Battista Petronilla, Aresta Simona, Tagliente Serena, Merlo Federico, Mongelli Davide, Lagravinese Gianvito, Falcone Rosanna, Palmirotta Cinzia, Turi Gilda, Castellari Micol, Zonno Alessandra, Gelao Christian, Picciola Emilia, Fiore Pietro, Battel Irene, Minafra Brigida
Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy.
Dysphagia. 2025 Feb;40(1):292-304. doi: 10.1007/s00455-024-10728-9. Epub 2024 Jun 29.
Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD.
约80%的帕金森病(PD)患者存在吞咽困难症状。尽管认知障碍可能导致吞咽困难,但很少有研究调查PD神经心理学特征与吞咽功能障碍客观指标之间的关联。由于吞咽功能包括非自主和自主动作,我们推测在PD相关吞咽困难中可突显注意力和执行功能的特定指标。因此,本研究的目的是广泛调查PD患者注意力和执行功能与吞咽咽部阶段安全性/效率之间的相关性及关系。所有参与者均接受了吞咽的纤维内镜评估,并使用渗透误吸量表(PAS)、耶鲁咽部残留严重程度评定量表(IT - YPRSRS)和功能性经口进食量表(FOIS - IT)进行评估。参与者还接受了涵盖整体认知状态、注意力和额叶执行功能的神经心理学评估。计算神经心理学指标与吞咽各成分之间的相关性和关联性。21名PD患者(平均年龄69.38±6.58岁,平均病程8.38±5.31年;平均MDS - UPDRS III评分为43.95±24.18)完成了所有评估。在注意力功能(即斯特鲁普测验时间)、执行功能(即瑞文渐进性矩阵测验、数字倒背和语义流畅性测验)与FOIS - IT、PAS以及IT - YPRSRS中的鼻窦和梨状窝之间发现了最显著的相关性。这些关联不受病程影响。这些结果表明,注意力过程和/或执行功能障碍可能导致中期PD患者出现误吸和咽部残留。