriatal dopaminergic system in Parkinson's disease are more effective for limb motor symptoms than cranial motor impairments.

Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia

OBJECTIVE

To quantitatively measure which dysphagic features, including swallowing time and hyoid bone displacement, would be associated with increased risk of aspiration pneumonia in dysphagic Parkinsonism patients.

DESIGN

Clinical survey.

SETTING

Tertiary care center.

PARTICIPANTS

Patients with Parkinsonism and dysphagia (N=25), referred for videofluoroscopic swallowing study, were recruited by retrospective review of medical records. They were divided into 2 groups according to the history of aspiration pneumonia.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Swallowing time including onset of pharyngeal swallowing, oral transit time and pharyngeal transit time, and maximum hyoid bone displacement including total, horizontal, and vertical displacement during swallowing in thin and thick bariums were recorded.

RESULTS

Patients with history of aspiration pneumonia had significantly longer pharyngeal transit time (4.14 vs 2.31s, P=.038) and onset of pharyngeal swallowing (2.16 vs 1.04s, P=.031) than those without, when swallowing thin barium. Patients with aspiration pneumonia also had significantly longer swallowing time when swallowing thick barium (oral transit time: 7.14 vs 2.33s, P=.018; pharyngeal transit time: 6.39 vs 1.23s, P=.004; onset of pharyngeal swallowing: 5.11 vs .31s, P=.006). There was no significant difference in hyoid bone displacement between the 2 groups.

CONCLUSIONS

Patients with Parkinsonism dysphagia and aspiration pneumonia had longer swallowing time than those without, but there was no difference in displacement of hyoid bone.