title: Decreased cough sensitivity and aspiration in Parkinson disease.
abstract: BACKGROUND
  Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia.
  
  
  METHODS
  Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 μM capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale.
  
  
  RESULTS
  Most participants with PD did not have a consistent two-cough response to 200 μM capsaicin. UTC ratings and total number of coughs produced at 200 μM capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC).
  
  
  CONCLUSIONS
  UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population.
authors: From the The Department of Speech, Language, and Hearing Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL. Electronic address: michi81@phhp.ufl.edu.
authors: Michelle S
authors: MS
authors: Troche
authors: From the The Department of Speech, Language, and Hearing Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL.
authors: Alexandra E
authors: AE
authors: Brandimore
authors: Department of Neurology, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL.
authors: Michael S
authors: MS
authors: Okun
authors: Department of Physiological Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL.
authors: Paul W
authors: PW
authors: Davenport
authors: From the The Department of Speech, Language, and Hearing Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL.
authors: Karen W
authors: KW
authors: Hegland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002211:Capsaicin; D003371:Cough / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology; D011015:Pneumonia, Aspiration / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D012018:Reflex / Q000187:drug effects / Q000502:physiology*; D015203:Reproducibility of Results; D018689:Sensory System Agents; D012684:Sensory Thresholds / Q000187:drug effects / Q000502:physiology*
chemical_list: D018689:Sensory System Agents; D002211:Capsaicin