Umemoto George, Furuya Hirokazu
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Japan.
Department of Neurology, Kochi Medical School, Kochi University, Japan.
Intern Med. 2020 Jan 1;59(1):7-14. doi: 10.2169/internalmedicine.2373-18. Epub 2019 Apr 17.
Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.
通过治疗中风患者的经验，人们提出了各种吞咽困难的康复方法。尽管这些患者中的大多数在短期内恢复了吞咽功能，但帕金森病（PD）和帕金森相关疾病（PRD）中的吞咽困难会随着疾病进展而恶化。肌肉僵硬和运动迟缓被认为是吞咽功能障碍的原因，并且难以轻易地将中风的康复策略应用于PD患者的吞咽困难康复。疾病严重程度、体重减轻、流口水和痴呆是重要的临床预测指标。隐性误吸是一种可能导致吸入性肺炎的特征性体征。重度PD患者需要常规的视频荧光吞咽造影检查或视频内镜检查，以调整其食物和液体的黏稠度。PRD患者的吞咽功能障碍进展迅速。由于误吸风险增加和口服营养给药困难，应考虑营养支持联合鼻胃管喂养或经皮内镜下胃造口术喂养。
