Background:Diagnosis of pharyngeal dysphagia in patients with Parkinson’s disease is often difficult as reliable screening methods are lacking so far and clinical examination fails to adequately assess the pharyngeal phase of swallowing. Objective:To identify clinical predictors indicating the presence of pharyngeal dysphagia in patients at risk. Methods:We examined pharyngeal dysphagia in a large cohort of patients with Parkinson’s disease (n = 200) divided in three clinical subtypes (tremor-dominant (TD), mainly bradykinetic (BK) and early postural instability and gait difficulty PIGD)) by using flexible endoscopic evaluation of swallowing. ANOVA-multivariance analysis and following t-tests as well as binary logistic regression analysis were performed to detect group differences and to identify clinical predictors for dysphagia. Results:Statistically significant differences were found in the dysphagic group: age, male gender, disease duration, stage of the disease, Levodopa equivalent dose and higher scores on the Unified Parkinson’s disease rating scale III and II, item 7. The PIGD subtype was affected more frequently than the TD and BK subtype. In a logistic regression model higher age (>63.5 years p < 0.05) and Levodopa equivalent dose (>475 mg, p < 0.01) were identified to be independent predictors for the presence of pharyngeal dysphagia. Conclusion:Particularly patients with an age > 63.5 years and a daily Levodopa equivalent dose >475 mg show an increased risk for pharyngeal dysphagia. These findings may partly be influenced by presbyphagia but are likely to represent disease progression. The PIGD subtype seems to be a risk factor due to more pronounced dyscoordination of oropharyngeal muscle movements.

中文翻译：

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帕金森病患者咽部吞咽困难的预测因素。

背景：帕金森病患者咽部吞咽困难的诊断通常很困难，因为目前缺乏可靠的筛查方法，临床检查未能充分评估吞咽的咽部阶段。目的：确定表明高危患者存在咽部吞咽困难的临床预测因素。方法：我们检查了一大群帕金森病患者（n = 200）的咽部吞咽困难，这些患者分为三种临床亚型（震颤为主（TD），主要是运动迟缓（BK）和早期姿势不稳定和步态困难 PIGD））吞咽的柔性内窥镜评估。进行方差分析多变量分析和以下 t 检验以及二元逻辑回归分析以检测组差异并确定吞咽困难的临床预测因素。结果：在吞咽困难组中发现统计学显着差异：年龄、男性、疾病持续时间、疾病阶段、左旋多巴等效剂量和统一帕金森病分级量表 III 和 II 第 7 项的更高分数。 PIGD 亚型受影响更频繁比 TD 和 BK 亚型。在逻辑回归模型中，较高的年龄（> 63.5 岁 p < 0.05）和左旋多巴等效剂量（> 475 mg，p < 0.01）被确定为存在咽部吞咽困难的独立预测因子。结论：尤其是年龄 > 63.5 岁且每日左旋多巴等效剂量 >475 mg 的患者出现咽部吞咽困难的风险增加。这些发现可能部分受到老年性吞咽障碍的影响，但可能代表疾病进展。