Objective: To investigate whether swallowing difficulties are associated with presynaptic dopaminergic deficits, distinct clinical phenotypes, CSF biomarkers as well as whether they can predict motor symptom progression and the development of cognitive impairment in early de novo patients with Parkinson’s Disease (PD).

Background: Swallowing difficulties have a multifactorial pathogenesis that has not been thoroughly elucidated. Impairment of dopaminergic and non-dopaminergic mechanisms, cortical swallowing network and peripheral involvement have been suggested to contribute to the development of swallowing difficulties.

Methods: Using the Parkinson’s Progression Markers Initiative database, we included 398 early de novo PD patients in the analysis. Swallowing difficulties were evaluated using the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale Part-II, Item 2.3 (Chewing and Swallowing). We investigated differences in striatal [123I]FP-CIT single photon emission computed tomography (SPECT) levels, motor and non-motor features and CSF biomarkers in early de novo PD patients with and without swallowing difficulties. 

Results: The prevalence of swallowing difficulties in early de novo PD patients was 12.3% (49/398). PD patients with swallowing difficulties had significant lower [123I]FP-CIT uptakes in the striatum (P=0.016),  caudate (P=0.008) compared to those without swallowing difficulties. The degree of swallowing impairment (MDS-UPDRS-II, item 2.3) and [123I]FP-CIT uptake in the striatum (rs=−0.157; P=0.002) and caudate (rs=−0.156; P=0.002) were significantly correlated. PD patients with swallowing difficulties have increased non-motor symptoms burden compared to those without swallowing difficulties. 

Conclusions: Our findings demonstrate a close relationship between swallowing difficulties and presynaptic dopaminergic function in early de novo PD patients. Such patients, have a significant burden of non-motor symptomatology without prominent motor involvement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/swallowing-difficulties-and-parkinsons-disease/