Objective: To characterize the nature of dysphagia accompanying progressive supranuclear palsy (PSP).

Background: Dysphagia is a frequent symptom of PSP, typically occurring early in the disease process relative to PD. Most studies describing dysphagia in PSP have included only patient report of presence and/or severity of dysphagia, with a small number of early reports addressing videofluorographic (VF) features of dysphagia in PSP (Johnston et al. 1997). This study expands on previous work by utilizing a nationally standardized protocol for conducting and interpreting the VF assessment.

Methods: As one component of a larger NIH-funded study examining tau imaging in PSP, participants (N=17) underwent VF swallow assessment [table1]. Dysphagia was described using the Modified Barium Swallow Impairment Profile, Penetration-Aspiration Scale, Functional Oral Intake Scale, and patient-reported swallowing-related quality of life (QOL). Analysis included descriptive statistics and correlational analyses.

Results: All participants complained of dysphagia and had detectable swallowing impairment [table2]. Oral phase deficits were more frequent and more severe than pharyngeal phase deficits.  Nearly all participants exhibited disrupted mastication and oral residue. Only one participant demonstrated the tongue-pumping bolus propulsion pattern typical of PD (Tjaden, 2009). Delayed swallow onset, often severe, was common. In contrast, pharyngeal residue was typically mild and aspiration was rare [figure1]. Trace esophageal residue was evident for a small number of subjects. Severity of dysphagia did not strongly correlate with patient-reported QOL or illness duration, but showed a moderate correlation with PSP Rating Scale [table3].

Conclusions: The current data support reports of high incidence of dysphagia in PSP. Patients with PSP demonstrated relatively spared pharyngeal phase swallowing function compared to oral phase and swallow onset impairments. Observed impairments did not always coincide with patient complaints, highlighting the importance of VF studies to characterize the nature of dysphagia and formulate appropriate rehabilitative strategies.

References: Johnston, B. T., J. A. Castell, et al. (1997). “Comparison of swallowing function in Parkinson’s disease and progressive supranuclear palsy.” Movement disorders, 12(3): 322-327.

Tjaden, K. (2008). Speech and Swallowing in Parkinson’s Disease. Topics in Geriatric Rehabilitation, 24(2), 115–126.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dysphagia-in-psp/