Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management.
C K Broadfoot, D Abur, J D Hoffmeister and 2 others
PMID 32104723WHAT IT FOUND
Parkinson disease commonly affects swallowing and speech, but patients often do not report it.
Objective assessment is needed. Medication and deep brain stimulation do not reliably improve these symptoms, while behavioral therapy can help short term.
Key findings
01Clinician-administered swallowing assessments found signs of dysphagia in 82% of individuals with Parkinson disease, while questionnaires or interviews found dysphagia in 35%.
02Dopaminergic medication does not consistently improve swallowing, and speech intelligibility has been consistently reported to reduce after subthalamic nucleus deep brain stimulation.
03Expiratory muscle strength training improved swallowing kinematics and reduced airway invasion, and behavioral speech therapy has short-term benefits that can lessen over time.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review, so it does not describe how studies were searched or selected. People with Parkinson disease vary in phenotype, medication, motivation, and disease stage, so the reviewed findings do not apply equally to every patient. Some cited therapy studies were small and included patients with little baseline airway compromise, so they do not show benefit in severe dysphagia. Effects of deep brain stimulation on speech are inconsistent and depend on target, baseline intelligibility, and surgical procedure. Follow-up speech intensity gains are small and can be near measurement error, so long-term functional benefit is unclear.
Declared interests
The authors declare no relevant conflicts of interest. The supplied text does not state a funding source.
The easy way to misread this
Do not assume a patient with Parkinson disease has no swallowing problem because they do not complain. Less than 10% spontaneously report difficulty, and only 50% admit problems when asked, while clinician-administered assessments found signs in 82%.