A Multinational Consensus on Dysphagia in Parkinson’s Disease: Screening, Diagnosis and Prognostic Value
Journal of Neurology
Cosentino, G., Avenali, M., et al. (2022).
Journal of Neurology, 269(3), 1335-1352.
This systematic explores best practice in the screening and assessment of dysphagia in individuals with Parkinson's disease.
IRCCS Mondino Foundation (Italy)
January 1990 to February 2021
Peer-reviewed articles
85
<div>Findings demonstrated that:</div>
<ul>
<li><span style="color: #333333;">Patients with Parkinson’s disease with positive screening for dysphagia should undergo an in-depth swallowing evaluation by a speech-language pathologist with training in dysphagia (Class II-IV Evidence and Expert Opinion).</span></li>
<li><span style="color: #333333;">Clinical dysphagia evaluations should include thorough examination of the cranial nerves, evaluation of dry swallows, reflexive and on-command cough testing, evaluation of swallows with various food and liquid consistencies, and investigation of potential signs and symptoms of reduced swallowing efficiency or safety. Assessment of cognition and speech should be conducted in conjunction with clinical swallow evaluation (Class II- IV Evidence and Expert Opinion). </span></li>
<li><span style="color: #333333;">In case</span><span style="color: #333333;"> of motor fluctuations, the swallowing evaluation should be performed during an ON Phase (i.e., peak performance, with coordination of medication regimen). In cases of cervical-cranial dyskinesias, clinical evaluation should preferably be conducted during both ON and OFF phases, but not during a period of exacerbation, in order to determine optimal swallowing safety (Class II, III, & IV Evidence and Expert Opinion).</span></li>
<li><span style="color: #333333;">Meal-time observation with assessment of a higher number of swallowing acts, information regarding feeding dependency and meal duration may be valuable, but often times not feasible in the outpatient setting. Information may be gathered by patient and carepartner report (Class II-IV Evidence and Expert Opinion).</span></li>
<li><span style="color: #333333;">Patients with deep brain stimulator (DBS) implants should be tested in an ON medication phase with the stimulator turned on, with assessment also with the DBS off in cases of strong suspicion for detrimental effects of DBS on swallowing. Assessment OFF medication phases should be also tested in selected patients in which detrimental interactions between different DBS and medication states are suspected (Class II-IV Evidence and Expert Opinion). </span></li>
<li><span style="color: #333333;">When clinical evaluation suggests the presence of dysphagia, patients should undergo an instrumental investigation for the assessment of swallowing by either Fiberoptic Endoscopic Evaluation of the Swallow (FEES) or Videofluoroscopy Study of Swallowing (VSS; Class I-IV Evidence and Expert Opinion). </span></li>
<li><span style="color: #333333;">On suspicion of esophageal disorders, patients should be referred for further investigations by gastroenterology (Class I-IV Evidence and Expert Opinion). </span></li>
<li><span style="color: #333333;">Electrophysiological evaluation of oropharyngeal swallowing might provide further insights into the pathophysiological basis of dysphagia in PD and give useful clues for treatment (Class I-IV Evidence and Expert Opinion).</span></li>
</ul>
<div>Swallowing severity may be assessed by the the Functional Oral Intake Scale (FOIS), the Dysphagia Outcome and Severity Scale (DOSS) and/or the Penetration-Aspiration Scale (PAS) alongside instrumental evaluation (Expert Opinion).</div>
<div>If unable to access dysphagia-related QoL scales validated for PD, the [Swallowing Quality of Life (SWAL-QOL)] scale can be used to measure quality of life impacts of dysphagia secondary to PD. The 39-item Parkinson’s disease Questionnaire (PDQ39) is validated for individuals with PD and can be used for indirectly evaluating the impact of dysphagia (Class II-IV Evidence and Expert Opinion).</div>
<div>Findings demonstrated that:</div>
<ul>
<li><span style="color: #333333;">Dysphagia screening is always recommended for individuals with Parkinson's disease if signs or symptoms of dysphagia are detected, with re-evaluation at least once a year (Class II, III, and IV Evidence).</span></li>
<li><span style="color: #333333;"> Dysphagia may be expected if patients endorse a history of difficulty swallowing foods and drinks or a history of having ever choked on food (Class I, III, and IV Evidence). </span></li>
<li><span style="color: #333333;">Dysphagia may also be expected if there is the presence of increased eating time, post-swallowing coughing, post-swallowing gurgling voice, drooling, choking, breathing disturbance, unintentional weight loss, difficulty swallowing pills, globus sensation, and/or pneumonia episodes (Class I, III, and IV Evidence). </span></li>
<li><span style="color: #333333;">The Swallowing Disturbance Questionnaire (SDQ) "represents the most appropriate self-reported" (p. 1342) screening test for dysphagia with a sensitivity of 80.5% and specificity of 81.3% (Class III and IV Evidence and Expert Opinion). </span></li>
<li><span style="color: #333333;">The Munich Dysphagia Test-Parkinson’s disease (MDT-PD) test, Swallowing Clinical Assessment Score in Parkinson’s disease (SCAS-PD), and the Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) may be also considered valid questionnaire-based tools for dysphagia screening in PD (Class III and IV Evidence and Expert Opinion).</span></li>
</ul>
