Dysphagia and hypersalivation in Parkinson’s Disease: a cross-sectional survey.

SANTIAGO PÉREZ LLORET; LAURENCE NEGRE-PAGES; OLIVIER RASCOL; MARCELO MERELLO

Paris, Francia

Congreso; Congreso Internacional de Movimientos Anormales; 2009

Introduction: Dysphagia and hypersialorrhea can affect patients with Parkinson’s Disease (PD). However such symptoms have been rarely evaluated in large samples of patients recruited out of tertiary specialized units and its prevalence, risk factors and impact on health-related quality of life is poorly known in the general population of PD patients. Objective: We explored the frequency of dysphagia and hypersalivation in 450 PD patients of the Toulouse area in a cross-sectional survey and compared the demographic, clinical and pharmacological features associated with the presence or absence of such symptoms. Methods:  450 patients underwent structured standardized clinical examination (UPDRS parts I-IV, MMSE, PDQ39). Dysphagia and hypersalivation were defined as UPDRS II items 6 or 7 ≥ 1, respectively. Drug consumption was obtained from clinical records. Results: The mean age of the 450 studied patients was 69±10 years, 57% of them were males, with a mean PD duration of 6±5 years, a mean UPDRS II+III in ON condition of 28±15. They were treated with levodopa for 5±4 years with a mean daily dose of 580±360 mg/day. 77/450 patients (18.4%) reported dysphagia and 154/450 (36.8%) hypersalivation. Patients complaining of dysphagia had longer PD duration (8±5 vs 5±4 years, p<0.0002), higher rates of hypotension (21% vs 10 p<0.001), higher UPDRS II+III score (37±15 vs 26±14 p<0.0001), more frequent depressive symptoms (60% vs 31% p<0.0001), longer duration of treatment (7±4 vs 5±4 years p<0.001), greater levodopa dose (720±417 vs 550±335 mg/day p<0.004), more frequent amantadine therapy (15% vs 6% p<0.01) and worse PDQ39 score (32.1±13.2 vs 25.5±13.3 p<0.0001) Patients complaining of hypersalivation had longer PD duration (7±5 vs 5±4 years, p<0.004), higher UPDRS II+III score (36±15 vs 24±13 p<0.0001), longer duration of treatment (6±4 vs 5±4 years p<0.001), greater levodopa dose (641±368 vs 543±350 mg/day p<0.004), less frequent benzodiazepine therapy (6% vs 14% p<0.02) and worse PDQ39 score (28.7±14.6 vs 25.7±12.8 p<0.02) Conclusion: Dysphagia and sialorrhea affected one-third of ambulatory non-demented PD patients recruited in academic and non academic outpatient clinics. Both symptoms were associated with more severe parkinsonism and impaired health-related quality of life. Dysphagia was more prevalent in patients on amantadine, while hypersalivation was less frequent among benzodiazepine users.