Objective: We make a hypothesis that dysphagia of anti-parkinsonian drugs may be associated with motor fluctuation, especially delay on. In this study, we compared videoendoscopy findings of PD patients with delayed on to PD patients without delayed on.

Background: Parkinson’s disease (PD) is second common neurodegenerative disorder next to Alzhemier disease. Although many motor and non-motor symptoms develop as disease progression, development of dysphagia is one of most problems in PD patients. Dysphagia induces aspiration pneumonia that is the leading cause of death. Although several previous videofluorographic studies have demonstrated that PD patients with dysphagia showed abnormal findings in all phases such as oral and pharyngeal phase, there is no study about evaluation of drug swallowing in PD patients.

Methods: Twenity patients (7 men, 13 women) with PD were studied. Age of examination ranged from 49 to 84 years (mean ± SD; 75.4 ± 8.7 years). According to Hoehn and Yahr’s stage, eight patients at stage 3, four patients at stage 4, and five patients at stage 5.

 In motor fluctuation, we notice relationship between dysphagia and delay on. Delay on is defined as taking more than 30 minutes to improvement of parkinsonism after a given treatment dose. We divided these PD patients into three groups: PD patients without delay on, PD patients with delay on, and PD patients in advance stage. To assess swallowing function of drugs, videoendoscopy study was performed. We then compared videoendoscopy findings between these three groups.

Results: Five PD patients include into group without delay on. No (0%) patients showed abonormal findings in videoendoscopy study. Six PD patients include into group with delay on. Three of sixth (50%) patients showed that drug tablet stuck in epiglottic vallecular. One patient showed pool of saliva. Nine PD patients include into group in advance stage. Six of ninth (66%) patients showed that drug tablet stuck in epiglottic vallecular. One patient showed pool of saliva, one patients delayed onset of laryngeal elevation, and another patients showed aspiration.

Conclusions: Detail mechanism of delay on is still unknown. The previous studies have suggested that impairment of gastric motility, and impairment of absorption of levodopa may be associated with delay on. The results of this study suggested that dysphagia of anti-parkinsonian drugs may be also associated with delay on.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/videoendoscopy-study-of-swallowing-in-parkinsons-disease/