Dysphagia in Progressive Supranuclear Palsy
Dysphagia in Progressive Supranuclear Palsy
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DOI：
10.1007/s00455-019-10073-2
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发表时间：
2019-11-01
期刊：
影响因子：
2.6
通讯作者：
Josephs, Keith A.
中科院分区：
文献类型：
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作者：
Clark, Heather M.;Stierwalt, Julie A. G.;Josephs, Keith A.
进行性核上性麻痹 (PSP) 是最常见的帕金森综合症，与帕金森病相关的早期吞咽困难相关。目前的研究通过采用国家标准化视频荧光镜检查方案和专门为 PSP 开发的疾病严重程度量表描述了大型 PSP 参与者的口咽吞咽特征，有助于加深对 PSP 吞咽功能障碍的了解。参与者是 51 名被诊断患有 PSP 的成年人。每个参与者都接受了临床访谈和标准化视频荧光检查评估。吞咽功能通过改良钡吞咽障碍量表 (MBSImP) 和穿透-误吸量表 (PAS) 进行表征。感兴趣的变量是参与者报告的液体和/或固体困难； 17 个单独的 MBSImP 组件中每一个组件的总体印象分数，以及口腔总和和咽部总和；和伊党。数据用中位四分位数范围、计数和比例来描述。计算 MBSImP 分数与参与者报告的指数、FOIS 和 PSP 评定量表之间的 Spearman 等级相关性。大约三分之二的参与者表示在使用液体、固体或两者时遇到困难，但只有不到 15% 的参与者表示需要修改稠度。荧光影像检查结果包括主要的口腔阶段障碍，包括舌头的前后摇动、咽部吞咽的延迟以及口腔残留物。咽相损伤相对罕见且相对轻微，除了导致咽残留物的舌根回缩减少以及喉前庭闭合轻度破坏之外。疾病严重程度与口腔（r = .0.42，p = .0.002）和咽部（r = 0.41，p = .0.003）总分以及口腔运输的口腔阶段组成部分（r = .0.33，p = .0.02）和咽部吞咽开始（r = .0.38，p = .0.007）显着相关，并且PAS 对于稀液体（r = .0.44，p = .0.001）。 PSP 评定量表与吞咽障碍的相关性并不比其他疾病严重程度评定量表所报道的更强。吞咽困难是 PSP 患者的常见主诉。目前的研究结果证实并扩展了文献中报道的结果，详细描述了相对更频繁和更严重的口期障碍和相对较少的舌喉偏移。需要进一步的研究来描述 PSP 吞咽困难的进展特征，并确定吞咽困难的特征或进展速度是否因 PSP 变体的不同而不同。
Progressive supranuclear palsy (PSP) is the most common Parkinson-Plus syndrome and is associated with early onset of dysphagia relative to Parkinson Disease. The current study contributes to the growing understanding of swallowing dysfunction in PSP by describing oropharyngeal swallowing characteristics in a large prospective cohort of participants with PSP employing a nationally standardized videofluoroscopy protocol and a disease severity scale developed expressly for PSP. Participants were 51 adults diagnosed with PSP. Each participant underwent a clinical interview and standardized videofluorographic assessment. Swallowing function was characterized with the Modified Barium Swallow Impairment Scale (MBSImP) and Penetration-Aspiration Scale (PAS). Variables of interest were participant-reported difficulties with liquids and/or solids; overall impression score for each of the 17 individual MBSImP components, as well as Oral Total Sum and Pharyngeal Total Sum; and PAS. Data were described with median interquartile range, counts, and proportions. Spearman's rank correlations were calculated between MBSImP scores and participant-reported indices, FOIS, and PSP Rating Scale. Approximately two-thirds of participants reported difficulties with liquids, solids, or both, although fewer than 15% reported modifying consistencies. Videofluorographic findings included predominant oral phase impairments, including back and forth rocking motion of the tongue, delayed initiation of the pharyngeal swallow, and oral residue. Pharyngeal phase impairments were relatively infrequent and comparatively mild, with the exception of reduced tongue base retraction contributing to pharyngeal residue, and mildly disrupted laryngeal vestibule closure. Disease severity correlated significantly with oral (r = .0.42, p = .0.002) and pharyngeal (r = 0.41, p = .0.003) total sum scores as well as with the oral phase components of oral transport (r = .0.33, p = .0.02) and initiation of the pharyngeal swallow (r = .0.38, p = .0.007), and PAS for thin liquids (r = .0.44, p = .0.001). The PSP Rating Scale was not more strongly correlated with swallowing impairment than has been reported for other disease severity rating scales. Dysphagia is a common complaint of patients with PSP. The current findings corroborate and expand upon those reported in the literature, detailing relatively more frequent and more severe oral phase impairments and relatively spared hyolaryngeal excursion. Further research is needed to characterize the progression of dysphagia in PSP and to determine whether dysphagia varies in character or in rate of progression across variants of PSP.