Swallowing Characteristics and Water Swallow Capacity in Patients with Parkinsonism.
Per Martell, Örjan Skogar, Liza Bergström
PMID 38703231WHAT IT FOUND
Thin water caused aspiration in 39% of patients, versus 12% for thickened liquid and 2% for solids.
Silent aspiration occurred in 28% of the cohort, often without coughing. Swallowing worsened with disease severity, not diagnosis subtype.
Key findings
01Aspiration was significantly more common with thin liquids (IDDSI 0) than with thicker liquids or solids.
02Nearly one-third of patients had silent aspiration, meaning material entered the airway without triggering a cough.
03Swallowing safety and capacity declined significantly with higher disease severity (Hoehn and Yahr stage), but did not differ significantly between parkinsonism diagnoses.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted at a single center in Sweden, which may limit generalizability. Participants were referred for speech pathology evaluation, meaning the cohort likely had a higher prevalence of swallowing issues than all patients with parkinsonism. The Timed Water Swallow Test was omitted for 8 patients who showed major aspiration on FEES, which may skew the data on swallowing capacity. Assessments were performed by a single clinician, and while recordings were re-rated blindly, formal inter-rater reliability testing was not conducted. The study did not include pharyngeal residue in the analysis. Sample sizes for specific parkinsonism subgroups (e.g., atypical forms) were small, limiting comparisons between diagnoses.
Declared interests
The study was funded by Karolinska Institute. No other conflicts of interest were reported.
The easy way to misread this
Do not interpret the lack of significant difference in dysphagia severity between parkinsonism diagnoses (e.g., idiopathic vs. atypical) as evidence that all subtypes have identical swallowing profiles. The study was underpowered for these subgroup comparisons, particularly for the atypical parkinsonism group (n=10), and the Dysphagia Outcome Severity Scale approached significance (p=0.051) across diagnoses.