Videofluoroscopic study of swallowing disorders in patients with parkinsonism

Background: Dysphagia in Parkinsonism is often reported, and diagnosed, late. This can be a contributor to morbidity and mortality. Hence, a screening tool is essential as part of routine workup of these patients. The gold standard diagnostic modality for dysphagia is Videofluoroscopic Swallowing Study (VFSS). However, being an interventional imaging procedure, it cannot be made routine for every case. Aim: To study swallowing problems in patients with Parkinsonism using a screening questionnaire and to objectively observe the findings at VFSS in these patients. Materials and Methods: Fifteen patients (nine males and six females) attending the Parkinsonism clinic over a period of 1 year, and meeting the inclusion criteria, were included in the study. After standard neurological evaluation, they were administered our screening tool, the Amrita Dysphagia Screening Questionnaire (ADSQ). Next, they underwent VFSS. The scores and findings from these were documented, and the results were tabulated. Results: The average Hoehn and Yahr scale and ADSQ scores were 0.488 and 0.799, respectively. Mean age was 68.9 years. In VFSS, all the patients showed features of oropharyngeal swallowing disorders characteristic of Parkinsonism. These included features of bradykinesia such as tongue pumping, smaller tongue movements and piecemeal deglutition in the oral preparatory stage of swallowing, and reduced pharyngeal constriction, premature spillage, vallecular and pyriform sinuses residue, reduced hyoid movement, prolonged transit time, delayed laryngeal closure, aspiration/penetration, and repetitive or multiple swallow in the pharyngeal stage of swallowing. Conclusion: The present study has documented the objective findings of swallowing disorders, especially of the oral phase, in patients with Parkinsonism. This, along with our screening tool, must be considered essential in the management protocol for this debilitating neurological condition.