Objective: To assess the predictive performance of clinical measures, including dopamine transporter (DaT) imaging, for identifying aspiration risk in patients with Parkinson’s disease (PD).

Background: Dysphagia often leads to aspiration, a critical complication associated with increased mortality in PD. Presently, subjective questionnaires and objective measures are unsuitable for routine implementation owing to time constraints, cost, or insufficient predictive accuracy.

Method: This retrospective study analyzed the data of patients with clinically established PD who underwent both videofluoroscopic swallowing examination (VF) and DaT imaging within a 12-month period. Patients were divided into aspiration and non-aspiration groups based on VF findings and compared using the Mann–Whitney U-test and chi-squared test. Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate the predictive performance of clinical measures. The mean striatal-specific binding ratio (SBRmean) of both hemispheres was used to quantify DaT imaging.

Results: Among a total of 87 patients (38 females; mean age: 64 years; disease duration: 8.3 years; modified Hoehn and Yahr stages: 1–4), 14.9% exhibited aspiration. Only SBRmean was significantly different between the aspiration and non-aspiration groups with respective median values of 1.71 (IQR 1.45–2.80) and 3.08 (IQR 2.49–3.98) (p<0.001). ROC analysis underscored the reliable predictive performance of SBRmean with a sensitivity of 0.62 and specificity of 0.92 at a cutoff of 1.87. Age, sex, disease duration, motor symptoms, nutritional status, cognitive function, and dysphagia awareness had no significant intergroup differences. Logistic regression showed a negative correlation between SBRmean and aspiration (p=0.002). ROC analysis underscored the reliable predictive performance of SBRmean (AUC = 0.79, 95% CI 0.66-0.93) with acceptable sensitivity of 0.62 and a high specificity of 0.92 at a cutoff of 1.87.

Conclusion: Reduced SBR in DaT imaging is a reliable, specific predictive marker of aspiration. These findings can help clinicians identify patients at risk of aspiration, allowing for proactive referral for detailed evaluation. We elucidate the pathophysiology of dysphagia in PD and suggest the critical role of dopaminergic dysfunction in aspiration.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-transporter-imaging-to-predict-the-risk-of-aspiration-in-patients-with-parkinsons-disease/