Have you given up on treating dysphagia in Parkinson's disease?

Abstract

Pneumonia is the most common cause of death in Parkinson's disease (PD), with dysphagia as the presumed cause of death. Patients with PD, who are older than 63.5 years and take more than 475mg/day of L–dopa, are at risk for dysphagia in the pharyngeal phase. However, silent aspiration is common in PD ; thus, patients may not be not aware of the risk of dysphagia. In light of this, these patients must be screened for dysphagia–related complications. Patients with PD complicated by severe oropharyngeal dysphagia have three clinical characteristics : higher modified Hoehn and Yahr stage, low body mass index, and increased difficulty in keeping food or drink in the mouth. Moreover, PD patients with severe oropharyngeal dysphagia are more likely to respond affirmatively to the following questions : “Have you lost weight in the past year?,” “Do you cough when you take some medicines?,” and “Do you have difficulty moving the food in your mouth while eating?” The Swallowing disturbance questionnaire is also useful in identifying PD patients with dysphagia. In the treatment of dysphagia in PD patients, those with poor motor symptoms should first be treated with medication. However, dysphagia in PD is not only an extrapyramidal system abnormality, but also the result of a combination of multiple causes, and does not improve with drug treatment alone. One treatment option is the chine down posture, which is useful in improving swallowing in PD patients, and is more effective when combined with expiratory muscle strength training. Further, some motor swallowing exercises on swallowing dynamic may reduce the difficulty in moving food in the mouth when chewing. Patients who have poor laryngeal elevation should be trained to strengthen the swallowing muscles, whereas those with delayed swallowing reflex onset, liquid food should be thickened to slow its passage through the pharynx. Additionally, PD patients with severe dysphagia should be considered for gastrostomy, for medication and nutritional management.