title: Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease.
abstract: BACKGROUND
  Dysphagia in patients with Parkinson's disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD.
  
  
  METHODS
  The two-phased project comprised the questionnaire, diagnostic scales construction (N = 105), and a validation study (N = 82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration.
  
  
  RESULTS
  The Munich Dysphagia Test - Parkinson's disease (MDT-PD) consists of 26 items that show high internal consistency (α = 0.91). For the validation study, 82 patients, aged 70.9 ± 8.7 (mean ± SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r = 0.70, p < 0.001). The MDT-PD sum score classified not noticeable dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively.
  
  
  CONCLUSIONS
  MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients.
authors.affiliation: Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany; Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany. Electronic address: Janine.Simons@uksh.de.
authors.forename: Janine A
authors.initials: JA
authors.lastname: Simons
authors.affiliation: Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany.
authors.forename: Urban M
authors.initials: UM
authors.lastname: Fietzek
authors.affiliation: Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Waldmann
authors.affiliation: Department of Neurology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Warnecke
authors.affiliation: Institute of Medical Statistics and Epidemiology, Technische Universität München (TUM), Munich, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.affiliation: Center for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing (MSW), Munich, Germany.
authors.forename: Andrés O
authors.initials: AO
authors.lastname: Ceballos-Baumann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis* / Q000209:etiology; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis*; D011788:Quality of Life; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Dysphagia; Movement disorders; Parkinson's disease; Patient-reported outcome questionnaire; Screening/scales; Swallowing disorders