title: Swallowing disturbances in Parkinson's disease: a multivariate analysis of contributing factors.
abstract: BACKGROUND
  Swallowing disturbances are an important issue in Parkinson's disease (PD) as several studies have shown that they are associated with increased risk of aspiration pneumonia and mortality. Information about factors related to swallowing disturbances, such as disease duration, age at assessment and concomitant dementia, is limited and would be useful for their management.
  
  
  METHODS
  All consecutive PD out-patients evaluated at a movement disorders clinic over a 7-year period (2007-2014), were included in the present retrospective study. Presence of symptomatic swallowing disturbances was assessed using the specific item of the Non Motor Symptom Questionnaire.
  
  
  RESULTS
  In the whole PD population (N = 6462), prevalence of symptomatic swallowing disturbances was 11.7% (95%CI, 10.9-12.5). Multivariable logistic regression analysis (adjusted for education) disclosed a significant interaction between disease duration and gender (P = 0.009). In both gender strata, swallowing disturbances were significantly associated with longer disease duration and dementia (P < 0.001 for all). A significant effect for age at assessment was also found in male patients. In non-demented patients, swallowing disturbances were associated with male gender, age and disease duration (P < 0.02 for all). In demented patients an association was found only with male gender (P = 0.018) and disease duration (P < 0.001).
  
  
  CONCLUSIONS
  Gender, age, disease duration and dementia all seem to contribute to the occurrence of swallowing disturbances independently. However, the role played by these factors in sub-groups of patients stratified by gender and concomitant dementia suggests that swallowing disturbances are likely related to different neuro-degenerative patterns within the brain. The underlying mechanisms deserve further investigation.
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cilia
authors.affiliation: Biometry and Statistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Canesi
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Anna Lena
authors.initials: AL
authors.lastname: Zecchinelli
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Claudio Bruno
authors.initials: CB
authors.lastname: Mariani
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Tesei
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Sacilotto
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Meucci
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Zini
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Ioannis Ugo
authors.initials: IU
authors.lastname: Isaias
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Cassani
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Goldwurm
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Barichella
authors.affiliation: Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pezzoli
mesh_terms: D017677:Age Distribution; D000368:Aged; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D011795:Surveys and Questionnaires
keywords: Dementia; Disease duration; Dysphagia; Parkinson's disease; Swallowing disturbances