Clinical assessment of dysphagia in early phases of Parkinson's disease

Dysphagia is a frequent symptom in parkinsonism, but it is less commonly reported by patients with idiopathic Parkinson's disease (IPD), especially in the early phases. Sixty-five patients with IPD were questioned about symptoms of dysphagia and an objective swallowing test was administered. Reduced swallowing speed for food and complaints of food sticking in the throat, wet voice and cough after liquid intake and nocturnal sialorrhea were reported, respectively, by 35%, 20% and 15% of patients. On objective examination, oral-phase (facial, tongue and palatal musculature) abnormalities were found in 70% of patients. Lingual transfer movements, mainly propulsion, and palatal elevation were severely hypokinetic. Wet voice after liquid intake and cough reflex after solid/liquid intake were detected in 40% of patients. On the other hand, severe dysphagia with frequent food aspiration and chest infections requiring antibiotics in the last 12 months was not found; cough reflex was retained in all patients. On the basis of these results, a regular assessment on swallowing abilities in patients with IPD is warranted in the clinical setting because with simple dietary advice and a short rehabilitative training, the quality of life in these patients can be improved.