Pitts Laura L, Morales Sarah, Stierwalt Julie A G
Department of Communication Sciences & Disorders, University of Northern Iowa, Cedar Falls.
Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Speech Lang Hear Res. 2018 Feb 15;61(2):257-265. doi: 10.1044/2017_JSLHR-S-17-0259.
Swallowing impairment, or dysphagia, is a known contributor to reduced quality of life, pneumonia, and mortality in Parkinson's disease (PD). However, the contribution of tongue dysfunction, specifically inadequate pressure generation, to dysphagia in PD remains unclear. Our purpose was to determine whether lingual pressures in PD are (a) reduced, (b) reflect medication state, or are (c) consistent with self-reported diet and swallowing function.
Twenty-eight persons with idiopathic PD (PwPD) and 28 age- and sex-matched controls completed lingual pressure tasks with the Iowa Oral Performance Instrument. PwPD were tested during practically defined ON and OFF dopaminergic medication states. Participants were also stratified into three sex- and age-matched cohorts (7 men, 5 women): (a) controls, (b) PwPD without self-reported dysphagia symptoms or diet restrictions, and (c) PwPD with self-reported dysphagia symptoms with or without diet restrictions.
PwPD exhibited reduced tongue strength and used elevated proportions of tongue strength during swallowing compared with controls (p < .05) without an effect of medication state (p > .05). Reduced tongue strength distinguished PwPD with self-reported dysphagia symptoms from PwPD without reported symptoms or diet restrictions (p = .045) and controls (p = .002).
Tongue strength was significantly reduced in PwPD and did not differ by medication state. Tongue strength differentiated between PwPD with and without self-reported swallowing symptoms. Therefore, measures of tongue strength and swallowing pressures may serve as clinical indicators for further dysphagia evaluation and may promote early diagnosis and management of dysphagia in PD.
吞咽障碍，即吞咽困难，是帕金森病（PD）患者生活质量下降、肺炎及死亡率升高的一个已知因素。然而，舌功能障碍，特别是压力产生不足，在帕金森病吞咽困难中所起的作用仍不明确。我们的目的是确定帕金森病患者的舌压力是否（a）降低，（b）反映药物状态，或（c）与自我报告的饮食及吞咽功能一致。
28例特发性帕金森病患者（PwPD）以及28例年龄和性别匹配的对照者使用爱荷华口腔功能仪器完成舌压力任务。PwPD在实际定义的多巴胺能药物开期和关期状态下接受测试。参与者还被分为三个年龄和性别匹配的队列（7名男性，5名女性）：（a）对照组，（b）无自我报告吞咽困难症状或饮食限制的PwPD，以及（c）有自我报告吞咽困难症状且有或无饮食限制的PwPD。
与对照组相比，PwPD表现出舌力量降低，且在吞咽过程中使用的舌力量比例升高（p < .05），而不受药物状态影响（p > .05）。舌力量降低可将有自我报告吞咽困难症状的PwPD与无报告症状或饮食限制的PwPD（p = .045）及对照组（p = .002）区分开来。
PwPD的舌力量显著降低，且不因药物状态而异。舌力量在有和无自我报告吞咽症状的PwPD之间存在差异。因此，舌力量和吞咽压力测量可作为进一步吞咽困难评估的临床指标，并可能促进帕金森病吞咽困难的早期诊断和管理。
