Objective: The goal of this study was to test the sensitivity and specificity of several airway protective and disease-specific factors for predicting swallowing safety in PD.

Background: Patients with Parkinson’s disease (PD) have progressive and pervasive disorders of airway protection. Recent work has highlighted the relationship among reflex cough, voluntary cough, and swallowing safety. Understanding these relationships in people with PD is essential for preventing aspiration pneumonia in this population.

Methods: Sixty-four participants (44 male) completed measures of voluntary cough, reflex cough, and swallowing safety. Clinical predictors included disease severity, disease duration, cough airflow, and cough sensitivity measures. ROC analysis identified predictors of swallowing safety (PA score) in PD.

Results: Disease duration significantly discriminated between patients with normal and abnormal swallowing safety (p=0.027, sensitivity 71%, specificity 55.4%). Reflex cough sensitivity significantly identified patients who penetrated above the level of the vocal folds versus those with more severe penetration/aspiration (p=0.021, sensitivity 71.0%, specificity 57.6%). Urge-to-cough sensitivity (log-log linear slope) was the only variable which significantly discriminated between patients with penetration versus aspiration (p=0.017, sensitivity 85.7%, specificity 73.2%).

Conclusions: It is important to identify the factors that influence airway protective outcomes in PD because aspiration pneumonia is a leading cause of death. These results identify important factors to consider in the screening of airway protective deficits in PD and highlight the significance of reflex cough testing in these patients.

This abstract is to be presented at the 2016 International Dysphagia Research Society Annual Meeting in Tucson, Arizona, February 26, 2016.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-predictors-of-airway-protective-dysfunction-in-parkinsons-disease/