Impact of Progression of Parkinson's Disease on Swallowing Ability and Oral Environment

George Umemoto; Shinsuke Fujioka; Yasuyuki Iwasa; Yoshie Ozaki; Kayoko Koga; Kazumi Nishimura; Yoshio Tsuboi

doi:10.1155/2021/5571556

Impact of Progression of Parkinson's Disease on Swallowing Ability and Oral Environment

Parkinsons Dis. 2021 Apr 23:2021:5571556. doi: 10.1155/2021/5571556. eCollection 2021.

Authors

George Umemoto^{1

2}, Shinsuke Fujioka³, Yasuyuki Iwasa⁴, Yoshie Ozaki⁵, Kayoko Koga⁶, Kazumi Nishimura⁷, Yoshio Tsuboi³

Affiliations

¹ Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan.
² Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan.
³ Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁴ Department of Dentistry, Haradoi Hospital, Fukuoka, Japan.
⁵ Maruozaki Dental Clinic, Oita, Japan.
⁶ Department of Home Care Nursing, School of Nursing, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁷ Japanese Red Cross Kyushu International College of Nursing, Fukuoka, Japan.

Abstract

This study investigated the impact of the severity and treatment of Parkinson's disease (PD) on the swallowing ability and oral environment of patients. Swallowing dysfunction increases the aspiration risk and may lead to poor oral health among patients with PD. We investigated the influences of PD progression and drug treatment on the swallowing ability and oral environment using simple noninvasive screening measurements. We recruited 87 patients with PD (mean age, 71.9 ± 8.0 years; mean Hoehn and Yahr score, 2.9 ± 0.9). The PD condition was assessed in each patient using the unified Parkinson's disease rating scale (UPDRS) part III, diet type and oropharyngeal function using the swallowing disturbances questionnaire (SDQ), maximum bite force (MBF), tongue pressure (TP), and oral bacterial count (OBC). Levodopa equivalent daily dose (LEDD) was also calculated for 56 participants. Based on an SDQ score of ≥11, 29.5% of patients were dysphagic, but almost all were still on a regular diet. The SDQ score was positively correlated with disease duration (rho = 0.228, p=0.047) and UPDRS part III score (rho = 0.307, p=0.007) but was negatively correlated with OBC (rho = -0.289, p=0.012). OBC was significantly higher among patients with an SDQ score of <11 (nondysphagic) (p=0.01), and the SDQ score was lower in patients with higher OBC requiring professional oral care (p=0.03). However, OBC was also negatively correlated with LEDD (rho = -0.411, p=0.004). These results indicated low self-awareness of dysphagia among the participants and an association between dysphagia and PD progression. Moreover, the oral environment could have deteriorated with swallowing dysfunction. Patients and clinicians should be aware that higher LEDD can increase xerostomia and associated deficits in oral health.