Profiles of Dysarthria and Dysphagia in Individuals With Amyotrophic Lateral Sclerosis.
Profiles of Dysarthria and Dysphagia in Individuals With Amyotrophic Lateral Sclerosis.
复制标题
肌萎缩侧索硬化症患者构音障碍和吞咽困难的概况。
DOI：
10.1044/2022_jslhr-22-00312
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Plowman,EmilyK
中科院分区：
文献类型：
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作者：
Donohue,Cara;Gray,LaurenTabor;Anderson,Amber;DiBiase,Lauren;Wymer,JamesP;Plowman,EmilyK
虽然构音障碍和吞咽困难是肌萎缩侧索硬化症（ALS）的延髓表现，但言语和吞咽障碍的相对患病率以及这些延髓症状是否在同一时间点出现或以相似的速度进展尚不清楚。因此，我们试图确定一组ALS患者中言语和吞咽障碍的相对患病率，并确定疾病持续时间、严重程度和发作类型对延髓损伤的影响。（ALSFRS-R），接受视频透视（VF），并在单次访视期间完成句子可懂性测试（SIT）。还从参与者中获得了人口统计学变量，包括疾病持续时间和发作类型。使用吞咽毒性动态成像分级（DIGEST）量表和SIT对吞咽困难（DIGEST ≥ 1）和构音障碍（< 96%可理解和/或< 150字/分钟）状态进行索引，完成重复、独立和盲法评级。描述性统计，Pearson卡方检验，独立的samplesttest，和优势比performed. Results吞咽困难和构音障碍分别在68%和78%的个体与ALS，仪器确认。构音障碍和吞咽困难相关（p= 0.01），按等级顺序排列的延髓损伤分布包括（a）吞咽困难-构音障碍（59%，n = 52），（B）无吞咽困难-构音障碍（19%，n = 17），（c）无吞咽困难-无构音障碍（13%，n = 11）和（d）吞咽困难-无构音障碍（9%，n = 8）。吞咽困难或构音障碍的受试者在其他领域表现出延髓损伤的几率比言语和吞咽正常的受试者高4.2倍（95% CI [1.5，12.2]）。在不同的眼球损害特征中，ALSFRS-R总分或疾病持续时间无差异（p> 0.05）。吞咽困难患者的ALSFRS-R延髓子量表评分显著低于无吞咽困难患者（8.4 vs. 10.4，p <0.0001），构音障碍患者的ALSFRS-R延髓子量表评分显著低于无构音障碍患者（8.5 vs. 10.9，p <0.0001）。吞咽困难和发作类型（p= .003）和构音障碍和发作类型相关（p< .0001）。在只有一个延髓损伤的人中，言语是第一个延髓症状退化的可能性的两倍。需要进一步的研究来证实这些发现，并确定该患者人群中延髓损伤的纵向进展。
PurposeWhile dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and whether these bulbar symptoms emerge at the same time point or progress at similar rates is not yet clear. We, therefore, sought to determine the relative prevalence of speech and swallowing impairments in a cohort of individuals with ALS and to determine the impact of disease duration, severity, and onset type on bulbar impairments.MethodEighty-eight individuals with a confirmed diagnosis of ALS completed the ALS Functional Rating Scale–Revised (ALSFRS-R), underwent videofluoroscopy (VF), and completed the Sentence Intelligibility Test (SIT) during a single visit. Demographic variables including disease duration and onset type were also obtained from participants. Duplicate, independent, and blinded ratings were completed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale and SIT to index dysphagia (DIGEST ≥ 1) and dysarthria (< 96% intelligible and/or < 150 words per minute) status. Descriptive statistics, Pearson chi-squared tests, independent-samplesttests, and odds ratios were performed.ResultsDysphagia and dysarthria were instrumentally confirmed in 68% and 78% of individuals with ALS, respectively. Dysarthria and dysphagia were associated (p= .01), and bulbar impairment profile distributions in rank order included (a) dysphagia – dysarthria (59%,n= 52), (b) no dysphagia – dysarthria (19%,n= 17), (c) no dysphagia – no dysarthria (13%,n= 11), and (d) dysphagia – no dysarthria (9%,n= 8). Participants with dysphagia or dysarthria demonstrated 4.2 higher odds of exhibiting a bulbar impairment in the other domain than participants with normal speech and swallowing (95% CI [1.5, 12.2]). There were no differences in ALSFRS-R total scores or disease duration across bulbar impairment profiles (p> .05). ALSFRS-R bulbar subscale scores were significantly lower in individuals with dysphagia versus no dysphagia (8.4 vs. 10.4,p< .0001) and dysarthria versus no dysarthria (8.5 vs. 10.9,p< .0001). Dysphagia and onset type (p= .003) and dysarthria and onset type were associated (p< .0001).ConclusionsOver half of the individuals with ALS in this study demonstrated both dysphagia and dysarthria. Of those with only one bulbar impairment, speech was twice as likely to be the first bulbar symptom to degrade. Future studies are needed to confirm these findings and determine the longitudinal progression of bulbar impairments in this patient population.