Risk and prognostic factors for pneumonia and choking amongst Parkinson's disease patients with dysphagia.
To evaluate the time to hospitalisation and baseline factors associated with pneumonia/choking in Parkinson's Disease (PD) patients.



Although dysphagia and pneumonia are common problems in PD, scarce research has been performed.



A total of 194 PD patients who underwent a VFS evaluation were retrospectively selected. The mode of feeding and admissions for pneumonia/choking were analyzed. Baseline clinical and demographic variables were compared between feeding groups. Kaplan-Meier survival analysis was performed to estimate time to pneumonia/choking. Clinical variables significantly associated with pneumonia/choking free survival were identified using Cox regression.



Hospitalisation for pneumonia/choking occurred in 89 out of 194 patients, with the highest admission rate in rejected enteral feeding group (66.7%), followed by enteral feeding (61.8%) and oral feeding (38.8%) groups. The estimates of median time to event were 11, 14, and 47 months for rejected enteral feeding, enteral and oral feeding groups respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest risk of pneumonia/choking (HR 4.61, 95%CI:2.33-9.08, p < 0.001), followed by enteral feeding group (HR 2.29, 95%CI:1.25-4.19, p = 0.007), when compared to oral feeding group after adjusting for possible confounders. A stepwise Cox regression showed that the rejected enteral feeding (HR 4.89, 95%CI:2.19-10.88, p < 0.001), enteral mode of feeding (HR 2.43, 95%CI:1.11-5.32, p = 0.026), and Charlson weighted index of co-morbidity (HR 1.27, 95%CI:1.03-1.58, p = 0.028) were independently associated with higher hazard of pneumonia/choking.



Compliance to feeding recommendations is important to reduce the risk of hospitalisation for pneumonia/choking. The recommended mode of feeding and comorbidity index was significantly associated with pneumonia/choking risk.
Department of Neurology, National Neuroscience Institute, Singapore.
Kwang-Hwee
KH
Goh
Duke-NUS Graduate Medical School, Singapore.
Sanchalika
S
Acharyya
Department of Neurology, National Neuroscience Institute, Singapore.
Samuel Yong-Ern
SY
Ng
Speech Therapy Department, Tan Tock Seng Hospital, Singapore.
Jasmine Pei-Ling
JP
Boo
Speech Therapy Department, Tan Tock Seng Hospital, Singapore.
Amanda Hui-Juan
AH
Kooi
Department of Neurology, National Neuroscience Institute, Singapore.
Hwee-Lan
HL
Ng
Department of Neurology, National Neuroscience Institute, Singapore.
Wei
W
Li
Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore.
Kay-Yaw
KY
Tay
Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore.
Wing-Lok
WL
Au
Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore. Electronic address: louis_tan@nni.com.sg.
Louis Chew-Seng
LC
Tan
D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology*; D003680:Deglutition Disorders / Q000150:complications* / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000073216:Mental Status and Dementia Tests; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014741:Video Recording
Dysphagia; Nasogastric feeding; Parkinson’s disease; Pneumonia