Clinical indicators of dysphagia in patients with Parkinson disease | Revista de Logopedia, Foniatría y Audiología

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Bayes factor (BF10) showed that alternative hypothesis was more probably than null hypothesis." ] ] ] "textoCompleto" => "IntroductionParkinson disease (PD) is the most common neurodegenerative disease after Alzheimer's dementia. Characteristic motor symptoms, such as tremor, bradykinesia, rigidity, and postural instability (<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al., 2021</a>), mainly exemplify PD. Globally, PD is estimated to affect approximately 3.6% of people over 40 years of age (<a class="elsevierStyleCrossRef" href="#bib0145">Pringsheim et al., 2014</a>) and it is predicted that the figure may double by 2030 in nations with larger populations (<a class="elsevierStyleCrossRef" href="#bib0035">Cheng et al., 2022</a>). In addition to the symptoms above, it is estimated that about 80% of PD patients will develop swallowing disturbances or dysphagia (<a class="elsevierStyleCrossRefs" href="#bib0140">Pitts et al., 2018, 2019</a>) in the early stages of the disease (<a class="elsevierStyleCrossRef" href="#bib0130">Pflug et al., 2017, 2020</a>) and 95% indecency in advanced stages (<a class="elsevierStyleCrossRef" href="#bib0010">Ayres et al., 2016</a>).Swallowing is the process of transporting swallowed material from the mouth to the pharynx and esophagus, with dysphagia being a swallowing disorder (<a class="elsevierStyleCrossRef" href="#bib0180">Tassorelli et al., 2008</a>). Oropharyngeal dysphagia refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, including an imbalance in the coordination between airway and nutritional functions. This leads to clinical complications such as malnutrition, dehydration, and risk factors such as aspiration pneumonia, asphyxia, and ultimately premature death (<a class="elsevierStyleCrossRefs" href="#bib0005">Audag et al., 2021; Cichero and Altman, 2012; Cichero et al., 2013; Leow et al., 2010; Logemann, 1998; Pennington et al., 2010; Rajati et al., 2022; Roldan-Vasco et al., 2021; Sheard et al., 2013; Van der Maarel-Wierink et al., 2011</a>). Consequently, the presence of dysphagia in people with PD can be very disabling and hurt the quality of life (<a class="elsevierStyleCrossRefs" href="#bib0075">Ekberg et al., 2002; Leow et al., 2010</a>).According to <a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al. (2021)</a>, although the incidence of dysphagia is high, it is irrelevant in clinical practice. The authors suggest that this may be due to several reasons. First, swallowing disorders are subjectively reported by one-third of PD patients (<a class="elsevierStyleCrossRef" href="#bib0175">Takizawa et al., 2016</a>) tend to underestimate swallowing difficulties only when specifically asked about it. The second option they raise is the need for more access to resources and methodologies for assessment (FEES, VFSS, IOPI, etc.), in addition to professionals trained in using such resources.The Swallowing Disturbance Questionnaire (SDQ), the Dysphagia-Specific Quality of Life (SWAL-QOL) scale, the Eating Assessment (EAT-10), and the DYMUS questionnaire have been mainly used to screen for dysphagia in PD. However, the SDQ, the SWAL-QOL, and the EAT-10 still need to be supported due to methodological limitations. On the one hand, the SDQ was tested in a small sample of PD patients. On the other hand, the SWAL-QOL tested dysphagia in neurodegenerative diseases in general (not specific for PD). Finally, although the EAT-10 has good psychometric properties, it must be evaluated using item response theory (Rash analysis). In this regard, <a class="elsevierStyleCrossRef" href="#bib0050">Cordier et al. (2017)</a> assessed the internal consistency and structural validity of the EAT-10, concluding that the questionnaire presents significant weaknesses in structural validity and internal consistency. On the other hand, the DYMUS questionnaire, initially validated for the early detection of dysphagia in patients with Multiple Sclerosis (<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al., 2008, 2009</a>), has recently been validated for patients with PD (<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al., 2021</a>). The authors demonstrated the tool's reliability for dysphagia screening in PD and highlighted its easy administration.It is well known that PD affects tongue movements, generating abnormality in their movements, specifically in their timing, speed, and direction (<a class="elsevierStyleCrossRefs" href="#bib0030">Bushmann et al., 1989; Logemann et al., 1973; Pitts et al., 2018, 2019; Umemoto et al., 2011</a>). Furthermore, it has been suggested that these dysfunctions generate a reduction in Tongue Strength (TS) or Lingual Pressure (LP) (<a class="elsevierStyleCrossRef" href="#bib0070">Dworkin and Aronson, 1986</a>) or Maximum Isometric Pressure (MIP) (<a class="elsevierStyleCrossRefs" href="#bib0115">O’Day et al., 2005; Pitts et al., 2017, 2020; Solomon et al., 1995</a>). Along these lines, the Iowa Oral Performance Instrument (IOPI) tool has been proposed for the diagnosis and/or assessment of dysphagia in PD. However, several studies described below have found heterogeneous results.On the one hand, in the study by <a class="elsevierStyleCrossRef" href="#bib0165">Solomon et al. (1995)</a> with a sample of 19 participants (Xage=64.4), significant differences were found between the PD group and the control group in MIP; patients with PD had lower MIP scores. The study by <a class="elsevierStyleCrossRef" href="#bib0115">O’Day et al. (2005)</a>, with a sample of 10 participants with no mean age reported, found similar results. In this line, only the study by <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al. (2018)</a> measured Tongue Strength during Swallowing with IOPI. The authors called this measure Lingual-Palatal Swallowing Pressures (LSPs). To take this measure, 28 PD patients made three consecutive tests for consistency: thin (i.e., water), nectar thick, honey thick, and puree with the IOPI bulb placed in the anteromedian position. In addition, they also instructed the participants to draw MIP measures. The authors showed that low LSPs and MIP correlate with swallowing difficulties. Furthermore, the authors concluded that LSPs and MIP measures could serve as clinical indicators for assessing and promoting early diagnosis and treating dysphagia in PD (<a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al., 2018</a>, 2020).On the other hand, in the study by <a class="elsevierStyleCrossRef" href="#bib0170">Solomon et al. (2000)</a> with 16 participants (Xage=68.4), no significant differences were found between the experimental group and the control group in MIP. Neither did the work of <a class="elsevierStyleCrossRef" href="#bib0110">McAuliffe et al. (2005)</a> with 14 participants (Xage=68.4) show significant results between MIP and swallowing disorders.Given the inconsistency of the results, both in subjective measures (questionnaires) and in objective measures (IOPI), we are faced with the need for a more exhaustive evaluation with greater reliability for the early detection of oropharyngeal dysphagia, to avoid and/or reduce the negative consequences that they cause in the health of patients with PD. Consequently, this work aimed to test whether the Lingual-Palatal Swallowing Pressures (LSPs), Maximum Isometric Pressure (MIP), DYMUS and Dysphapark questionnaires can be used as clinical indicators for the assessment and diagnosis of dysphagia in PD patients. Participants with PD are expected to have lower scores on the IOPI measures compared to participants in the control group. On the other hand, IOPI scores are expected to correlate with DYMUS questionnaire scores for dysphagia detection in PD participants. In addition, IOPI and DYMUS questionnaire scores are expected to correlate with the level of dysphagia awareness (Dysphapark) in PD patients.Material and methodsParticipantsA total of 76 people participated in this study. Half of the participants were patients with PD, of whom 22 were men (Xage=70.5) and 16 were women (Xage=67.5). The other half of the participants were healthy people without diagnosed pathologies or swallowing disorders, of whom 21 were men (Xage=65.14) and 17 were women (Xage=71.11). The participants with PD came from the Parkinson's Association of Salamanca, in Salamanca (Castilla y León, Spain). All of them had a diagnosis of PD made by a neurologist and were in the first three stages of the disease. The participants in the control group were relatives of PD patients from the same association. All participants were native Spanish speakers and resided in Salamanca.Ethical considerationsThe present study has the approval of the Research Ethics Committee of the Universidad Pontificia de Salamanca, recorded in Acta 25/03/2022. Before collection, participants were informed about using their data for research purposes. Each participant was then given an informed consent form to sign. All identifying information of the participants was anonymized entirely. The data were kept in a password-protected database on the researchers’ computers.MaterialsLingual pressures were obtained using the IOPI tool. The IOPI is a handheld, portable device that provides a digital reading in kilopascals of the pressure applied to an air-filled plastic bulb placed between the tongue and palate (approximately 3.5cm long and 4.5cm in diameter) that is connected to the device through an 11.5cm plastic tube. According to <a class="elsevierStyleCrossRef" href="#bib0201">Youmans et al. (2009)</a>, the IOPI exhibits robust test–retest reliability and has been widely used in investigations of tongue function (<a class="elsevierStyleCrossRefs" href="#bib0060">De Letter et al., 2003; Farpour et al., 2022; Oh, 2022; Pitts et al., 2018, 2019; Yoshikawa et al., 2021</a>). IOPI calibration was performed according to the IOPI manual to ensure accurate measurement.The DYMUS questionnaire by <a class="elsevierStyleCrossRef" href="#bib0020">Bergamaschi et al. (2008)</a> assessed the presence of dysphagia. The DYMUS detects oropharyngeal dysphagia and identifies individuals needing more objective swallowing assessments and aspiration prevention programs. It is a self-administered questionnaire consisting of ten questions that assess two subscales: dysphagia for solids and dysphagia for liquids. The answers to the questions are dichotomous, coded as existing (1 point) or absent (0 point). The total score is obtained by the sum of the two subscales, ranging from 0 to 10 points (<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al., 2008, 2009</a>). Consequently, dysphagia is identified by at least one abnormal response and is considered “alarming” when the score is three or more (<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al., 2008, 2009</a>). Although the DYMUS was designed to detect dysphagia in people with Multiple Sclerosis, it has been validated for detecting dysphagia in people with PD (<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al., 2021</a>). The original version by <a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al. (2008, 2009)</a>, translated into Spanish by the authors, was used.To assess the level of awareness of swallowing disorders in PD patients, the Dysphapark questionnaire (<a class="elsevierStyleCrossRef" href="#bib0015">Bayés-Rusiñol et al., 2011</a>) was used. This questionnaire consists of two unidimensional subscales; 9 items related to swallowing efficiency disturbances and 9 items related to swallowing safety disturbances. Each item allowed four possible responses, scored from 0 to 3 (0=never; 1=sometimes; 2: often; 3: always have problems). To determine the participants’ level of awareness, as suggested by the indications of the Dysphapark questionnaire, the values marked by the participants in the three columns of each subscale (efficacy and safety) were summed. In this way, a raw total score was obtained. Next, each raw score was looked up in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> to transform it into the “final total linear score” (<a class="elsevierStyleCrossRef" href="#bib0015">Bayés-Rusiñol et al., 2011</a>).ProcedureThe participants in this study were recruited from Parkinson's Association of Salamanca. All of them participated voluntarily and altruistically. A previously trained speech therapist carried out the administration of the tests to ensure the correct administration. The tests were administered in the organization's quiet, noise-free room.First, the participants were informed about the study and were asked to sign the informed consent document to authorize using the data for academic and scientific purposes. Next, the IOPI was administered. During the IOPI tasks, participants were seated upright in a straight-backed chair. First, participants performed the LSPs task and then the MIP test. For the LSPs task, participants were asked to swallow saliva. As in the studies by <a class="elsevierStyleCrossRef" href="#bib0060">De Letter et al. (2003)</a>, <a class="elsevierStyleCrossRef" href="#bib0085">Gingrich et al. (2012)</a>, and <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al. (2018)</a>, both tasks were performed with the IOPI bulb on the anteromedian portion of the participant's tongue. The position of the tongue bulb was delineated by placing a mark on the tongue bulb anterior to the participant's closed lips. Next, the mark was visually monitored for consistent placement by the investigator throughout the experimental tasks. LSPs and MIP were measured as the greatest pressure exerted on three consecutive trials in anteromedial placement. Both trials lasted approximately 2–3s. All trials were instructed by the speech therapist, accompanied by verbal commands to the participant to ensure maximal effort as recommended by the IOPI manual.Next, the two questionnaires were administered only to the participants with PD; first, the DYMUS and then the Dysphapark. In total, it took between 10 and 12min to complete both questionnaires.Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the means and standard deviations of the control and PD participants in the two measures provided by the IOPI; Lingual-Palatal Swallowing Pressure (LSPs) and Maximum Isometric Pressure (MIP).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>To estimate the possible significant differences between the variables of interest in the PD and control group, independent mean comparisons were carried out and showed significant effects. The analysis of the LSPs variable showed that the means of the PD group was significantly lower than that of the control group [t(74)=−7.38, p<.001, effect size r2 0.41]. The data also showed that there was a significant difference between PD and control in the dependent variable MIP [t(58.96)=−7.86, p<.001, effect size r2 0.51]. There were no differences between gender in the PD group for the variables of interest. Likewise, and considering the scarce evidence on this type of comparison in nature, a Bayesian contrast of independent means was carried out, and the data found showed that the alternative hypothesis had a greater probability of occurrence than the null hypothesis. The Bayes factor for LSPs showed a value of 2.706*107. For the MIP variable, the Bayes factor yielded a value of 2.753*108 (see <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the means and standard deviations in the scores of the DYMUS and Dysphapark questionnaires in PD patients. The study of the correlations between the variables of interest for the PD group showed significant correlations that we can observe in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The data showed a significant negative correlation between MIP and solid DYMUS [r=−0.53, n=38]; between MIP and E [r=−0.48, n=38]; and between MIP and S [r=−0.51, n=38]. In other words, as the values in MIP increase, the values in solid DYMUS, Efficacy, and Safety decrease. It should be noted that the interpretation of these data must consider that, both in the DYMUS questionnaire and in the Dysphapark questionnaire, the higher the scores, the greater the swallowing problems. In summary, the higher the MIP values in the PD group, the fewer swallowing difficulties they present.On the other hand, the data showed a significant positive correlation between MIP and LSPs [r=0.62, n=38], between DYS and DYL [r=0.49, n=39]; between DYS and E [r=0.62, n=38]; between DYS and S [r=0.64, n=38]; between DYL and E [r=0.42, n=38]; between DYL and S [r=0.72, n=38] and between E and S [r=0.58, n=38]. These significant positive correlations indicate that as one variable increases, the other increases.DiscussionThe main objective of this work was to test whether LSPs and MIP can be used as clinical indicators for assessing and diagnosing dysphagia in PD patients. Participants with PD were expected to have lower scores on IOPI measures than healthy participants in the control group. On the other hand, IOPI scores were expected to correlate with DYMUS questionnaire scores for dysphagia detection in PD participants. Also, IOPI and DYMUS questionnaire scores were expected to correlate with the level of dysphagia awareness (Dysphapark) in PD patients. Thus, the present study contributes to the literature by exposing convergent results with the most prominent findings in the field.About the first hypothesis posed, the results of this study show that participants with PD present significantly lower scores, both in LSPs and MIP, compared to the control group. Thus, the findings of the present work support the results of the studies by <a class="elsevierStyleCrossRef" href="#bib0165">Solomon et al. (1995)</a>, <a class="elsevierStyleCrossRef" href="#bib0115">O’Day et al. (2005)</a> and <a class="elsevierStyleCrossRefs" href="#bib0140">Pitts et al. (2018, 2019)</a>, previously described. It should be emphasized that in the <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al. (2018)</a> study, participants with PD performed the tongue pressure tasks twice; they completed the tasks before taking a single dose of their medications (OFF state) and repeated the protocol after 40min of medication administration (ON state). However, their results showed no significant differences in tongue pressures between states. Similar findings were found in the study by <a class="elsevierStyleCrossRef" href="#bib0060">De Letter et al. (2003)</a>, in which the authors concluded that the medication state does not influence the magnitude or duration of MIP generation. Because of the above, no information on the types of medication taken by PD patients was collected in the present investigation to ratify these findings. Consequently, IOPI measures in PD patients may serve as an accurate and effective marker for detecting and assessing dysphagia, regardless of the state (ON/OFF) is the patient is in when the test is administered.The analysis of correlations between the objective measures of the IOPI with the measures of the questionnaires (DYMUS and Dyspharak) showed a significant negative correlation between MIP and solid DYMUS, indicating that as MIP increases in PD patients, problems swallowing solids (solid DYMUS) decrease. However, the correlation between MIP and liquid DYMUS did not show significance. A plausible explanation could be that solid bolus swallowing is more sensitive to alterations due to motor fluctuations (the greater the bolus weight, the greater the force required for transport) than liquid swallowing. This finding is consistent with the results of <a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al. (2021)</a> and <a class="elsevierStyleCrossRef" href="#bib0105">Mamolar et al. (2017)</a>.The MIP also showed significant negative correlations with the Dyspharak Efficacy and Safety questionnaire subscales, indicating that the higher the MIP values, the less PD patients consider that they have swallowing efficacy and safety disturbances. This finding suggests that the sample of PD patients in this study has a high level of awareness of their swallowing problems. Thus, it can be concluded that the Dysphapark questionnaire is an adequate measure of dysphagia in PD. In this line, it should be noted that the correlation analysis did not show significant results between the LSPs and the questionnaires. However, given the significant differences in the IOPI measures, it could be interpreted that the LSPs measure is valid for screening dysphagia in PD versus healthy controls and that the MIP yields more information on the swallowing process in PD patients.Finally, analyzing the correlations between the questionnaires showed the expected results. In the DYMUS questionnaire, the correlation between solids and liquids was significant, indicating that as problems in swallowing solids increase, problems in swallowing liquids increase. On the other hand, when correlating the scores between the DYMUS questionnaire and the Dysphapark swallowing awareness questionnaire, the results indicate that the more swallowing problems (both solids and liquids) PD patients present, the greater the degree of awareness (both of presenting alterations in swallowing efficacy and swallowing safety). Thus, this set of findings adds to the literature demonstrating the robustness and reliability of questionnaires for detecting, evaluating, and following up dysphagia in PD patients.The results of this study support the theory that the IOPI measures (LSPs and MIP) and the DYMUS and Dysphapark questionnaires could be used as indicators for the assessment of dysphagia in PD patients and thus promote early diagnosis and specific speech therapy.FundingThis research has not received any funding.Conflict of interestThe authors have no conflicts of interest to declare.Data availability statementAll data generated and analyzed during this study are included in the article. Further inquiries can be directed to the corresponding author." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2278572" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1897191" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2278571" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Propósito" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1897192" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Ethical considerations" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Materials" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Procedure" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Data availability statement" ] 11 => array:2 [ "identificador" => "xack783427" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-03-13" "fechaAceptado" => "2024-05-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1897191" "palabras" => array:5 [ 0 => "Parkinson disease" 1 => "IOPI" 2 => "DYMUS" 3 => "Dysphapark" 4 => "Dysphagia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1897192" "palabras" => array:5 [ 0 => "Enfermedad de Parkinson" 1 => "IOPI" 2 => "DYMUS" 3 => "Dysphapark" 4 => "Disfagia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "PurposeIt is well known that dysphagia in patients with Parkinson disease (PD) can be very disabling and hurt the quality of life. Thus, tongue function is crucial for swallowing. In this line, it has been proposed that inadequate lingual pressure conditions the swallowing process. We aimed to determine whether lingual pressures in PD patients are lower than in a control group. Also, to test whether objective lingual pressures correlate with questionnaires designed to detect dysphagia. MethodThirty-eight patients with PD and thirty-eight age- and gender-matched controls completed lingual pressure tasks with the IOWA oral performance instrument. Additionally, the experimental group completed the DYMUS questionnaire for the early detection of dysphagia and the Dysphapark questionnaire for assessing swallowing disorder awareness. ResultPatients with PD presented significantly lower scores in lingual pressure tasks compared to the control group. Correlation analysis showed significant correlations between lingual pressure tasks and both questionnaires. ConclusionLingual pressures, DYMUS and Dysphapark questionnaires can serve as clinical indicators for assessing dysphagia and prompt diagnosis and early speech therapy intervention of dysphagia in PD patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "PropósitoEs bien sabido que la disfagia en pacientes con enfermedad de Parkinson (EP) puede ser muy incapacitante y perjudicar la calidad de vida. Por lo tanto, la función de la lengua es crucial para la deglución. En esta línea, se ha propuesto que una presión lingual inadecuada condiciona el proceso de deglución. Nuestro objetivo fue determinar si las presiones linguales en los pacientes con EP son más bajas que en un grupo control. También, para comprobar si las presiones linguales objetivas se correlacionan con los cuestionarios diseñados para detectar la disfagia. MétodoTreinta y ocho pacientes con EP y 38 controles emparejados por edad y sexo completaron tareas de presión lingual con el instrumento de rendimiento oral IOWA. Además, el grupo experimental completó el cuestionario DYMUS para la detección precoz de la disfagia y el cuestionario Dysphapark para evaluar el conocimiento del trastorno de la deglución. ResultadosLos pacientes con EP presentaron puntuaciones significativamente más bajas en las tareas de presión lingual en comparación con el grupo control. El análisis de correlación mostró correlaciones significativas entre las tareas de presión lingual y ambos cuestionarios. ConclusiónLas presiones linguales, los cuestionarios DYMUS y Dysphapark pueden servir como indicadores clínicos para evaluar la disfagia y el diagnóstico precoz y la intervención logopédica precoz de la disfagia en pacientes con EP." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Propósito" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1341 "Ancho" => 1547 "Tamanyo" => 135104 ] ] "descripcion" => array:1 [ "en" => "Bayes factor robustness check Lingual-Palatal Swallowing Pressures for Parkinson's and control groups. Bayes factor (BF10) showed that alternative hypothesis was more probably than null hypothesis." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1455 "Ancho" => 1601 "Tamanyo" => 151096 ] ] "descripcion" => array:1 [ "en" => "Bayes factor robustness check for max isometric pressure for Parkinson's and control groups. Bayes factor (BF10) showed that alternative hypothesis was more probably than null hypothesis." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note. LSPs=Lingual-Palatal Swallowing Pressures, MIP=Maximum Isometric Pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Participants \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">LSPs (kPA) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">MIP (kPA) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M (SD), range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M, F \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M (SD), range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M (SD), range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.23 (10.93)41–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22, 16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.58 (6.71)6–32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.5 (12.02)11–63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.82 (6.93)51–82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21, 17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.53 (5.07)17–34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.16 (6.89)40–65 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3697658.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptive and mean statistics, standard deviations and ranges of IOPI." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Questionnaires \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M (SD), range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DYMUS solid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.34 (1.95), 0–6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DYMUS liquid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 (0.95), 0–3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dysphapark effectiveness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.07 (2.88), 0–11.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dysphapark security \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.28 (2.26), 0–6.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3697660.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Means, standard deviations and ranges in questionnaires in participants PD." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note. LSPs=Lingual-Palatal Swallowing Pressures, MIP=Maximum Isometric Pressure; DYS=DYMUS sol; DYL=DYMUS liq; E=efficacy; S=safety.* indicates the degree of significance." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LSPs \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MIP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DYS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DYL \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">E \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.62*** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DYS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.53*** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DYL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.48** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.62*** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.42** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.51** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64*** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72*** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58*** \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3697659.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlations between the variables of interest for PD." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "Audag et al., 2021" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "N. 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Stierwalt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00455-008-9193-9" "Revista" => array:7 [ "tituloSerie" => "Dysphagia" "fecha" => "2009" "volumen" => "24" "numero" => "1" "paginaInicial" => "57" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18690406" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack783427" "titulo" => "Acknowledgements" "texto" => "Our most sincere thanks to the users of Parkinson's Salamanca Association for participating in this study. We would also like to thank the workers of the Association for their availability and kind treatment." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02144603/0000004400000003/v3_202410220646/S0214460324000664/v3_202410220646/en/main.assets" "Apartado" => array:4 [ "identificador" => "7595" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02144603/0000004400000003/v3_202410220646/S0214460324000664/v3_202410220646/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0214460324000664?idApp=UINPBA00004N"]

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Original article

Clinical indicators of dysphagia in patients with Parkinson disease

Indicadores clínicos de disfagia en pacientes con enfermedad de Parkinson

Adrián Pérez del Olmoa, Moisés Betancortb, Germán Gálvez-Garcíac,d, Lucía Sabatera, Tatiana Romero-Ariase,

Corresponding author

tatiana.romero@universidadeuropea.es

Corresponding author.

a Facultad de Ciencias de la Salud, Sección Logopedia, Universidad Pontificia de Salamanca, Spain

b Dpto. de Psicología Clínica, Metodología y Psicobiología, Universidad de La Laguna, Spain

c Dpto. de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Spain

d Dpto. de Psicología, Universidad de la Frontera, Temuco, Chile

e Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Parkinson disease &#40;PD&#41; is the most common neurodegenerative disease after Alzheimer&#39;s dementia&#46; Characteristic motor symptoms&#44; such as tremor&#44; bradykinesia&#44; rigidity&#44; and postural instability &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al&#46;&#44; 2021</a>&#41;&#44; mainly exemplify PD&#46; Globally&#44; PD is estimated to affect approximately 3&#46;6&#37; of people over 40 years of age &#40;<a class="elsevierStyleCrossRef" href="#bib0145">Pringsheim et al&#46;&#44; 2014</a>&#41; and it is predicted that the figure may double by 2030 in nations with larger populations &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Cheng et al&#46;&#44; 2022</a>&#41;&#46; In addition to the symptoms above&#44; it is estimated that about 80&#37; of PD patients will develop swallowing disturbances or dysphagia &#40;<a class="elsevierStyleCrossRefs" href="#bib0140">Pitts et al&#46;&#44; 2018&#44; 2019</a>&#41; in the early stages of the disease &#40;<a class="elsevierStyleCrossRef" href="#bib0130">Pflug et al&#46;&#44; 2017&#44; 2020</a>&#41; and 95&#37; indecency in advanced stages &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Ayres et al&#46;&#44; 2016</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Swallowing is the process of transporting swallowed material from the mouth to the pharynx and esophagus&#44; with dysphagia being a swallowing disorder &#40;<a class="elsevierStyleCrossRef" href="#bib0180">Tassorelli et al&#46;&#44; 2008</a>&#41;&#46; Oropharyngeal dysphagia refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract&#44; including an imbalance in the coordination between airway and nutritional functions&#46; This leads to clinical complications such as malnutrition&#44; dehydration&#44; and risk factors such as aspiration pneumonia&#44; asphyxia&#44; and ultimately premature death &#40;<a class="elsevierStyleCrossRefs" href="#bib0005">Audag et al&#46;&#44; 2021&#59; Cichero and Altman&#44; 2012&#59; Cichero et al&#46;&#44; 2013&#59; Leow et al&#46;&#44; 2010&#59; Logemann&#44; 1998&#59; Pennington et al&#46;&#44; 2010&#59; Rajati et al&#46;&#44; 2022&#59; Roldan-Vasco et al&#46;&#44; 2021&#59; Sheard et al&#46;&#44; 2013&#59; Van der Maarel-Wierink et al&#46;&#44; 2011</a>&#41;&#46; Consequently&#44; the presence of dysphagia in people with PD can be very disabling and hurt the quality of life &#40;<a class="elsevierStyleCrossRefs" href="#bib0075">Ekberg et al&#46;&#44; 2002&#59; Leow et al&#46;&#44; 2010</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to <a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al&#46; &#40;2021&#41;</a>&#44; although the incidence of dysphagia is high&#44; it is irrelevant in clinical practice&#46; The authors suggest that this may be due to several reasons&#46; First&#44; swallowing disorders are subjectively reported by one-third of PD patients &#40;<a class="elsevierStyleCrossRef" href="#bib0175">Takizawa et al&#46;&#44; 2016</a>&#41; tend to underestimate swallowing difficulties only when specifically asked about it&#46; The second option they raise is the need for more access to resources and methodologies for assessment &#40;FEES&#44; VFSS&#44; IOPI&#44; etc&#46;&#41;&#44; in addition to professionals trained in using such resources&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Swallowing Disturbance Questionnaire &#40;SDQ&#41;&#44; the Dysphagia-Specific Quality of Life &#40;SWAL-QOL&#41; scale&#44; the Eating Assessment &#40;EAT-10&#41;&#44; and the DYMUS questionnaire have been mainly used to screen for dysphagia in PD&#46; However&#44; the SDQ&#44; the SWAL-QOL&#44; and the EAT-10 still need to be supported due to methodological limitations&#46; On the one hand&#44; the SDQ was tested in a small sample of PD patients&#46; On the other hand&#44; the SWAL-QOL tested dysphagia in neurodegenerative diseases in general &#40;not specific for PD&#41;&#46; Finally&#44; although the EAT-10 has good psychometric properties&#44; it must be evaluated using item response theory &#40;Rash analysis&#41;&#46; In this regard&#44; <a class="elsevierStyleCrossRef" href="#bib0050">Cordier et al&#46; &#40;2017&#41;</a> assessed the internal consistency and structural validity of the EAT-10&#44; concluding that the questionnaire presents significant weaknesses in structural validity and internal consistency&#46; On the other hand&#44; the DYMUS questionnaire&#44; initially validated for the early detection of dysphagia in patients with Multiple Sclerosis &#40;<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al&#46;&#44; 2008&#44; 2009</a>&#41;&#44; has recently been validated for patients with PD &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al&#46;&#44; 2021</a>&#41;&#46; The authors demonstrated the tool&#39;s reliability for dysphagia screening in PD and highlighted its easy administration&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is well known that PD affects tongue movements&#44; generating abnormality in their movements&#44; specifically in their timing&#44; speed&#44; and direction &#40;<a class="elsevierStyleCrossRefs" href="#bib0030">Bushmann et al&#46;&#44; 1989&#59; Logemann et al&#46;&#44; 1973&#59; Pitts et al&#46;&#44; 2018&#44; 2019&#59; Umemoto et al&#46;&#44; 2011</a>&#41;&#46; Furthermore&#44; it has been suggested that these dysfunctions generate a reduction in Tongue Strength &#40;TS&#41; or Lingual Pressure &#40;LP&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0070">Dworkin and Aronson&#44; 1986</a>&#41; or Maximum Isometric Pressure &#40;MIP&#41; &#40;<a class="elsevierStyleCrossRefs" href="#bib0115">O&#8217;Day et al&#46;&#44; 2005&#59; Pitts et al&#46;&#44; 2017&#44; 2020&#59; Solomon et al&#46;&#44; 1995</a>&#41;&#46; Along these lines&#44; the Iowa Oral Performance Instrument &#40;IOPI&#41; tool has been proposed for the diagnosis and&#47;or assessment of dysphagia in PD&#46; However&#44; several studies described below have found heterogeneous results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On the one hand&#44; in the study by <a class="elsevierStyleCrossRef" href="#bib0165">Solomon et al&#46; &#40;1995&#41;</a> with a sample of 19 participants &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#46;4&#41;&#44; significant differences were found between the PD group and the control group in MIP&#59; patients with PD had lower MIP scores&#46; The study by <a class="elsevierStyleCrossRef" href="#bib0115">O&#8217;Day et al&#46; &#40;2005&#41;</a>&#44; with a sample of 10 participants with no mean age reported&#44; found similar results&#46; In this line&#44; only the study by <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al&#46; &#40;2018&#41;</a> measured Tongue Strength during Swallowing with IOPI&#46; The authors called this measure Lingual-Palatal Swallowing Pressures &#40;LSPs&#41;&#46; To take this measure&#44; 28 PD patients made three consecutive tests for consistency&#58; thin &#40;i&#46;e&#46;&#44; water&#41;&#44; nectar thick&#44; honey thick&#44; and puree with the IOPI bulb placed in the anteromedian position&#46; In addition&#44; they also instructed the participants to draw MIP measures&#46; The authors showed that low LSPs and MIP correlate with swallowing difficulties&#46; Furthermore&#44; the authors concluded that LSPs and MIP measures could serve as clinical indicators for assessing and promoting early diagnosis and treating dysphagia in PD &#40;<a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al&#46;&#44; 2018</a>&#44; 2020&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">On the other hand&#44; in the study by <a class="elsevierStyleCrossRef" href="#bib0170">Solomon et al&#46; &#40;2000&#41;</a> with 16 participants &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#46;4&#41;&#44; no significant differences were found between the experimental group and the control group in MIP&#46; Neither did the work of <a class="elsevierStyleCrossRef" href="#bib0110">McAuliffe et al&#46; &#40;2005&#41;</a> with 14 participants &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#46;4&#41; show significant results between MIP and swallowing disorders&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the inconsistency of the results&#44; both in subjective measures &#40;questionnaires&#41; and in objective measures &#40;IOPI&#41;&#44; we are faced with the need for a more exhaustive evaluation with greater reliability for the early detection of oropharyngeal dysphagia&#44; to avoid and&#47;or reduce the negative consequences that they cause in the health of patients with PD&#46; Consequently&#44; this work aimed to test whether the Lingual-Palatal Swallowing Pressures &#40;LSPs&#41;&#44; Maximum Isometric Pressure &#40;MIP&#41;&#44; DYMUS and Dysphapark questionnaires can be used as clinical indicators for the assessment and diagnosis of dysphagia in PD patients&#46; Participants with PD are expected to have lower scores on the IOPI measures compared to participants in the control group&#46; On the other hand&#44; IOPI scores are expected to correlate with DYMUS questionnaire scores for dysphagia detection in PD participants&#46; In addition&#44; IOPI and DYMUS questionnaire scores are expected to correlate with the level of dysphagia awareness &#40;Dysphapark&#41; in PD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 76 people participated in this study&#46; Half of the participants were patients with PD&#44; of whom 22 were men &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#46;5&#41; and 16 were women &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#46;5&#41;&#46; The other half of the participants were healthy people without diagnosed pathologies or swallowing disorders&#44; of whom 21 were men &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>65&#46;14&#41; and 17 were women &#40;<span class="elsevierStyleItalic">X</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">age</span></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71&#46;11&#41;&#46; The participants with PD came from the Parkinson&#39;s Association of Salamanca&#44; in Salamanca &#40;<span class="elsevierStyleItalic">Castilla y Le&#243;n</span>&#44; Spain&#41;&#46; All of them had a diagnosis of PD made by a neurologist and were in the first three stages of the disease&#46; The participants in the control group were relatives of PD patients from the same association&#46; All participants were native Spanish speakers and resided in Salamanca&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical considerations</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present study has the approval of the Research Ethics Committee of the Universidad Pontificia de Salamanca&#44; recorded in Acta 25&#47;03&#47;2022&#46; Before collection&#44; participants were informed about using their data for research purposes&#46; Each participant was then given an informed consent form to sign&#46; All identifying information of the participants was anonymized entirely&#46; The data were kept in a password-protected database on the researchers&#8217; computers&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Materials</span><p id="par0055" class="elsevierStylePara elsevierViewall">Lingual pressures were obtained using the IOPI tool&#46; The IOPI is a handheld&#44; portable device that provides a digital reading in kilopascals of the pressure applied to an air-filled plastic bulb placed between the tongue and palate &#40;approximately 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm long and 4&#46;5<span class="elsevierStyleHsp" style=""></span>cm in diameter&#41; that is connected to the device through an 11&#46;5<span class="elsevierStyleHsp" style=""></span>cm plastic tube&#46; According to <a class="elsevierStyleCrossRef" href="#bib0201">Youmans et al&#46; &#40;2009&#41;</a>&#44; the IOPI exhibits robust test&#8211;retest reliability and has been widely used in investigations of tongue function &#40;<a class="elsevierStyleCrossRefs" href="#bib0060">De Letter et al&#46;&#44; 2003&#59; Farpour et al&#46;&#44; 2022&#59; Oh&#44; 2022&#59; Pitts et al&#46;&#44; 2018&#44; 2019&#59; Yoshikawa et al&#46;&#44; 2021</a>&#41;&#46; IOPI calibration was performed according to the IOPI manual to ensure accurate measurement&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The DYMUS questionnaire by <a class="elsevierStyleCrossRef" href="#bib0020">Bergamaschi et al&#46; &#40;2008&#41;</a> assessed the presence of dysphagia&#46; The DYMUS detects oropharyngeal dysphagia and identifies individuals needing more objective swallowing assessments and aspiration prevention programs&#46; It is a self-administered questionnaire consisting of ten questions that assess two subscales&#58; dysphagia for solids and dysphagia for liquids&#46; The answers to the questions are dichotomous&#44; coded as existing &#40;1 point&#41; or absent &#40;0 point&#41;&#46; The total score is obtained by the sum of the two subscales&#44; ranging from 0 to 10 points &#40;<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al&#46;&#44; 2008&#44; 2009</a>&#41;&#46; Consequently&#44; dysphagia is identified by at least one abnormal response and is considered &#8220;alarming&#8221; when the score is three or more &#40;<a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al&#46;&#44; 2008&#44; 2009</a>&#41;&#46; Although the DYMUS was designed to detect dysphagia in people with Multiple Sclerosis&#44; it has been validated for detecting dysphagia in people with PD &#40;<a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al&#46;&#44; 2021</a>&#41;&#46; The original version by <a class="elsevierStyleCrossRefs" href="#bib0020">Bergamaschi et al&#46; &#40;2008&#44; 2009&#41;</a>&#44; translated into Spanish by the authors&#44; was used&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To assess the level of awareness of swallowing disorders in PD patients&#44; the Dysphapark questionnaire &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Bay&#233;s-Rusi&#241;ol et al&#46;&#44; 2011</a>&#41; was used&#46; This questionnaire consists of two unidimensional subscales&#59; 9 items related to swallowing efficiency disturbances and 9 items related to swallowing safety disturbances&#46; Each item allowed four possible responses&#44; scored from 0 to 3 &#40;0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>never&#59; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>sometimes&#59; 2&#58; often&#59; 3&#58; always have problems&#41;&#46; To determine the participants&#8217; level of awareness&#44; as suggested by the indications of the Dysphapark questionnaire&#44; the values marked by the participants in the three columns of each subscale &#40;efficacy and safety&#41; were summed&#46; In this way&#44; a raw total score was obtained&#46; Next&#44; each raw score was looked up in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> to transform it into the &#8220;final total linear score&#8221; &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Bay&#233;s-Rusi&#241;ol et al&#46;&#44; 2011</a>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Procedure</span><p id="par0070" class="elsevierStylePara elsevierViewall">The participants in this study were recruited from Parkinson&#39;s Association of Salamanca&#46; All of them participated voluntarily and altruistically&#46; A previously trained speech therapist carried out the administration of the tests to ensure the correct administration&#46; The tests were administered in the organization&#39;s quiet&#44; noise-free room&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">First&#44; the participants were informed about the study and were asked to sign the informed consent document to authorize using the data for academic and scientific purposes&#46; Next&#44; the IOPI was administered&#46; During the IOPI tasks&#44; participants were seated upright in a straight-backed chair&#46; First&#44; participants performed the LSPs task and then the MIP test&#46; For the LSPs task&#44; participants were asked to swallow saliva&#46; As in the studies by <a class="elsevierStyleCrossRef" href="#bib0060">De Letter et al&#46; &#40;2003&#41;</a>&#44; <a class="elsevierStyleCrossRef" href="#bib0085">Gingrich et al&#46; &#40;2012&#41;</a>&#44; and <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al&#46; &#40;2018&#41;</a>&#44; both tasks were performed with the IOPI bulb on the anteromedian portion of the participant&#39;s tongue&#46; The position of the tongue bulb was delineated by placing a mark on the tongue bulb anterior to the participant&#39;s closed lips&#46; Next&#44; the mark was visually monitored for consistent placement by the investigator throughout the experimental tasks&#46; LSPs and MIP were measured as the greatest pressure exerted on three consecutive trials in anteromedial placement&#46; Both trials lasted approximately 2&#8211;3<span class="elsevierStyleHsp" style=""></span>s&#46; All trials were instructed by the speech therapist&#44; accompanied by verbal commands to the participant to ensure maximal effort as recommended by the IOPI manual&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Next&#44; the two questionnaires were administered only to the participants with PD&#59; first&#44; the DYMUS and then the Dysphapark&#46; In total&#44; it took between 10 and 12<span class="elsevierStyleHsp" style=""></span>min to complete both questionnaires&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the means and standard deviations of the control and PD participants in the two measures provided by the IOPI&#59; Lingual-Palatal Swallowing Pressure &#40;LSPs&#41; and Maximum Isometric Pressure &#40;MIP&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">To estimate the possible significant differences between the variables of interest in the PD and control group&#44; independent mean comparisons were carried out and showed significant effects&#46; The analysis of the LSPs variable showed that the means of the PD group was significantly lower than that of the control group &#91;<span class="elsevierStyleItalic">t</span>&#40;74&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;7&#46;38&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; effect size <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span> 0&#46;41&#93;&#46; The data also showed that there was a significant difference between PD and control in the dependent variable MIP &#91;<span class="elsevierStyleItalic">t</span>&#40;58&#46;96&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;7&#46;86&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; effect size <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span> 0&#46;51&#93;&#46; There were no differences between gender in the PD group for the variables of interest&#46; Likewise&#44; and considering the scarce evidence on this type of comparison in nature&#44; a Bayesian contrast of independent means was carried out&#44; and the data found showed that the alternative hypothesis had a greater probability of occurrence than the null hypothesis&#46; The Bayes factor for LSPs showed a value of 2&#46;706<span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">7</span>&#46; For the MIP variable&#44; the Bayes factor yielded a value of 2&#46;753<span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">8</span> &#40;see <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the means and standard deviations in the scores of the DYMUS and Dysphapark questionnaires in PD patients&#46; The study of the correlations between the variables of interest for the PD group showed significant correlations that we can observe in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The data showed a significant negative correlation between MIP and solid DYMUS &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;53&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#59; between MIP and E &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;48&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#59; and between MIP and S &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;51&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#46; In other words&#44; as the values in MIP increase&#44; the values in solid DYMUS&#44; Efficacy&#44; and Safety decrease&#46; It should be noted that the interpretation of these data must consider that&#44; both in the DYMUS questionnaire and in the Dysphapark questionnaire&#44; the higher the scores&#44; the greater the swallowing problems&#46; In summary&#44; the higher the MIP values in the PD group&#44; the fewer swallowing difficulties they present&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">On the other hand&#44; the data showed a significant positive correlation between MIP and LSPs &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#44; between DYS and DYL &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;49&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#93;&#59; between DYS and E &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#59; between DYS and S &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#59; between DYL and E &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#59; between DYL and S &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;72&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93; and between E and S &#91;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;58&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#93;&#46; These significant positive correlations indicate that as one variable increases&#44; the other increases&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The main objective of this work was to test whether LSPs and MIP can be used as clinical indicators for assessing and diagnosing dysphagia in PD patients&#46; Participants with PD were expected to have lower scores on IOPI measures than healthy participants in the control group&#46; On the other hand&#44; IOPI scores were expected to correlate with DYMUS questionnaire scores for dysphagia detection in PD participants&#46; Also&#44; IOPI and DYMUS questionnaire scores were expected to correlate with the level of dysphagia awareness &#40;Dysphapark&#41; in PD patients&#46; Thus&#44; the present study contributes to the literature by exposing convergent results with the most prominent findings in the field&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">About the first hypothesis posed&#44; the results of this study show that participants with PD present significantly lower scores&#44; both in LSPs and MIP&#44; compared to the control group&#46; Thus&#44; the findings of the present work support the results of the studies by <a class="elsevierStyleCrossRef" href="#bib0165">Solomon et al&#46; &#40;1995&#41;</a>&#44; <a class="elsevierStyleCrossRef" href="#bib0115">O&#8217;Day et al&#46; &#40;2005&#41;</a> and <a class="elsevierStyleCrossRefs" href="#bib0140">Pitts et al&#46; &#40;2018&#44; 2019&#41;</a>&#44; previously described&#46; It should be emphasized that in the <a class="elsevierStyleCrossRef" href="#bib0140">Pitts et al&#46; &#40;2018&#41;</a> study&#44; participants with PD performed the tongue pressure tasks twice&#59; they completed the tasks before taking a single dose of their medications &#40;OFF state&#41; and repeated the protocol after 40<span class="elsevierStyleHsp" style=""></span>min of medication administration &#40;ON state&#41;&#46; However&#44; their results showed no significant differences in tongue pressures between states&#46; Similar findings were found in the study by <a class="elsevierStyleCrossRef" href="#bib0060">De Letter et al&#46; &#40;2003&#41;</a>&#44; in which the authors concluded that the medication state does not influence the magnitude or duration of MIP generation&#46; Because of the above&#44; no information on the types of medication taken by PD patients was collected in the present investigation to ratify these findings&#46; Consequently&#44; IOPI measures in PD patients may serve as an accurate and effective marker for detecting and assessing dysphagia&#44; regardless of the state &#40;ON&#47;OFF&#41; is the patient is in when the test is administered&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The analysis of correlations between the objective measures of the IOPI with the measures of the questionnaires &#40;DYMUS and Dyspharak&#41; showed a significant negative correlation between MIP and solid DYMUS&#44; indicating that as MIP increases in PD patients&#44; problems swallowing solids &#40;solid DYMUS&#41; decrease&#46; However&#44; the correlation between MIP and liquid DYMUS did not show significance&#46; A plausible explanation could be that solid bolus swallowing is more sensitive to alterations due to motor fluctuations &#40;the greater the bolus weight&#44; the greater the force required for transport&#41; than liquid swallowing&#46; This finding is consistent with the results of <a class="elsevierStyleCrossRef" href="#bib0055">Dagna et al&#46; &#40;2021&#41;</a> and <a class="elsevierStyleCrossRef" href="#bib0105">Mamolar et al&#46; &#40;2017&#41;</a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The MIP also showed significant negative correlations with the Dyspharak Efficacy and Safety questionnaire subscales&#44; indicating that the higher the MIP values&#44; the less PD patients consider that they have swallowing efficacy and safety disturbances&#46; This finding suggests that the sample of PD patients in this study has a high level of awareness of their swallowing problems&#46; Thus&#44; it can be concluded that the Dysphapark questionnaire is an adequate measure of dysphagia in PD&#46; In this line&#44; it should be noted that the correlation analysis did not show significant results between the LSPs and the questionnaires&#46; However&#44; given the significant differences in the IOPI measures&#44; it could be interpreted that the LSPs measure is valid for screening dysphagia in PD versus healthy controls and that the MIP yields more information on the swallowing process in PD patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally&#44; analyzing the correlations between the questionnaires showed the expected results&#46; In the DYMUS questionnaire&#44; the correlation between solids and liquids was significant&#44; indicating that as problems in swallowing solids increase&#44; problems in swallowing liquids increase&#46; On the other hand&#44; when correlating the scores between the DYMUS questionnaire and the Dysphapark swallowing awareness questionnaire&#44; the results indicate that the more swallowing problems &#40;both solids and liquids&#41; PD patients present&#44; the greater the degree of awareness &#40;both of presenting alterations in swallowing efficacy and swallowing safety&#41;&#46; Thus&#44; this set of findings adds to the literature demonstrating the robustness and reliability of questionnaires for detecting&#44; evaluating&#44; and following up dysphagia in PD patients&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The results of this study support the theory that the IOPI measures &#40;LSPs and MIP&#41; and the DYMUS and Dysphapark questionnaires could be used as indicators for the assessment of dysphagia in PD patients and thus promote early diagnosis and specific speech therapy&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This research has not received any funding&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data availability statement</span><p id="par0140" class="elsevierStylePara elsevierViewall">All data generated and analyzed during this study are included in the article&#46; Further inquiries can be directed to the corresponding author&#46;</p></span></span>"
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    "fechaRecibido" => "2024-03-13"
    "fechaAceptado" => "2024-05-16"
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            0 => "Parkinson disease"
            1 => "IOPI"
            2 => "DYMUS"
            3 => "Dysphapark"
            4 => "Dysphagia"
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            0 => "Enfermedad de Parkinson"
            1 => "IOPI"
            2 => "DYMUS"
            3 => "Dysphapark"
            4 => "Disfagia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">It is well known that dysphagia in patients with Parkinson disease &#40;PD&#41; can be very disabling and hurt the quality of life&#46; Thus&#44; tongue function is crucial for swallowing&#46; In this line&#44; it has been proposed that inadequate lingual pressure conditions the swallowing process&#46; We aimed to determine whether lingual pressures in PD patients are lower than in a control group&#46; Also&#44; to test whether objective lingual pressures correlate with questionnaires designed to detect dysphagia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty-eight patients with PD and thirty-eight age- and gender-matched controls completed lingual pressure tasks with the IOWA oral performance instrument&#46; Additionally&#44; the experimental group completed the DYMUS questionnaire for the early detection of dysphagia and the Dysphapark questionnaire for assessing swallowing disorder awareness&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with PD presented significantly lower scores in lingual pressure tasks compared to the control group&#46; Correlation analysis showed significant correlations between lingual pressure tasks and both questionnaires&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lingual pressures&#44; DYMUS and Dysphapark questionnaires can serve as clinical indicators for assessing dysphagia and prompt diagnosis and early speech therapy intervention of dysphagia in PD patients&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Prop&#243;sito</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Es bien sabido que la disfagia en pacientes con enfermedad de Parkinson &#40;EP&#41; puede ser muy incapacitante y perjudicar la calidad de vida&#46; Por lo tanto&#44; la funci&#243;n de la lengua es crucial para la degluci&#243;n&#46; En esta l&#237;nea&#44; se ha propuesto que una presi&#243;n lingual inadecuada condiciona el proceso de degluci&#243;n&#46; Nuestro objetivo fue determinar si las presiones linguales en los pacientes con EP son m&#225;s bajas que en un grupo control&#46; Tambi&#233;n&#44; para comprobar si las presiones linguales objetivas se correlacionan con los cuestionarios dise&#241;ados para detectar la disfagia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Treinta y ocho pacientes con EP y 38 controles emparejados por edad y sexo completaron tareas de presi&#243;n lingual con el instrumento de rendimiento oral IOWA&#46; Adem&#225;s&#44; el grupo experimental complet&#243; el cuestionario DYMUS para la detecci&#243;n precoz de la disfagia y el cuestionario Dysphapark para evaluar el conocimiento del trastorno de la degluci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con EP presentaron puntuaciones significativamente m&#225;s bajas en las tareas de presi&#243;n lingual en comparaci&#243;n con el grupo control&#46; El an&#225;lisis de correlaci&#243;n mostr&#243; correlaciones significativas entre las tareas de presi&#243;n lingual y ambos cuestionarios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las presiones linguales&#44; los cuestionarios DYMUS y Dysphapark pueden servir como indicadores cl&#237;nicos para evaluar la disfagia y el diagn&#243;stico precoz y la intervenci&#243;n logop&#233;dica precoz de la disfagia en pacientes con EP&#46;</p></span>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#46; LSPs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Lingual-Palatal Swallowing Pressures&#44; MIP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Maximum Isometric Pressure&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col">Participants&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Age&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Gender&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">LSPs &#40;kPA&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">MIP &#40;kPA&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">M</span>&#44; <span class="elsevierStyleItalic">F</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">M</span> &#40;SD&#41;&#44; range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">M</span> &#40;SD&#41;&#44; range&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&#46;23 &#40;10&#46;93&#41;41&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">22&#44; 16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">15&#46;58 &#40;6&#46;71&#41;6&#8211;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">34&#46;5 &#40;12&#46;02&#41;11&#8211;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Control&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#46;82 &#40;6&#46;93&#41;51&#8211;82&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descriptive and mean statistics&#44; standard deviations and ranges of IOPI&#46;</p>"
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              "identificador" => "bib0005"
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                      "titulo" => "Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "N&#46; Audag"
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                            4 => "W&#46; Poncin"
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                    0 => array:2 [
                      "doi" => "10.1002/mus.27254"
                      "Revista" => array:7 [
                        "tituloSerie" => "Muscle &#38; Nerve"
                        "fecha" => "2021"
                        "volumen" => "64"
                        "numero" => "3"
                        "paginaInicial" => "277"
                        "paginaFinal" => "284"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/39434176"
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              "identificador" => "bib0010"
              "etiqueta" => "Ayres et al&#46;&#44; 2016"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of dysphagia therapy on quality of life in patients with Parkinson&#39;s disease as measured by the swallowing quality of life questionnaire &#40;SWALQOL&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ayres"
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                            2 => "C&#46;R&#46;D&#46;M&#46; Rieder"
                            3 => "A&#46;F&#46;S&#46; Schuh"
                            4 => "M&#46;R&#46; Olchik"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0036-1582450"
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                        "tituloSerie" => "International Archives of Otorhinolaryngology"
                        "fecha" => "2016"
                        "volumen" => "20"
                        "paginaInicial" => "202"
                        "paginaFinal" => "206"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27413399"
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                      "titulo" => "Dysphagia awareness in Parkinson&#39;s disease"
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                          "autores" => array:7 [
                            0 => "&#192;&#46; Bay&#233;s-Rusi&#241;ol"
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                            2 => "A&#46; Ayala"
                            3 => "M&#46;D&#46;C&#46; Crespo"
                            4 => "A&#46; Prats"
                            5 => "E&#46; Valles"
                            6 => "M&#46; Garolera-Freixa"
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                      "Revista" => array:6 [
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