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Tankink M, Horlings CGC, Voermans N, van der Sluijs B, Kessels RPC, van Engelen B, Raaphorst J. Behavioural Impairment and Frontotemporal Dementia in Oculopharyngeal Muscular Dystrophy. J Neuromuscul Dis 2021; 9:129-135. [PMID: 34334411 PMCID: PMC8842748 DOI: 10.3233/jnd-200592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Some patients with Oculopharyngeal Muscular Dystrophy (OPMD) develop frontotemporal dementia (FTD). The prevalence and clinical correlates of behavioural impairment, including FTD, is unknown in OPMD. 24 OPMD patients and their proxies completed a questionnaire concerning behavioural impairment (ALS-FTD-Q). We examined proportions with mild or severe behavioural changes, according to validated cut-off proxy scores. We examined correlations with the Hospital Anxiety and Depression Scale (HADS), the Short Form Health Survey (SF-36), motor symptoms, genotype and disease duration. In this small patient sample, behavioural impairment was present in 29%of OPMD patients; in 17%the severity of symptoms was compatible with bvFTD. Correlations were small to medium.
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Affiliation(s)
- Maurits Tankink
- Department of Neurology, Radboud UniversityMedical Center, EX Nijmegen, the Netherlands
| | - Corinne G C Horlings
- Department of Neurology, Donders Institute forBrain, Cognition and Behaviour, Radboud University Medical Center, EX Nijmegen, the Netherlands.,Department ofNeurology, Medical University Innsbruck, Innsbruck, Austria
| | - Nicol Voermans
- Department of Neurology, Donders Institute forBrain, Cognition and Behaviour, Radboud University Medical Center, EX Nijmegen, the Netherlands
| | | | - Roy P C Kessels
- Donders Institute forBrain, Cognition and Behaviour, Radboud University. HR Nijmegen, TheNetherlands.,Department of MedicalPsychology, Radboud University Medical Center, EX Nijmegen, theNetherlands
| | - Baziel van Engelen
- Department of Neurology, Donders Institute forBrain, Cognition and Behaviour, Radboud University Medical Center, EX Nijmegen, the Netherlands
| | - Joost Raaphorst
- Amsterdam UMC, University ofAmsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, Netherlands
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Nisbet MK, Marshall L. Oculopharyngeal muscular dystrophy (OPMD) and dementia in a 75-year-old female. BMJ Case Rep 2019; 12:12/9/e230521. [PMID: 31537606 DOI: 10.1136/bcr-2019-230521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a relatively rare, adult-onset disorder characterised by proximal limb weakness, progressive eyelid drooping and swallowing difficulties. Preliminary research suggests there could be a link between OPMD and dementia; however, the current literature is relatively limited and inconsistent. This case study describes a 75-year-old female with OPMD, presenting to an older adults community mental health team with memory problems and word finding difficulties. A neuropsychological assessment was carried out. The results of her assessment were difficult to interpret; she demonstrated impairments in most cognitive domains tested and her presentation did not appear to reflect any typical dementia profile. It was thought she was most likely presenting with a dementia; however, the exact aetiology remains unclear. The dementia could be a result of OPMD, vascular changes or both. This report emphasises the need for further research into the possible causal link between OPMD and dementia/cognitive decline.
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Affiliation(s)
| | - Louise Marshall
- Department of Older Adult Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK
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Waito AA, Steele CM, Peladeau-Pigeon M, Genge A, Argov Z. A Preliminary Videofluoroscopic Investigation of Swallowing Physiology and Function in Individuals with Oculopharyngeal Muscular Dystrophy (OPMD). Dysphagia 2018; 33:789-802. [PMID: 29725764 DOI: 10.1007/s00455-018-9904-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Dysphagia is one of the primary symptoms experienced by individuals with Oculopharyngeal Muscular Dystrophy (OPMD). However, we lack understanding of the discrete changes in swallowing physiology that are seen in OPMD, and the resulting relationship to impairments of swallowing safety and efficiency. This study sought to describe the pathophysiology of dysphagia in a small sample of patients with OPMD using a videofluoroscopy examination (VFSS) involving 3 × 5 mL boluses of thin liquid barium (22% w/v). The aim of this study is to extend what is known about the pathophysiology of dysphagia in OPMD, by quantifying changes in swallow timing, kinematics, safety, and efficiency, measured from VFSS. This study is a secondary analysis of baseline VFSS collected from 11 adults (4 male), aged 48-62 (mean 57) enrolled in an industry-sponsored phase 2 therapeutic drug trial. Blinded raters scored the VFSS recordings for safety [Penetration-Aspiration Scale (PAS)], efficiency [Normalized Residue Ratio Scale (NRRS)], timing [Pharyngeal Transit Time (PTT), Swallow Reaction Time (SRT), Laryngeal Vestibule Closure Reaction Time (LVCrt), Upper Esophageal Sphincter Opening Duration (UESD)], and kinematics (hyoid movement, pharyngeal constriction, UES opening width). Impairment thresholds from existing literature were defined to characterize swallowing physiology and function. Further, Fisher's Exact tests and Pearson's correlations were used to conduct a preliminary exploration of associations between swallowing physiology (e.g., kinematics, timing) and function (i.e., safety, efficiency). Compared to published norms, we identified significant differences in the degree of maximum pharyngeal constriction, hyoid movement distance and speed, as well as degree and timeliness of airway closure. Unsafe swallowing (PAS ≥ 3) was seen in only 3/11 patients. By contrast, clinically significant residue (i.e., NRRS scores ≥ 0.09 vallecular; ≥ 0.2 pyriform) was seen in 7/11 patients. Fisher's Exact tests revealed associations between prolonged SRT, PTT, and unsafe swallowing. Weak associations were also identified between post-swallow residue and poor pharyngeal constriction during the swallow. Detailed analysis of swallowing physiology in this series of adults with OPMD aligns with impaired muscular function (e.g., reduced pharyngeal constriction, incomplete laryngeal vestibule closure) associated with the disease, and primary functional challenges with swallow efficiency. Further work is needed to explore a greater range of food and liquid textures, and to identify additional physiological mechanisms underlying swallowing impairment in OPMD.
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Affiliation(s)
- Ashley A Waito
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada
| | - Angela Genge
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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