Progression of Dysphagia in Parkinson's Disease

项目总结/摘要 帕金森病（PD）是一种进行性神经退行性疾病， 系统.吞咽障碍（吞咽困难）经常发生在PD中，并可能严重影响发病率， 死亡率和生活质量。由于以PD为中心的医疗和手术方法不会对 对于患有PD相关吞咽困难的患者，行为康复是护理标准。但 尚不清楚PD患者吞咽功能何时以及如何开始下降， 临床吞咽困难这种对PD患者吞咽困难进展的不明确理解，在 知识，迫使临床医生等待开始治疗，直到病人抱怨吞咽困难，这可能不会 发生，直到发生显著的神经变性和吞咽的持续改善 功能可能无法实现。几种定量、客观和灵敏的测量技术 吞咽生理学已经确定了健康个体和患有PD的个体之间的功能差异， 但这些生理指标如何随时间变化尚不清楚。在这项研究中，我们的目标是确定 帕金森病患者吞咽功能障碍进展的特征性指标。这 一项研究提出了一种交叉顺序的观察设计，以全面评估吞咽生理学， 横截面和纵向的方式，铺平了道路，为更好地了解吞咽下降， PD和吞咽困难康复的个性化医学方法。具体而言，这项研究将允许 收集足够的初步数据，优化数据收集和分析协议， NIH R 01应用程序的总体目标是纵向随访患者，评估吞咽困难 进展，并开发算法来预测吞咽困难发展的风险。我们的主要假设是 1）压力和咀嚼测量将表现出比成像更大的随时间的变化量， 呼吸测量;和2）与对照组相比，早期PD的吞咽功能变化速率较慢。 中期PD优化综合吞咽生理学评估将改善 了解吞咽缺陷的进展和吞咽行为改变的潜力， PD的人。改善吞咽下降的表征将导致更精确的评估， 吞咽困难的诊断，更好地定位吞咽康复的机会窗口，等等 随着该领域探索新的治疗方法，具体的结果测量。

PROJECT SUMMARY/ABSTRACT Parkinson’s disease (PD) is a progressive, neurodegenerative condition that impacts multiple sensorimotor systems. Swallowing disorders (dysphagia) occur frequently in PD and can devastatingly impact morbidity, mortality, and quality of life. As PD-centered medical and surgical approaches do not meaningfully impact dysphagia, behavioral rehabilitation is the standard of care for persons with PD-related dysphagia. However, it is unknown when and how swallowing function begins to decline in PD, prior to crossing the threshold into clinical dysphagia. This unclear understanding of dysphagia progression in PD leaves a critical gap in knowledge, forcing clinicians to wait to begin therapy until the patient complains of dysphagia, which may not occur until a point when significant neurodegeneration has occurred and lasting improvement in swallowing function may be unattainable. Several quantitative, objective, and sensitive techniques for measuring swallowing physiology have identified differences in function between healthy individuals and those with PD, but it is unknown how these measures of physiology change over time. In this study, we aim to identify measures that characterize progression of swallowing dysfunction in persons with Parkinson’s disease. This study proposes a cross-sequential, observational design to comprehensively assess swallowing physiology in a cross-sectional and longitudinal manner, paving the way for improved understanding of swallowing decline in PD and for a personalized medicine approach for dysphagia rehabilitation. Specifically, this study will allow for the collection of sufficient preliminary data and optimization of data collection and analysis protocols to support an NIH R01 application, with the overall objective to longitudinally follow patients, asses for dysphagia progression, and develop algorithms to predict risk for dysphagia development. Our central hypotheses are that 1) Pressure and mastication measures will exhibit greater amounts of change over time than imaging or respiratory measures; and 2) Rate of swallowing function change will be slower in early-stage PD compared to mid-stage PD. Optimization of comprehensive swallowing physiology assessment will lead to improvements in understanding of progression of swallowing deficits and potential for behavioral modification of swallowing in persons with PD. Improved characterization of swallowing decline will lead to more precise assessment and diagnosis of dysphagia, better targeting of windows of opportunity for swallowing rehabilitation, and more specific outcome measurements as the field explores novel treatment approaches.