Association between Perceived Dysphagia Symptoms and Swallowing Physiology in Parkinson's Disease

Background: Swallowing disorders are prevalent in Parkinson's disease (PD). Swallowing assessment often relies on patient-reported outcome measures (PROMs). Although PROMs and physiologic swallowing measures correlate with disease severity, the relationship between PROMs and physiologic swallowing impairments is unclear. Objectives: Our aim was to (1) delineate the relationship between perceived swallowing symptoms and physiologic swallowing impairments; and (2) determine the relationship between swallowing-related quality of life (QoL) and physiologic impairments. Methods: A total of 31 individuals with PD (mean age = 64.8, standard deviation = 9.4) and dysphagia were recruited. PROMs included the Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Survey (SWAL-QOL) to measure perceived swallowing-related symptoms and QoL, respectively. Participants underwent a Modified Barium Swallow Study (MBSS) to obtain physiologic swallowing measures, including the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS). Multiple linear regression analyses assessed the associations between PROMs and physiologic measures, controlling for disease duration. Results: Perceived swallowing difficulties indicated mild to moderate symptoms (SSQ: 20-871.5), and perceived swallowing-related QoL showed moderate to no impact (SWAL-QOL: 52.5%-100%). Swallowing components oral residue (97%) and delayed pharyngeal swallow (97%) were the most frequently impaired on the MBSImP. Furthermore, 45.2% of participants showed airway invasion (PAS >= 3) in at least one swallow trial. Regression analysis showed significant associations between MBSImP pharyngeal total score with SSQ (P < 0.001, R-2 = 0.49) and SWAL-QOL (P = 0.014, R-2 = 0.36). Conclusions: These findings suggest that PROMs may not fully capture all aspects of physiological swallowing impairments. Relying solely on PROMs may overlook critical swallowing deficits not perceived by the patient, highlighting the need for objective swallowing assessments in PD.