title: Reflex Cough and Disease Duration as Predictors of Swallowing Dysfunction in Parkinson's Disease.
abstract: Patients with Parkinson's disease (PD) have progressive and pervasive disorders of airway protection. Recent work has highlighted the relationship between reflex and voluntary cough and swallowing safety. The goal of this study was to test the sensitivity and specificity of several airway protective and disease-specific factors for predicting swallowing safety outcomes in PD. Sixty-four participants (44 males) completed measures of voluntary and reflex cough, and swallowing safety. Clinical predictors included disease severity and duration, and cough airflow and sensitivity measures. ROC and Chi-square analyses identified predictors of swallowing safety (penetration-aspiration score) in PD. Disease duration significantly discriminated between patients with normal and abnormal swallowing safety (p = 0.027, sensitivity: 71 %, specificity: 55.4 %). Cough reflex sensitivity significantly discriminated between patients who penetrated above the level of the vocal folds and those with more severe penetration/aspiration (p = 0.021, sensitivity: 71.0 %, specificity 57.6 %). Urge-to-cough sensitivity (log-log linear slope) was the only variable which significantly discriminated between patients with penetration versus aspiration (p = 0.017, sensitivity: 85.7 %, specificity 73.2 %). It is important to identify the factors which influence airway protective outcomes in PD especially given that aspiration pneumonia is a leading cause of death. Results from this study highlight the ecological validity of reflex cough in the study of airway protection and this study further identifies important factors to consider in the screening of airway protective deficits in PD.
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike 1054A, Thorndike Hall 955, New York, NY, 10027, USA. Mst2139@tc.columbia.edu.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Troche
authors.affiliation: Department of Neurology, University Hospital RWTH Aachen, Pauwelsstrabe 30, 52074, Aachen, NRW, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Schumann
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike 1054A, Thorndike Hall 955, New York, NY, 10027, USA.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Brandimore
authors.affiliation: Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA.|Department of Speech, Language, & Hearing Sciences, University of Florida, P.O. Box 117420, Gainesville, FL, 32611, USA.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hegland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000209:etiology / Q000503:physiopathology*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012018:Reflex / Q000502:physiology*; D053120:Respiratory Aspiration / Q000209:etiology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013997:Time Factors
keywords: Aspiration; Deglutition; Deglutition disorders; Dysphagia; Dystussia; Parkinson’s disease; Reflex cough