Objective: The purpose of the present study is to investigate characteristic patterns of swallowing problems in each clinical entity of parkinsonism including Parkinson’s disease (PD) by means of the video-fluorography (VF) study.

Background: Dysphagia is a common complication of the later stages of PD. Once prominent swallowing problems manifest themselves in a patient with PD, he cannot intake not only nutrition but also antiparkinsonian drugs which could potentially ameliorate his swallowing function itself. Swallowing consists of 4 steps; the cognitive phase, the oral phase, the pharyngeal phase, and the esophageal phase. However, it has not been fully clarified which swallowing steps are impaired in each category of parkinsonism. We, therefore, tried to elucidate characteristics of dysphagia in patients with PD and other diseases.

Method: Sixteen patients (7 males and 9 females) who were admitted to our hospital (from Jan. 2016 to Jan. 2019) were studied. The subjects included PD (n=9), dementia with Lewy body (DLB, n=4), 2 progressive supra-nuclear palsy (PSP, n=2), and multisystem atrophy (MSA-P, n=1). Mean modified Hoehn and Yahr scale of these PD patients was 4.1+0.8, and their mean levodopa dose was 767+209 mg. Before the VF study, we made the neurological examination and a screening test for dysphagia with the modified mater swallowing test (MWST) using 3 mL of cold water. Then, we performed VF using fluorescent contrast medium, and checked residual medium in the epiglottis valley and the piriform recesses.

Results: Among 9 PD patients, swallowing problems were found in the pharyngeal phase (89%), the oral phase (44%), the cognitive phase (22%), and the esophageal phase (11%). In these PD patients, residual medium was frequently detected in the epiglottis valley (89%) and in the piriform recesses (75%). On the other hand, in the patients with DLB, problems were detected mainly in the cognitive phase (75%) and in the oral phase (50%). Both patients with PSP had problems in the cognitive phase, because their vertical gaze movements of the eyes were disturbed.

Conclusion: In the PD patients, swallowing problems were detected in all phases, especially in the pharyngeal phase, while significant problems in the cognitive phase were observed in the DLB patients or in the PSP. These data suggested that useful strategies for dysphagia could be varied in each entity of parkinsonism.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-swallowing-function-by-video-fluorography-in-patients-with-parkinsonism/