Objective: To analyze the frequency and severity of swallowing difficulties in patients with Parkinson’s disease (PD) and Parkinsonian syndromes.

Background: Swallowing difficulties are common in patients with PD and Parkinsonian syndromes, especially at more advanced stages of the disease and are generally unresponsive to antiparkinson therapies [Pascal H.H.M. Van Lieshout et al., 2001; Shinagawa S. et al., 2009; Michou E., Hamdy S., 2010; Miller N. et al., 2009]. Aspiration related to swallowing difficulties can lead to aspiration pneumonia, which is a major cause of mortality in PD and Parkinsonian syndromes [Troche M.S. et al., 2010; Johnston B.T. et al., 1995; Litvan I. et al., 1997].

Methods: 230 consecutive patients with idiopathic PD and 37 patients with Parkinsonian syndromes were questioned at time of routine clinic visits.

Results: Swallowing difficulties were observed in 29.57% of PD patients, which was significantly less (p < 0.01) than in patients with Vascular Parkinsonism (VP) (100.0%), Progressive Supranuclear Palsy (PSP) (77.78%) and Multiple System Atrophy (MSA) (76.47%) (Table 1).

Table 1. The frequency and severity of swallowing difficulties in patients with Parkinson’s disease and Parkinsonian syndromes

Disease	Total	Patients with swallowing difficulties	UPDRS, swallowing subscale (all patients)		Statistical significance
	n	%	Average value	Me (LQ; UQ)
Parkinson’s disease	68	29.57	0.39	0 (0; 1)	–
Multiple System Atrophy	13	76.47*	1.53	2 (1; 2)	p < 0.001*
Progressive Supranuclear Palsy	7	77.78*	2.0	2 (1; 3)	p < 0.003*
Dementia with Lewy Bodies	2	40.0	0.6	0 (0; 1)	p > 0.05
Corticobasal Degeneration	2	66.67	0.67	1 (0; 1)	p > 0.05
Vascular parkinsonism	3	100.0*	1.67	2 (1; 2)	p < 0.01*

* – statistical significance from Parkinson’s disease (p < 0.05)” Early onset of dysphagia (in the first 3 years after disease onset) was observed only in 11.3% of PD patients, which was significantly less (p < 0.004) than in patients with PSP (77.78%), VP (66.67%), Corticobasal Degeneration (CBD) (66.67%) and MSA (52.94%) (Table 2).

Table 2. The frequency and severity of swallowing difficulties in patients with Parkinson’s disease and Parkinsonian syndromes in the first 3 years after disease onset

Disease	Total	Patients with swallowing difficulties	UPDRS, swallowing subscale (all patients)		Statistical significance
	n	%	Average value	Me (LQ; UQ)
Parkinson’s disease	26	11.3	0.11	0 (0; 0)	–
Multiple System Atrophy	9	52.94*	0.71	1 (0; 1)	p < 0.001*
Progressive Supranuclear Palsy	7	77.78*	1.78	2 (1; 3)	p < 0.001*
Dementia with Lewy Bodies	2	40.0	0.6	0 (0; 1)	p > 0.05
Corticobasal Degeneration	2	66.67*	0.67	1 (0; 1)	p < 0.004*
Vascular parkinsonism	2	66.67*	0.67	1 (0; 1)	p < 0.004*

* – statistical significance from Parkinson’s disease (p < 0.05)” The highest average values of the swallowing subscale of the UPDRS (subscale No. 7) were observed in patients with PSP (2.0 points), VP (1.67 points) and MSA (1.53 points). The lowest average value of the swallowing subscale of the UPDRS was in PD patients, and it was only 0.39 point (Table. 1). Severe swallowing impairments were common signs of PSP (44.44%) and MSA (17.65%) (Figure 1) and can lead to the development of aspiration pneumonia and patient’s death.

Conclusions: The presence and severity of swallowing difficulties can be considered as a differential diagnostic factor between Parkinson’s disease and Parkinsonian syndromes, in early stages of the disease. The results of the videofluoroscopic swallowing study in patients with PSP and MSA mainly identified impairments of the pharyngeal phase of swallowing, leading to aspiration of food. The results obtained by using the videofluoroscopic swallowing study, do not always correlate with clinical data and more severe disturbances were often found by using the videofluoroscopic swallowing study.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/swallowing-difficulties-in-patients-with-parkinsons-disease-and-parkinsonian-syndromes/