Objective: Swallow and speech disturbances are common in patients with atypical parkinsonism. The emergence of swallowing problems, or dysphagia, is associated with increased morbidity and mortality among all Parkinsonian patients. However, to date it is unclear at what point in the disease process that these patients develop dysphagia. The goal of this study was to determine whether certain UPDRS items correlate with dysphagia, and thus may be used as indicators of when patients should be referred for swallow evaluation and management.

Methods: A retrospective chart review was conducted to identify patients with atypical parkinsonism seen at a tertiary movement disorders center who had undergone a videofluoroscopic swallowing evaluation. Swallowing safety was assessed with the penetration-aspiration score (PAS) observed during a sequential swallow task. For each patient group, the PAS was compared to the total UPDRS score as well as the Part 2 individual swallowing, speech, salivation and cognition items using two-tailed Spearman’s rho (rs) correlations, with alpha level set at p < 0.05.

Results: Twelve (12) participants with corticobasal syndrome (CBS), 17 with progressive supranuclear palsy (PSP) and 21 with multiple systems atrophy (MSA) were included. The disease groups were not significantly different in terms of age (mean: 69.9 +/-7.6 years), disease duration (mean: 4.3 +/- 1.7 years), Hoehn & Yahr stage (median: 3; range 1-5), or PAS score (median: 2, range 1-8). For the CBD group, there were no significant correlations between the speech, swallow, salivation, cognition or total UPDRS items and swallowing safety. For the PSP and MSA groups, the PAS had a moderate positive correlation with cognition (PSP: rs = .542, p = .030; MSA: rs = .473, p = .035).

Conclusions: These results indicate that for all patient groups studied, the UPDRS swallowing item is not a sufficient indicator of whether a patient actually has dysphagia. These patients may benefit from an early swallow assessment despite not having subjective swallow complaints. For individuals with PSP and MSA, a higher reported score on the cognition UPDRS question correlates significantly with decreased swallowing safety, and thus may be a good subjective indicator that the patient is at an increased risk for dysphagia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/subjective-report-does-not-predict-objective-swallow-impairment-in-atypical-parkinsonian-syndromes/