Objective: We hypothesized that decreased cough sensitivity is crucial to the development of aspiration pneumonia in Parkinson’s disease (PD). We examined the relationship between cough sensitivity and aspiration pneumonia, and brain regions that are associated with a decrease cough sensitivity in PD.

Background: Although aspiration pneumonia is the most common cause of death in PD, however the pathogenesis of aspiration pneumonia is not fully validated.

Method: We recruited 127 patients with PD (male, 51%; mean age, 73.2±7.3 years; mean disease duration, 10.1±5.3 years). We evaluated cough sensitivity using citric acid induced cough test and regional cerebral blood flow (rCBF) using I-123 IMP-SPECT. The concentration of citric acid that induced cough was compared between patients with and without the history of aspiration pneumonia and healthy controls (n = 11, 116 and 19, respectively). Among patients without the history of aspiration pneumonia, the interval from the cough test to the development of aspiration pneumonia in 18 months was compared between patients with and without a decrease in cough sensitivity using survival time analysis. Furthermore, rCBF were compared between the two groups using voxel-wise analysis.

Results: Cough sensitivity in patients with the history of aspiration pneumonia was significantly decreased (one-way ANOVA P<0.001). Among patients without the history of aspiration pneumonia, 32 patients (29%) had decreased cough sensitivity. Kaplan-Meier analysis demonstrated that decreased cough sensitivity was a significant predictor of shorter latency to aspiration pneumonia (Log-rank P=0.009). There was a significant decrease in rCBF in the left angular gyrus in patients with decreased cough sensitivity as compared with patients without it (two sample t-test Puncorrected<0.001).

Conclusion: Decreased cough sensitivity attributes aspiration pneumonia and it might be associated with cortical dysfunction in the left angular gyrus in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cough-sensitivity-and-aspiration-pneumonia-in-parkinsons-disease/