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

Abstract

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.

Keywords: Parkinson's disease; Parkinson-related disorder; aspiration pneumonia; dysphagia; video endoscopy; video fluoroscopy.

Figure.

The trajectory of tongue movements in video fluoroscopy. Lingual movements to transport the bolus from the oral cavity to the pharynx even in patients with stroke who have an adequate oral function seem to be achieved by the coordination of the dorsum-root of the tongue (a). In contrast, patients with Parkinson’s disease (PD) often show a specific oral phase characterized by lingual pumping without the coordination of the dorsum-root of the tongue and need more time for the transportation of the bolus (b).