Review

. 2022 Mar;269(3):1335-1352.

doi: 10.1007/s00415-021-10739-8. Epub 2021 Aug 21.

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

Giuseppe Cosentino^#^{1

2}, Micol Avenali^#^{3

4}, Antonio Schindler⁵, Nicole Pizzorni⁵, Cristina Montomoli⁶, Giovanni Abbruzzese⁷, Angelo Antonini⁸, Filippo Barbiera⁹, Marco Benazzo¹⁰, Eduardo Elias Benarroch¹¹, Giulia Bertino¹⁰, Emanuele Cereda¹², Pere Clavè^{13

14}, Pietro Cortelli^{15

16}, Roberto Eleopra¹⁷, Chiara Ferrari⁵, Shaheen Hamdy¹⁸, Maggie-Lee Huckabee¹⁹, Leonardo Lopiano²⁰, Rosario Marchese Ragona²¹, Stefano Masiero²², Emilia Michou²³, Antonio Occhini¹⁰, Claudio Pacchetti²⁴, Ronald F Pfeiffer²⁵, Domenico A Restivo²⁶, Mariangela Rondanelli²⁷, Giovanni Ruoppolo²⁸, Giorgio Sandrini¹, Anthony H V Schapira²⁹, Fabrizio Stocchi³⁰, Eduardo Tolosa³¹, Francesca Valentino²⁴, Mauro Zamboni³², Roberta Zangaglia²⁴, Mario Zappia³³, Cristina Tassorelli^{1

34}, Enrico Alfonsi²

Affiliations

¹ Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy.
² Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
³ Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy. micol.avenali@mondino.it.
⁴ Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy. micol.avenali@mondino.it.
⁵ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
⁶ Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
⁷ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁸ Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.
⁹ Azienda Sanitaria Provinciale Agrigento-UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera. Presidio Ospedaliero di Sciacca (AG), Sciacca, Agrigento, Italy.
¹⁰ Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
¹¹ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
¹² Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹³ Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain.
¹⁴ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.
¹⁵ IRCCS Istituto di Scienze Neurologiche, Bologna, Italy.
¹⁶ DIBINEM, University of Bologna, Bologna, Italy.
¹⁷ Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁸ Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Salford Royal Hospital, Salford, UK.
¹⁹ Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand.
²⁰ Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.
²¹ ENT Department, University of Padova, Padua, Italy.
²² Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy.
²³ Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
²⁴ Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
²⁵ Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
²⁶ Department of Neurology, Garibaldi Hospital, Catania, Italy.
²⁷ Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy.
²⁸ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
²⁹ Department of Clinical and Movement Neurosciences, UCL, Queen Square Institute of Neurology, London, UK.
³⁰ University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy.
³¹ Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII), University of Barcelona, Barcelona, Spain.
³² Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy.
³³ Department GF Ingrassia, University of Catania, Catania, Italy.
³⁴ Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.

^# Contributed equally.

PMID: 34417870
PMCID: PMC8857094
DOI: 10.1007/s00415-021-10739-8

Review

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

Giuseppe Cosentino et al. J Neurol. 2022 Mar.

. 2022 Mar;269(3):1335-1352.

doi: 10.1007/s00415-021-10739-8. Epub 2021 Aug 21.

Authors

Affiliations

¹ Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy.
² Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
³ Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy. micol.avenali@mondino.it.
⁴ Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy. micol.avenali@mondino.it.
⁵ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
⁶ Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
⁷ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁸ Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.
⁹ Azienda Sanitaria Provinciale Agrigento-UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera. Presidio Ospedaliero di Sciacca (AG), Sciacca, Agrigento, Italy.
¹⁰ Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
¹¹ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
¹² Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹³ Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain.
¹⁴ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.
¹⁵ IRCCS Istituto di Scienze Neurologiche, Bologna, Italy.
¹⁶ DIBINEM, University of Bologna, Bologna, Italy.
¹⁷ Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁸ Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Salford Royal Hospital, Salford, UK.
¹⁹ Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand.
²⁰ Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.
²¹ ENT Department, University of Padova, Padua, Italy.
²² Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy.
²³ Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
²⁴ Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
²⁵ Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
²⁶ Department of Neurology, Garibaldi Hospital, Catania, Italy.
²⁷ Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy.
²⁸ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
²⁹ Department of Clinical and Movement Neurosciences, UCL, Queen Square Institute of Neurology, London, UK.
³⁰ University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy.
³¹ Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII), University of Barcelona, Barcelona, Spain.
³² Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy.
³³ Department GF Ingrassia, University of Catania, Catania, Italy.
³⁴ Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.

^# Contributed equally.

PMID: 34417870
PMCID: PMC8857094
DOI: 10.1007/s00415-021-10739-8

Abstract

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.

Keywords: Deglutition disorders; Dysphagia; Parkinson's disease; Swallowing disorders.

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Conflict of interest statement

The authors report no disclosures relevant to the manuscript.

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References

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

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

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Conflict of interest statement

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