Progression of Dysphagia in Parkinson's Disease

项目摘要/摘要 帕金森病(PD)是一种进行性神经退行性疾病，影响多种感觉运动 系统。吞咽障碍(吞咽困难)在帕金森病中经常发生，并可能对发病率造成毁灭性的影响， 死亡率和生活质量。因为以帕金森病为中心的内科和外科手术方法不会对 吞咽困难，行为康复是帕金森病相关吞咽困难患者的标准护理。然而，它 尚不清楚帕金森病患者吞咽功能何时以及如何开始下降，在跨过阈值之前 临床吞咽困难。这种对帕金森病吞咽困难进展的不清楚理解在以下方面留下了一个关键空白 知识，迫使临床医生等待开始治疗，直到患者主诉吞咽困难，这可能不是 直到发生显著的神经变性，吞咽情况持续改善 功能可能无法实现。几种定量的、客观的和灵敏的测量技术 吞咽生理学已经确定了健康人和帕金森病患者之间的功能差异， 但目前尚不清楚这些生理指标是如何随着时间的推移而变化的。在这项研究中，我们的目标是确定 描述帕金森氏症患者吞咽功能障碍进展的指标。这 研究提出了一种交叉序贯观察性设计，以全面评估患者的吞咽生理 一种横向和纵向的方式，为更好地理解吞咽下降铺平了道路 帕金森病和吞咽困难康复的个人化医学方法。具体来说，这项研究将考虑到 收集足够的初步数据并优化数据收集和分析协议，以支持 NIH R01应用程序，总体目标是纵向跟踪患者，评估吞咽困难 进展，并开发算法来预测吞咽困难的发展风险。我们的中心假设是 1)压力和咀嚼测量随着时间的推移将显示出比成像或咀嚼测量更大的变化量 呼吸措施；2)早期PD患者吞咽功能改变的速度较慢 中期警局。综合吞咽生理评估的优化将导致改善 了解吞咽障碍的进展和吞咽行为改变的可能性 帕金森病患者。改善吞咽下降的特征将导致更准确的评估和 吞咽困难的诊断，更好地瞄准吞咽康复的机会窗，以及更多 随着该领域探索新的治疗方法，具体的结果衡量。

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.