Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(01): e41-e47
DOI: 10.1055/s-0039-3402440
Original Research

Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status

Luciana Grolli Ardenghi 
1   Department of Speech Therapy, Universidade de Passo Fundo, Passo Fundo, Brazil
,
Alana Verza Signorini
2   Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
,
Gerson Schulz Maahs
3   Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Fabio Selaimen
2   Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
,
Konrado Massing Deutsch
3   Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Silvia Dornelles
4   Department of Developmental Psychology and Personality Ramiro Barcelos, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Carlos Roberto de Mello Rieder
5   Department of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
6   Department of Neurology, Distúrbios do Movimento, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously.

Objective The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES).

Methods A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS).

Results The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL: p ≤ 0.001; 5 mL: p ≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found.

Conclusion These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.

Keywords

deglutition disorders - Parkinson disease - endoscopy - cognition


Publication History

Received: 18 May 2018

Accepted: 26 October 2019

Article published online:
24 April 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Lees AJ, Hardy J, Revesz T. Parkinson's disease. Lancet 2009; 373 (9680): 2055-2066
    CrossrefPubMedGoogle Scholar
  • 2 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17 (05) 427-442
    CrossrefPubMedGoogle Scholar
  • 3 Fernandes GC, Socal MP, Schuh AFS, Rieder CRM. Clinical and Epidemiological Factors Associated with Mortality in Parkinson's Disease in a Brazilian Cohort. Parkinsons Dis 2015; 2015: 959304 DOI: 10.1155/2015/959304.
    CrossrefPubMedGoogle Scholar
  • 4 Argolo N, Sampaio M, Pinho P, Melo A, Nóbrega AC. Videofluoroscopic Predictors of Penetration-Aspiration in Parkinson's Disease Patients. Dysphagia 2015; 30 (06) 751-758
    CrossrefPubMedGoogle Scholar
  • 5 Felix VN, Corrêa SMA, Soares RJ. A therapeutic maneuver for oropharyngeal dysphagia in patients with Parkinson's disease. Clinics (São Paulo) 2008; 63 (05) 661-666
    CrossrefPubMedGoogle Scholar
  • 6 Malandraki GA, Perlman AL, Karampinos DC, Sutton BP. Reduced somatosensory activations in swallowing with age. Hum Brain Mapp 2011; 32 (05) 730-743
    CrossrefPubMedGoogle Scholar
  • 7 Troche MS, Hubener I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory- Swallowing Coordination and Swallowing Coordination and Swallowing Safety in Patients with Parkinson's Disease. Dysphagia 2011; 26 (03) 218-224
    CrossrefPubMedGoogle Scholar
  • 8 Simons JA, Fietzek UM, Waldmann A, Warnecke T, Schuster T, Ceballos-Baumann AO. Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease. Parkinsonism Relat Disord 2014; 20 (09) 992-998
    CrossrefPubMedGoogle Scholar
  • 9 Simons JA. Swallowing Dysfunctions in Parkinson's Disease. Int Rev Neurobiol 2017; 134: 1207-1238
    CrossrefPubMedGoogle Scholar
  • 10 Sung HY, Park JW, Kim JS. The frequency and severity of gastrointestinal symptoms in patients with early Parkinson's disease. J Mov Disord 2014; 7 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 11 Kalf JG, de Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 2012; 18 (04) 311-315
    CrossrefPubMedGoogle Scholar
  • 12 Pflug C, Bihler M, Emich K. et al. Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study. Dysphagia 2018; 33 (01) 41-50
    CrossrefPubMedGoogle Scholar
  • 13 Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope 2000; 110 (04) 563-574
    CrossrefPubMedGoogle Scholar
  • 14 Tabaee A, Johnson PE, Gartner CJ, Kalwerisky K, Desloge RB, Stewart MG. Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy. Laryngoscope 2006; 116 (05) 821-825
    CrossrefPubMedGoogle Scholar
  • 15 Lord S, Rochester L, Hetherington V, Allcock LM, Burn D. Executive dysfunction and attention contribute to gait interference in ‘off’ state Parkinson's Disease. Gait Posture 2010; 31 (02) 169-174
    CrossrefPubMedGoogle Scholar
  • 16 Plotnik M, Dagan Y, Gurevich T, Giladi N, Hausdorff JM. Effects of cognitive function on gait and dual tasking abilities in patients with Parkinson's disease suffering from motor response fluctuations. Exp Brain Res 2011; 208 (02) 169-179
    CrossrefPubMedGoogle Scholar
  • 17 Wild LB, de Lima DB, Balardin JB. et al. Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson's disease. J Neurol 2013; 260 (02) 580-589
    CrossrefPubMedGoogle Scholar
  • 18 Troche MS, Okun MS, Rosenbek JC, Altmann LJ, Sapienza CM. Attentional resource allocation and swallowing safety in Parkinson's disease: a dual task study. Parkinsonism Relat Disord 2014; 20 (04) 439-443
    CrossrefPubMedGoogle Scholar
  • 19 Brodsky MB, Verdolini Abbott K, McNeil MR, Palmer CV, Grayhack JP, Martin-Harris B. Effects of divided attention on swallowing in persons with idiopathic Parkinson's disease. Dysphagia 2012; 27 (03) 390-400
    CrossrefPubMedGoogle Scholar
  • 20 Pinto S, Mancini L, Jahanshahi M. et al. Functional magnetic resonance imaging exploration of combined hand and speech movements in Parkinson's disease. Mov Disord 2011; 26 (12) 2212-2219
    CrossrefPubMedGoogle Scholar
  • 21 Zadikoff C, Fox SH, Tang-Wai DF. et al. A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson's disease. Mov Disord 2008; 23 (02) 297-299
    CrossrefPubMedGoogle Scholar
  • 22 Dalrymple-Alford JC, MacAskill MR, Nakas CT. et al. The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 2010; 75 (19) 1717-1725
    CrossrefPubMedGoogle Scholar
  • 23 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2 (04) 216-219
    CrossrefPubMedGoogle Scholar
  • 24 Kaneoka AS, Langmore SE, Krisciunas GP. et al. The Boston Residue and Clearance Scale: preliminary reliability and validity testing. Folia Phoniatr Logop 2013; 65 (06) 312-317
    CrossrefPubMedGoogle Scholar
  • 25 Hanson B, Steele CM, Lam P, Cichero JAY. Fluid Testing Methods Recommended by IDDSI. Dysphagia 2018; ••• DOI: 10.1007/s00455-018-9957-9.
    CrossrefPubMedGoogle Scholar
  • 26 Daniels SK, Corey DM, Fraychinaud A, DePolo A, Foundas AL. Swallowing lateralization: the effects of modified dual-task interference. Dysphagia 2006; 21 (01) 21-27
    CrossrefPubMedGoogle Scholar
  • 27 Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia 2013; 28 (04) 494-500
    CrossrefPubMedGoogle Scholar
  • 28 Wu T, Hallett M. A functional MRI study of automatic movements in patients with Parkinson's disease. Brain 2005; 128 (Pt 10): 2250-2259
    CrossrefPubMedGoogle Scholar