Objective: To evaluate (1) Time to hospitalisation for pneumonia/choking in Parkinson’s disease (PD) patients. (2) Demographic and clinical features that associated with pneumonia/choking.

Background: Dysphagia is a common symptom in PD and can result in pneumonia. Information about predictors of pneumonia in PD patients is limited and will be useful for management.

Methods: A total of 202 PD patients, attending the PD Clinic of National Neuroscience Institute at Tan Tock Seng Hospital, who had completed a video fluoroscopy (VFS) from 1 Jan 2010 till 31 Dec 2014 were recruited. After an objective VFS assessment, patients were recommended to have either oral feeding with normal or modified diets; enteral feeding; or oral feeding after rejecting recommended enteral feed. Baseline clinical and demographic variables were compared between feeding groups. Retrospective review of medical record regarding admission of pneumonia/choking was performed. Kaplan-Meier survival analysis was used to estimate median time to development of pneumonia/choking. Cox regression analysis was applied to identify clinical variables significantly associated with pneumonia free survival.

Results: Pneumonia was diagnosed in 89 of 202 patients (44%), with the highest admission rate in enteral feeding group (62%), followed by rejected enteral feeding (57%) and oral feeding (38%) groups. The estimates of median time to event were 47, 14 and 11 months for oral, enteral, and rejected enteral feeding, respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest hazard of pneumonia and choking (HR 4.66, 95% CI 2.37-9.18, p < 0.001), followed by enteral feeding group (HR 2.30, 95% CI 1.26-4.20, p = 0.007), when compared to oral feeding group after adjusting for gender, comorbidity index, disease duration, Hoehn & Yahr stage and depression. The hazard ratio (HR) between rejected enteral and enteral feeding group was not significantly different. A stepwise Cox regression showed that the independent predictors for pneumonia free survival were enteral mode of feeding (HR 2.17, 95% CI 1.24-3.78, p = 0.006), rejected enteral feeding (HR 3.89, 95% CI 2.07-7.33, p < 0.001) and Charlson weighted index of co-morbidity (HR 1.31, 95% CI 1.17-1.46, p < 0.001).

Conclusions: PD patients who rejected enteral feeding had the highest hazard of pneumonia/choking with shortest median time to the event, followed by the enteral feeding group.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/risks-and-predictive-factors-for-pneumonia-amongst-parkinsons-disease-patients-with-dysphagia/