Investigation of oropharyngeal dysphagia in Parkinson's disease.
Deglutition; Deglutition Disorders; Evaluation; Parkinson Disease; Neurodegenerative Diseases.
Introduction: Oropharyngeal dysphagia (OD) is a common clinical condition in Parkinson's disease (PD)
and can be present in people with late PD, early-onset Parkinson's disease (PPD) and at any stage of
evolution. The signs and symptoms of this disorder may reflect changes in the efficiency and safety of swallowing to take food from the mouth to the esophagus, as well as being influenced by the decreased function of the tongue during the swallowing process, which can cause risks of penetration and aspiration. Objective: Article 1 aimed to measure the maximum isometric pressure (MIP) of the tongue in different PD stages and whether there was any interference from the decrease in (MIP) of the tongue with changes in the efficiency and safety of swallowing. For article 2, the objective was to identify whether there are changes in swallowing efficiency and safety that signal the presence of oropharyngeal dysphagia in PPD. Method: Article 1 is an analytical, cross-sectional study and article 2 is a case series. To obtain the data, sample characterization protocols, self-assessment of swallowing changes, tongue MIP assessment using a tongue peak pressure transducer and swallowing volume/viscosity test were applied. An exploratory analysis of the data was carried out by calculating simple frequency and percentage with results expressed as mean and standard deviation and subjected to analysis of variance (ANOVA). Normal distribution was assessed using the Shapiro-Wilks test and comparisons between tongue MIP levels, final assessment of the swallowing test, PD stage and interaction between final assessment and stage were performed using the Tukey test. Results of article 1: 50 individuals participated in the study, 22 in the initial stage, 20 in the moderate stage and 8 in the advanced stage. The average PIMax of the tongue was 33.82 kPa (±17.08), which identified the interference of the PD projects in the PIMax of the tongue, but without any influence on changes in swallowing efficiency and safety. Results of article 2: 12 individuals participated in the study, six in the initial stage and six in the moderate stage and among these, only two did not show any sign of change in the efficiency and safety of swallowing. In relation to safety, the change in vocal quality was the most frequent in the volume of 5mL in IDDSI level 0, 2 and 4 consistencies and in efficiency they were: suspected pharyngeal residue and multiple swallowing in IDDSI level 2 and 4 consistencies. Conclusion: Individuals with PD have a decrease in tongue MIP and as the disease progresses, the pressure oftongue tends to decrease, despite this, the efficiency and safety of swallowing were not related to the decrease in tongue MIP. It was also identified that people with PPD in less aggressive stages of the disease showed signs of changes in swallowing, due to the presence of pharyngeal residues.