J.G. Kalf

Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis.

Dysphagia is a potentially harmful feature, also in Parkinsons disease (PD). As published prevalence rates vary widely, we aimed to estimate the prevalence of oropharyngeal dysphagia in PD in a meta-analysis. We conducted a systematic literature search in February 2011 and two independent reviewers selected the papers. We computed the estimates of the pooled prevalence weighted by sample size. Twelve studies were suitable for calculating prevalence rates. Ten studies provided an estimate based on subjective outcomes, which proved statistically heterogeneous (p < 0.001), with a pooled prevalence estimate with random effect analysis of 35% (95% CI 28-41). Four studies provided an estimate based on objective measurements, which were statistically homogeneous (p = 0.23), with a pooled prevalence estimate of 82% (95% CI 77-87). In controls the pooled subjective prevalence was 9% (95% CI 2-17), while the pooled objective prevalence was 23% (95% CI 13-32). The pooled relative risk was 3.2 for both subjective outcomes (95% CI 2.32-4.41) and objective outcomes (95% CI 2.08-4.98). Clinical heterogeneity between studies was chiefly explained by differences in disease severity. Subjective dysphagia occurs in one third of community-dwelling PD patients. Objectively measured dysphagia rates were much higher, with 4 out of 5 patients being affected. This suggests that dysphagia is common in PD, but patients do not always report swallowing difficulties unless asked. This underreporting calls for a proactive clinical approach to dysphagia, particularly in light of the serious clinical consequences.

Allied health care interventions and complementary therapies in Parkinson's disease

Allied health care and complementary therapies are used by many patients with Parkinsons disease (PD). For allied health care, supportive scientific evidence is gradually beginning to emerge, and interventions are increasingly integrated in the treatment programs for PD patients. To evaluate whether such multidisciplinary programs are justifiable, we review the literature of allied health care and complementary therapies in PD. According to the level of available evidence, we provide recommendations for clinical practice. Finally, we discuss the need for an improved organization of allied health care, and identify topics for future research to further underpin the pros and cons of allied health care and complementary therapies in PD.

Dysphagia in facioscapulohumeral muscular dystrophy.

Dysphagia is not considered a symptom of facioscapulohumeral muscular dystrophy (FSHD). In this study, the authors found that dysphagia does occur in patients with advanced FSHD showing mild involvement of the jaw and lingual muscles. Dysphagia is seldom life threatening in these patients. The authors conclude that dysphagia should not be considered an exclusion criterion for FSHD.

Reproducibility and Validity of Patient-Rated Assessment of Speech, Swallowing, and Saliva Control in Parkinson's Disease

OBJECTIVE To report on the development and psychometric evaluation of the Radboud Oral Motor Inventory for Parkinsons Disease (ROMP), a newly developed patient-rated assessment of speech, swallowing, and saliva control in patients with Parkinsons disease (PD). DESIGN Reliability and validity study. SETTING Tertiary-care Parkinson center for multidisciplinary assessment. PARTICIPANTS Consecutive community-dwelling patients with PD (n=129) or atypical parkinsonism (AP; n=49; mean ± SD age, 64±9.8y; mean ± SD disease duration, 7y; median Hoehn and Yahr [HY] stage, 2.5). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES To evaluate reproducibility, 60 patients completed the ROMP twice within a mean of 24±12 days. To study validity, another cohort of 118 patients who had completed the ROMP was assessed by both a neurologist (HY stage, Unified Parkinsons Disease Rating Scale III) and speech-language pathologist (severity of dysarthria, dysphagia, drooling) who were blinded to ROMP scores. RESULTS Confirmatory factor analysis identified the 3 a priori-designed ROMP domains of speech, swallowing, and saliva control. Internal consistency was .95 for the total ROMP and .87 to .94 for the 3 domains or subscales. Intraclass correlation coefficients for reproducibility were .94 and .83 to .92 for the subscales. Construct validity was substantial to good with correlations ranging from .36 to .82. The ROMP differentiated significantly (P<.001) between patients indicated for speech therapy (based on independent assessment) and those who were not and between mild, moderate, and severe PD according to HY stage. CONCLUSIONS The ROMP provides a reliable and valid instrument to evaluate patient-perceived problems with speech, swallowing, and saliva control in patients with PD or AP.

The Radboud Dysarthria Assessment: Development and Clinimetric Evaluation.

Objective: In the absence of an adequate dysarthria assessment in the Netherlands, we developed the Radboud Dysarthria Assessment (RDA). This article describes its development and clinimetric evaluation. Patients and Methods: Forty-three patients were assessed with the RDA. The recording forms were subjected to exploratory factor analysis and estimation of internal consistency. The self-evaluation questionnaire was tested for internal consistency and the severity scale for intra- and inter-rater reliability. Construct validity of the severity scale and questionnaire was determined by relating them to the Speech Handicap Index (SHI), Dutch sentence intelligibility assessment (NSVO-Z), and category fluency task. Results: Exploratory factor analysis extracted 4 factors (articulation, resonance, phonation, respiration/prosody) yielding an explained variance of 70.3%. Each factor showed good internal consistency (Cronbach’s α: 0.89–0.91). The self-evaluation questionnaire showed excellent internal consistency (Cronbach’s α: 0.90). Intra-class correlation coefficients of the severity scale (0.85–0.86) showed good reliability. The severity scores and self-evaluation questionnaire correlated substantially to strongly with the SHI (rs = 0.40 and 0.80) and substantially with the NSVO-Z (rs = –0.65 and –0.52). Conclusions: The RDA is a valid and reliable tool, but further investigation is needed to demonstrate whether this instrument can successfully support speech-language therapists in correctly diagnosing the type of dysarthria.

Author reply to "Oropharyngeal dysphagia in Parkinson's disease: Comments on paper by Kalf et al." by Boot & Chaudhuri

Dear Editor,WehavereadthecommentbyBootandChaudhurionourpaper[1] and highly appreciate their input on this topic. Oropharyngealdysphagia is poorly indexed in databases, so the risk of missingrelevant studies is indeed present. However, we believe that wedid not fail to include key papers which could have led to anotheroutcome of our meta-analysis.While systematically searching for eligible papers for thisreview, we were well aware of the NMSQuest being the new stan-dard of screening for non-motor symptoms in Parkinson’s disease(PD), with an item on swallowing. In fact, we included two studiesusing NMSQuest [2,3] in our meta-analysis, which added signifi-cantly to the overall prevalence rate because of their populationsize.In our first search strategy, we used “deglutition disorders”, theMESH term – which includes “swallowing disorders”–to identifystudies with data on swallowing disorders or dysphagia. We rana second search including “non-motor” as a search term, in orderto find prevalence studies using NMSQuest or SCOAP-AUT. Weincluded the NMSQuest study by Martinez-Martin et al. [2],because this study was explicitly done to report prevalence ratesof non motor symptoms using the NMSQuest, while precedingNMSQuest-studies focussed on the development and validation ofthe instrument.InthissecondsearchwealsofoundtheNMSS-studytheauthorsrefer to in their comment [4], but we did not include this study inour meta-analysis, because it focuses on the psychometric charac-teristics of the instrument, instead of reporting prevalence rates.Finally,wedidmissthestudydemonstratingthenondeclarationof non motor symptoms to health professionals [5]. The dysphagiaprevalence rate in this study was 27% and if included in the meta-analysis, it would have had a small lowering effect on the pooledprevalence rate of 35% based on subjective outcomes. Interestingly,37% of the patients in this study who had scored positive on the‘swallowing’ item had not previously discussed their complaintwith a healthcare professional. This underreporting justifies theroutinely use of questionnaires like NMSQuest and timely referralto a speech-language therapist, as we advocated in our conclusion.References