Relationship Between Sialorrhea And Dysphagia In Chinese Patients With Parkinson Disease

Objective:To explore the prevalence of sialorrhea and its clinical correlation with dysphagia and other related clinical features in Chinese patients with Parkinson disease.Methods:116 consecutive patients with a clinical diagnosis of Parkinson disease were enrolled.Demographic data included sex,age,years of education,age at onset of Parkinson disease,clinical genotype,disease duration,treatment,Hoehn and Yahr stage.Sialorrhea was assessed using the Unified Parkinson Disease Rating Scale item number 6.All patients were studied with Videofluoroscopic study of swallowing.Results:We found the prevalence rate of sialorrhea in Parkinson disease was 59.5%(95%CI 0.506-0.684).Gender was found to be a significant factor in developing sialorrhea.Males are twice as more likely to develop sialorrhea than females.Parkinson disease patients’sialorrhea correlated with the oral stage of swallowing:(a)with food leaking from the mouth(liquid P = 0.014,juice P = 0.034,pudding viscosities P = 0.013,solid food P=0.006),(b)with more than 1ml of oral food residues(liquid P<0.001,solid food P =0.047),(c)with delay in food transfer to the root of the tongue(liquid P = 0.002,juice P =0.024),and(d)delayed swallow transfer(pudding viscosities P = 0.005).We also found that Parkinson disease patients’ sialorrhea had no correlation with pharyngeal and esophageal stages of dysphagia.In addition,sialorrhea was not related to age,age of onset,clinical presentation,clinical course,Hoehn and Yahr stage and the application of anticholinergic drugs(like benzhexol).Sialorrhea score was not related to Hoehn and Yahr stage,clinical course and levodopa equivalent doses.The prevalence rate of dysphagia in Parkinson disease was 87.1%(95%CI 0.810-0.932).Food-type was not related to the oral stage of swallowing.Among the various types of food,pharyngeal dysphagia phase occurred more frequently with liquid(P = 0.03).With the increase in Hoehn and Yahr stage,so did the oral and pharyngeal stages of dysphagia.Dysphagia was compared with the course of the disease:(a)when late clinical course was compared with early clinical course,oral dysphagia was found to have increased(with more than lml of oral food residue:pudding viscosities P = 0.003,solid food P = 0.001),and pharyngeal dysphagia had also increased(liquid P = 0.009),(b)when mid-clinical course was compared with early clinical course,oral dysphagia was found to have increased(with more than lml of oral food residue;juice P = 0.005),(c)no statistical significance was found when compared between late and mid-clinical course.Conclusion:We found that sialorrhea and dysphagia were common non-motor symptoms in Parkinson disease patients.Sialorrhea was more prevalent in males and it correlated with oral phase of dysphagia.Liquid was more likely to cause pharyngeal dysphagia.With increase in Hoehn and Yahr,so did oral and pharyngeal dysphagia.Even though late clinical course was more likely to develop oral and pharyngeal dysphagia than early clinical course,the comparison between late and intermediate clinical courses did not reach statistical significance.