Swallowing disorders in PD

125 Oropharyngeal swallow mechanism.Critical structures of the oropharynx and cervical oesophagus involved in swallowing.

O Oral-stage deficits may include drooling, increased oral transit time, repetitive tongue pumping motions with the posterior tongue remaining elevated, and premature spillage of the bolus. O Pharyngeal-stage problems include pharyn-geal swallow delay, the presence of pharyn-geal residue after the swallow, laryngeal penetration, and aspiration. O Oesophageal-stage swallowing problems are also common, and most frequently include abnormalities in oesophageal motility.

♦ Although dysphagia is common in PD, it rarely is severe enough to require an alternative means of nutritional support. However, gastrostomy may be considered for some patients as an efficient means of providinge additional nutritional support. In some situations, oral intake may continue with the presence of a gastrostomy tube.

SWALLOWING PROBLEMS IN PD

Swallowing problems (dysphagia) in PD commonly involve the mechanisms controlling the tongue, pharynx and upper oesophageal sphincter (125).

Oropharyngeal dysphagia is reported in up to 95% of patients with PD, depending on the method of assessment. However, dysphagia is often unrecognized or underestimated by patients.

The severity of dysphagia may not correspond to the duration of PD or severity of other motor symptoms.

All stages of swallowing function can be affected in patients with PD including the oral, pharyngeal, and oesophageal stages (126).

Oral stage Drooling; increased oral transit time; tongue pumping; premature bolus spillage

Pharyngeal stage

Pharyngeal swallow delay; post-swallow pharyngeal residue; penetration; aspiration

Oesophageal stage

Dysphagia also occurs commonly as oesophageal dysmotility

126 Dysphagia in PD. Swallowing disorders are encountered in all stages of the swallow.

Nasopharynx Velum (soft palate) Orophaynx Laryngopharynx

Nasopharynx Velum (soft palate) Orophaynx Laryngopharynx

Upper oesophageal sphincter (UES)

Upper oesophageal sphincter (UES)

Tongue Hard palate Epiglottis Vocal folds Larynx Trachea

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