Dysphagia in Progressive Supranuclear Palsy.
Heather M Clark, Julie A G Stierwalt, Nirubol Tosakulwong and 4 others
PMID 31676923WHAT IT FOUND
In PSP, swallowing problems are mostly oral: tongue control and bolus transport are impaired, and pharyngeal swallow starts late.
Airway protection and pharyngeal clearance were often spared, and few reported changing food textures. Higher PSP severity tracked worse oral and pharyngeal scores.
Key findings
01Oral phase impairment was more severe than pharyngeal phase impairment, with disrupted bolus transport seen in 76% of participants and delayed pharyngeal swallow in 76%.
02Pharyngeal impairment was often mild, with median Pharyngeal Total Sum score 2 out of 31, and no participant was recommended for non-oral nutrition.
03Disease severity showed weak but statistically significant correlations with oral and pharyngeal impairment scores, including r=0.42 (p=0.009) and r=0.41 (p=0.01).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
PSP diagnosis was based on clinical criteria, not autopsy confirmation. The cohort was heavily weighted toward Richardson Syndrome, so findings may not represent other PSP variants. Small numbers in several variants prevented comparisons between variants. Swallowing ratings were perceptual, so subtle pharyngeal timing problems may have been missed. The paper proposes exercises but does not test whether they improve swallowing. Some pharyngeal and penetration-aspiration measures were excluded from correlation analysis because scores clustered at zero.
Declared interests
The study was funded by NIH. Authors Clark, Stierwalt, Tosakulwong, Botha, and Ali have no conflicts to declare. Drs. Botha, Whitwell, and Josephs receive research support from the National Institute of Health.
The easy way to misread this
Do not treat lingual strengthening or expiratory muscle strengthening as proven treatments for PSP dysphagia. The paper describes swallowing impairment patterns and proposes these ideas, but it did not test whether they help.