Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Department of Rehabilitation, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Dysphagia. 2024 Oct;39(5):905-915. doi: 10.1007/s00455-024-10672-8. Epub 2024 Feb 6.
Airway invasion is common in patients with Parkinson's disease (PD) and can cause serious complications. However, a PD-related dysphagic pattern has not been clearly elucidated. In this study, 53 patients with early to moderate PD were enrolled to undergo a videofluoroscopic study of swallowing evaluation (VFSS) and a battery of neuropsychological assessments. A set of VFSS variables (three visuoperceptual, nine temporal, and six spatial) were measured. The main effects of bolus viscosity and volume on airway invasion were calculated. Statistical analyses were performed to determine key kinematic factors of airway invasion for swallowing each bolus type. Airway invasion frequency was significantly higher for liquid boluses (liquid vs. pudding P < 0.001; liquid vs. honey P = 0.006). Laryngeal vestibule closure reaction time (LVCrt) was the key kinematic factor of airway invasion for 3 ml liquid swallow (P = 0.040), anterior displacement of hyoid bone was the key kinematic factor for both 5 ml and 10 ml liquid swallows (P = 0.010, 0.034, respectively). Male sex and advanced Hoehn and Yahr stage were significantly related to reduced anterior displacement of hyoid bone. These results reveal the dysphagic pattern related to PD, demonstrating that prolonged LVCrt and reduced anterior displacement of hyoid bone are two crucial kinematic factors contributing to airway invasion during the liquid swallow. In addition, hyoid bone dysfunction was correlated with disease severity and male sex. Our findings warrant further investigation of the pathophysiological mechanism of dysphagia in PD and would guide clinical intervention.
气道侵犯在帕金森病（PD）患者中很常见，并可能导致严重的并发症。然而，PD 相关的吞咽困难模式尚未得到明确阐明。在这项研究中，纳入了 53 名早期至中度 PD 患者进行吞咽评估的视频荧光透视检查（VFSS）和一系列神经心理学评估。测量了一组 VFSS 变量（三个视知觉、九个时间和六个空间）。计算了食团粘度和体积对气道侵犯的主要影响。进行了统计分析，以确定吞咽每种食团类型时气道侵犯的关键运动学因素。对于液体食团，气道侵犯的频率明显更高（液体与布丁 P<0.001；液体与蜂蜜 P=0.006）。声门裂闭合反应时间（LVCrt）是 3ml 液体吞咽时气道侵犯的关键运动学因素（P=0.040），舌骨的前向位移是 5ml 和 10ml 液体吞咽时的关键运动学因素（P=0.010，0.034）。男性和更高级别的 Hoehn 和 Yahr 分期与舌骨前向位移减少显著相关。这些结果揭示了与 PD 相关的吞咽困难模式，表明延长 LVCrt 和减少舌骨前向位移是导致液体吞咽时气道侵犯的两个关键运动学因素。此外，舌骨功能障碍与疾病严重程度和男性有关。我们的发现需要进一步研究 PD 吞咽困难的病理生理机制，并指导临床干预。
