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. 2023 Jun;11(2):176-187.
doi: 10.1007/s40141-023-00392-9. Epub 2023 Mar 28.

Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices

Denis Michael Rudisch  1   2 , Maryann N Krasko  1   2 , Ryan Burdick  3   4 , Courtney K Broadfoot  3   4 , Nicole Rogus-Pulia  3   4 , Michelle R Ciucci  1   2   5
Affiliations

Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices

Denis Michael Rudisch et al. Curr Phys Med Rehabil Rep. 2023 Jun.

Abstract

Purpose of review: Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions.

Recent findings: Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations.

Summary: Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.

Keywords: Diagnosis; Dysphagia; Motor; Non-motor; Parkinson disease; Pathophysiology; Saliva; Swallowing.

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Conflict of interest statement

Conflict of Interest Dr. Michelle R. Ciucci is on the board of directors of the National Foundation of Swallowing Disorders (NFOSD) and receives no compensation as member of the board of directors.

Figures

Figure 1.
Figure 1.
Schematic timeline of non-motor features of PD [1]
Figure 2.
Figure 2.
Braak’s proposed disease staging system [35]; List of abbreviations: co, coeruleus–subcoeruleus complex; dm, dorsal motor nucleus of the glossopharyngeal and vagal nerves; fc, first order sensory association areas, premotor areas, and primary sensory/motor field; hc, high order sensory association areas and prefrontal fields; mc, anteromedial temporal mesocortex; sn, substantia nigra.
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