Effect of an impaired oral stage on swallowing in patients with Parkinson's disease

Abstract

Background and Objective

We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because PD patients frequently exhibit an impaired oral stage of swallowing and the tongue movement affects to oral and pharyngeal stage.

Methods

In total, 201 PD patients (106 men, 95 women; mean age 70.6 ± 8.0 years; median Hoehn-Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70.3 ± 7.8 years) with an OTT +2 standard deviation (0.89+2×0.46) of 1.81 seconds, the PD patients were divided into 167 patients with an OTT < 1.81 seconds and 34 patients with an OTT ≥ 1.81 seconds. Swallowing function was compared between the groups and assessed using logistic regression analysis.

Results

The following factors were significantly associated with oral stage impairment in both groups: tongue-to-palate contact, tongue root-to-posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration, and onset of swallowing reflex. Logistic regression analysis showed that tongue root-to-posterior pharyngeal wall contact, onset of swallowing reflex, and aspiration were independent factors.

Conclusions

PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD.

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