A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value.

Deglutition Deglutition Disorders / diagnosis Humans Italy Parkinson Disease / complications Prognosis Quality of Life
Deglutition disorders Dysphagia Parkinson's disease Swallowing disorders

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
Mar 2022
Historique:
received: 20 05 2021
accepted: 02 08 2021
revised: 01 08 2021
pubmed: 22 8 2021
medline: 23 2 2022
entrez: 21 8 2021
Statut: ppublish

Résumé

Parkinson's disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Eighty-five papers were used to inform the Panel's statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD.

Sections du résumé

BACKGROUND BACKGROUND
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD.
OBJECTIVE OBJECTIVE
To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients.
METHODS METHODS
A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.
RESULTS RESULTS
Eighty-five papers were used to inform the Panel's statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions.
CONCLUSIONS CONCLUSIONS
The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD.

Identifiants

DOI: 10.1007/s00415-021-10739-8 PMID: 34417870 PMC: PMC8857094
pubmed: 34417870
doi: 10.1007/s00415-021-10739-8
pii: 10.1007/s00415-021-10739-8
pmc: PMC8857094
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1335-1352

Subventions

Organisme : IRCCS MONDINO FOUNDATION
ID : RC

Informations de copyright

© 2021. The Author(s).

Références

Elbaz A, Carcaillon L, Kab S, Moisan F (2016) Epidemiology of Parkinson’s disease. Rev Neurol (Paris) 172:14–26. https://doi.org/10.1016/j.neurol.2015.09.012
doi: 10.1016/j.neurol.2015.09.012
Armstrong MJ, Okun MS (2020) Diagnosis and treatment of Parkinson disease. JAMA 323:548. https://doi.org/10.1001/jama.2019.22360
doi: 10.1001/jama.2019.22360
Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79:368–376. https://doi.org/10.1136/jnnp.2007.131045
doi: 10.1136/jnnp.2007.131045 pubmed: 18344392
Postuma RB, Berg D, Stern M et al (2015) MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 30:1591–1601. https://doi.org/10.1002/mds.26424
doi: 10.1002/mds.26424 pubmed: 26474316
Pflug C, Bihler M, Emich K et al (2018) Critical dysphagia is common in Parkinson disease and occurs even in early stages: a prospective cohort study. Dysphagia 33:41–50. https://doi.org/10.1007/s00455-017-9831-1
doi: 10.1007/s00455-017-9831-1 pubmed: 28828545
Miller N, Allcock L, Hildreth AJ et al (2009) Swallowing problems in Parkinson disease: frequency and clinical correlates. J Neurol Neurosurg Psychiatry 80:1047–1049. https://doi.org/10.1136/jnnp.2008.157701
doi: 10.1136/jnnp.2008.157701 pubmed: 19028764
Kalf JG, de Swart BJM, Bloem BR, Munneke M (2012) Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord 18:311–315. https://doi.org/10.1016/j.parkreldis.2011.11.006
doi: 10.1016/j.parkreldis.2011.11.006 pubmed: 22137459
Sapir S, Ramig L, Fox C (2008) Speech and swallowing disorders in Parkinson disease. Curr Opin Otolaryngol Head Neck Surg 16:205–210. https://doi.org/10.1097/MOO.0b013e3282febd3a
doi: 10.1097/MOO.0b013e3282febd3a pubmed: 18475072
Barichella M, Cereda E, Madio C et al (2013) Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson’s disease outpatients hospitalised on a scheduled basis. Br J Nutr 110:347–353. https://doi.org/10.1017/S0007114512004941
doi: 10.1017/S0007114512004941 pubmed: 23228187
Martinez-Ramirez D, Almeida L, Giugni JC et al (2015) Rate of aspiration pneumonia in hospitalized Parkinson’s disease patients: a cross-sectional study. BMC Neurol 15:104. https://doi.org/10.1186/s12883-015-0362-9
doi: 10.1186/s12883-015-0362-9 pubmed: 26141135 pmcid: 4491262
Fujioka S, Fukae J, Ogura H et al (2016) Hospital-based study on emergency admission of patients with Parkinson’s disease. eNeurologicalSci 4:19–21. https://doi.org/10.1016/j.ensci.2016.04.007
doi: 10.1016/j.ensci.2016.04.007 pubmed: 29430543 pmcid: 5803112
Akbar U, Dham B, He Y et al (2015) Incidence and mortality trends of aspiration pneumonia in Parkinson’s disease in the United States, 1979–2010. Park Relat Disord 21:1082–1086. https://doi.org/10.1016/j.parkreldis.2015.06.020
doi: 10.1016/j.parkreldis.2015.06.020
Cilia R, Cereda E, Klersy C et al (2015) Parkinson’s disease beyond 20 years. J Neurol Neurosurg Psychiatry 86:849–855. https://doi.org/10.1136/jnnp-2014-308786
doi: 10.1136/jnnp-2014-308786 pubmed: 25280915
Fabbri M, Coelho M, Abreu D et al (2019) Dysphagia predicts poor outcome in late-stage Parkinson’s disease. Park Relat Disord 64:73–81. https://doi.org/10.1016/j.parkreldis.2019.02.043
doi: 10.1016/j.parkreldis.2019.02.043
Institute of Medicine (US) (1992) Committee on Clinical Practice Guidelines. Guidelines for Clinical Practice: From Development to Use. Field MJ, Lohr KN, editors. Washington (DC): National Academies Press (US). PMID: 25121254
Nair R, Aggarwal R, Khanna D (2011) Methods of formal consensus in classification/diagnostic criteria and guideline development. Semin Arthritis Rheum 41:95–105. https://doi.org/10.1016/j.semarthrit.2010.12.001
doi: 10.1016/j.semarthrit.2010.12.001 pubmed: 21420149 pmcid: 3131416
Candiani G., Colombo C. et al (2009) Come organizzare una conferenza di consenso. Manuale metodologico, Roma, ISS-SNLG.
AAN (American Academy of Neurology) (2011) Clinical Practice Guideline Process Manual. MN: The American Academy of Neurology. Ed. St. Paul
Moher D, Shamseer L, Clarke M et al (2016) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Rev Esp Nutr Humana y Diet. https://doi.org/10.1186/2046-4053-4-1
doi: 10.1186/2046-4053-4-1
Monteiro L, Souza-Machado A, Pinho P et al (2014) Swallowing impairment and pulmonary dysfunction in Parkinson’s disease: the silent threats. J Neurol Sci 339:149–152. https://doi.org/10.1016/j.jns.2014.02.004
doi: 10.1016/j.jns.2014.02.004 pubmed: 24572726
Hartelius L, Svensson P (1994) Speech and swallowing symptoms associated with Parkinson’s disease and multiple sclerosis: a survey. Folia Phoniatr Logop 46:9–17. https://doi.org/10.1159/000266286
doi: 10.1159/000266286 pubmed: 8162135
Takizawa C, Gemmell E, Kenworthy J, Speyer R (2016) A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia 31:434–441. https://doi.org/10.1007/s00455-016-9695-9
doi: 10.1007/s00455-016-9695-9 pubmed: 26970760
Ali G, Wallace K, Schwartz R et al (1996) Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson’s disease. Gastroenterology 110:383–392. https://doi.org/10.1053/gast.1996.v110.pm8566584
doi: 10.1053/gast.1996.v110.pm8566584 pubmed: 8566584
Bird MR, Woodward MC, Gibson EM et al (1994) Asymptomatic swallowing disorders in elderly patients with parkinson’s disease: a description of findings on clinical examination and videofluoroscopy in sixteen patients. Age Ageing 23:251–254. https://doi.org/10.1093/ageing/23.3.251
doi: 10.1093/ageing/23.3.251 pubmed: 8085513
Wallace KL, Middleton S, Cook IJ (2000) Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology 118:678–687. https://doi.org/10.1016/S0016-5085(00)70137-5
doi: 10.1016/S0016-5085(00)70137-5 pubmed: 10734019
Roy N, Stemple J, Merrill RM, Thomas L (2007) Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 116:858–865. https://doi.org/10.1177/000348940711601112
doi: 10.1177/000348940711601112 pubmed: 18074673
Troche MS, Schumann B, Brandimore AE et al (2016) Reflex cough and disease duration as predictors of swallowing dysfunction in Parkinson’s disease. Dysphagia 31:757–764. https://doi.org/10.1007/s00455-016-9734-6
doi: 10.1007/s00455-016-9734-6 pubmed: 27461481
Sampaio M, Argolo N, Melo A, Nóbrega AC (2014) Wet voice as a sign of penetration/aspiration in Parkinson’s disease: does testing material matter? Dysphagia 29:610–615. https://doi.org/10.1007/s00455-014-9552-7
doi: 10.1007/s00455-014-9552-7 pubmed: 25001523
Buhmann C, Bihler M, Emich K et al (2019) Pill swallowing in Parkinson’s disease: a prospective study based on flexible endoscopic evaluation of swallowing. Park Relat Disord 62:51–56. https://doi.org/10.1016/j.parkreldis.2019.02.002
doi: 10.1016/j.parkreldis.2019.02.002
Nóbrega AC, Rodrigues B, Torres AC et al (2008) Is drooling secondary to a swallowing disorder in patients with Parkinson’s disease? Parkinsonism Relat Disord 14:243–245. https://doi.org/10.1016/j.parkreldis.2007.08.003
doi: 10.1016/j.parkreldis.2007.08.003 pubmed: 17892967
Rodrigues B, Nóbrega AC, Sampaio M et al (2011) Silent saliva aspiration in Parkinson’s disease. Mov Disord 26:138–141. https://doi.org/10.1002/mds.23301
doi: 10.1002/mds.23301 pubmed: 21322025
van Wamelen DJ, Leta V, Johnson J et al (2020) Drooling in Parkinson’s disease: prevalence and progression from the non-motor international longitudinal study. Dysphagia 35:955–961. https://doi.org/10.1007/s00455-020-10102-5
doi: 10.1007/s00455-020-10102-5 pubmed: 32130515 pmcid: 7669801
Claus I, Muhle P, Suttrup J et al (2020) Predictors of pharyngeal dysphagia in patients with Parkinson’s disease. J Parkinsons Dis 10:1727–1735. https://doi.org/10.3233/JPD-202081
doi: 10.3233/JPD-202081 pubmed: 32773397
Potulska A, Friedman A, Królicki L, Spychala A (2003) Swallowing disorders in Parkinson’s disease. Parkinsonism Relat Disord 9:349–353. https://doi.org/10.1016/S1353-8020(03)00045-2
doi: 10.1016/S1353-8020(03)00045-2 pubmed: 12853234
Lam K, Kwai Yi Lam F, Kwong Lau K et al (2007) Simple clinical tests may predict severe oropharyngeal dysphagia in Parkinson’s disease. Mov Disord 22:640–644. https://doi.org/10.1002/mds.21362
doi: 10.1002/mds.21362 pubmed: 17266075
Loureiro F, Caline A, Sampaio M et al (2013) A Swallowing Clinical Assessment Score (SCAS) to evaluate outpatients with Parkinson’s disease. Pan Am J Aging Res 1:16–19
Singer C, Weiner WJ, Sanchez-Ramos JR (1992) Autonomic dysfunction in men with Parkinson’s disease. Eur Neurol 32:134–140. https://doi.org/10.1159/000116810
doi: 10.1159/000116810 pubmed: 1592069
Manor Y, Giladi N, Cohen A et al (2007) Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson’s disease. Mov Disord 22:1917–1921. https://doi.org/10.1002/mds.21625
doi: 10.1002/mds.21625 pubmed: 17588237
Simons JA, Fietzek UM, Waldmann A et al (2014) Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson’s disease. Parkinsonism Relat Disord 20:992–998. https://doi.org/10.1016/j.parkreldis.2014.06.008
doi: 10.1016/j.parkreldis.2014.06.008 pubmed: 25012695
Branco LL, Trentin S, Augustin Schwanke CH et al (2019) The Swallowing Clinical Assessment Score in Parkinson’s Disease (SCAS-PD) is a valid and low-cost tool for evaluation of dysphagia: a gold-standard comparison study. J Aging Res 2019:1–7. https://doi.org/10.1155/2019/7984635
doi: 10.1155/2019/7984635
Kalf JG, Borm GF, De Swart BJ et al (2011) Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in parkinson’s disease. Arch Phys Med Rehabil 92:1152–1158. https://doi.org/10.1016/j.apmr.2011.02.011
doi: 10.1016/j.apmr.2011.02.011 pubmed: 21704797
Minagi Y, Ono T, Hori K et al (2018) Relationships between dysphagia and tongue pressure during swallowing in Parkinson’s disease patients. J Oral Rehabil 45:459–466. https://doi.org/10.1111/joor.12626
doi: 10.1111/joor.12626 pubmed: 29575051
Vogel AP, Rommel N, Sauer C et al (2017) Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment. J Neurol 264:1107–1117. https://doi.org/10.1007/s00415-017-8499-7
doi: 10.1007/s00415-017-8499-7 pubmed: 28470593
Volonte’ MA, Porta M, Comi G (2002) Clinical assessment of dysphagia in early phases of Parkinson’s disease. Neurol Sci 23:s121–s122. https://doi.org/10.1007/s100720200099
doi: 10.1007/s100720200099
Belo LR, Gomes NAC, Coriolano MDGWDS et al (2014) The relationship between limit of dysphagia and average volume per swallow in patients with Parkinson’s disease. Dysphagia 29:419–424. https://doi.org/10.1007/s00455-013-9512-7
doi: 10.1007/s00455-013-9512-7 pubmed: 24993052
Buhmann C, Flügel T, Bihler M et al (2019) Is the Munich dysphagia Test-Parkinson’s disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Parkinsonism Relat Disord 61:138–143. https://doi.org/10.1016/j.parkreldis.2018.10.031
doi: 10.1016/j.parkreldis.2018.10.031 pubmed: 30414724
Curtis JA, Troche MS (2020) Handheld cough testing: a novel tool for cough assessment and dysphagia screening. Dysphagia 35:993–1000. https://doi.org/10.1007/s00455-020-10097-z
doi: 10.1007/s00455-020-10097-z pubmed: 32095899
Kanna SV, Bhanu K (2014) A simple bedside test to assess the swallowing dysfunction in Parkinson’s disease. Ann Indian Acad Neurol 17:62–65. https://doi.org/10.4103/0972-2327.128556
doi: 10.4103/0972-2327.128556 pubmed: 24753662 pmcid: 3992772
Miyazaki Y, Arakawa M, Kizu J (2002) Introduction of simple swallowing ability test for prevention of aspiration pneumonia in the elderly and investigation of factors of swallowing disorders. Yakugaku Zasshi 122:97–105. https://doi.org/10.1248/yakushi.122.97
doi: 10.1248/yakushi.122.97 pubmed: 11828754
Mari F, Matei M, Ceravolo MG et al (1997) Predictive value of clinical indices in detecting aspiration in patients with neurological disorders. J Neurol Neurosurg Psychiatry 63:456–460. https://doi.org/10.1136/jnnp.63.4.456
doi: 10.1136/jnnp.63.4.456 pubmed: 9343123 pmcid: 2169753
Clarke CE, Gullaksen E, Macdonald S, Lowe F (2009) Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson’s disease. Acta Neurol Scand 97:27–35. https://doi.org/10.1111/j.1600-0404.1998.tb00605.x
doi: 10.1111/j.1600-0404.1998.tb00605.x
Troche MS, Brandimore AE, Okun MS et al (2014) Decreased cough sensitivity and aspiration in Parkinson disease. Chest 146:1294–1299. https://doi.org/10.1378/chest.14-0066
doi: 10.1378/chest.14-0066 pubmed: 24968148 pmcid: 4219343
Pitts LL, Morales S, Stierwalt JAG (2018) Lingual pressure as a clinical indicator of swallowing function in Parkinson’s disease. J Speech Lang Hear Res 61:257–265. https://doi.org/10.1044/2017_JSLHR-S-17-0259
doi: 10.1044/2017_JSLHR-S-17-0259 pubmed: 29396576
Coates C, Bakheit AMO (1997) Dysphagia in Parkinson’s disease. Eur Neurol 38:49–52. https://doi.org/10.1159/000112902
doi: 10.1159/000112902 pubmed: 9252799
Ertekin C, Tarlaci S, Aydogdu I et al (2002) Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson’s disease. Mov Disord 17:942–949. https://doi.org/10.1002/mds.10240
doi: 10.1002/mds.10240 pubmed: 12360543
Alfonsi E, Versino M, Merlo IM et al (2007) Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes. Neurology 68:583–589. https://doi.org/10.1212/01.wnl.0000254478.46278.67
doi: 10.1212/01.wnl.0000254478.46278.67 pubmed: 17310027
Jones CA, Ciucci MR (2016) Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. J Parkinsons Dis 6:197–208. https://doi.org/10.3233/JPD-150687
doi: 10.3233/JPD-150687 pubmed: 26891176 pmcid: 4816667
Suttrup I, Suttrup J, Suntrup-Krueger S et al (2017) Esophageal dysfunction in different stages of Parkinson’s disease. Neurogastroenterol Motil 29:1–7. https://doi.org/10.1111/nmo.12915
doi: 10.1111/nmo.12915
Ding X, Gao J, Xie C et al (2018) Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Eur J Clin Nutr 72:82–86. https://doi.org/10.1038/ejcn.2017.100
doi: 10.1038/ejcn.2017.100 pubmed: 28699630
Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA et al (2017) Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 127:2002–2010. https://doi.org/10.1002/lary.26419
doi: 10.1002/lary.26419 pubmed: 27859291
Stroudley J, Walsh M (1991) Radiological assessment of dysphagia in Parkinson’s disease. Br J Radiol 64:890–893. https://doi.org/10.1259/0007-1285-64-766-890
doi: 10.1259/0007-1285-64-766-890 pubmed: 1954529
Tomita S, Oeda T, Umemura A et al (2018) Video-fluoroscopic swallowing study scale for predicting aspiration pneumonia in Parkinson’s disease. PLoS One 13:1–14. https://doi.org/10.1371/journal.pone.0197608
doi: 10.1371/journal.pone.0197608
Gaeckle M, Domahs F, Kartmann A et al (2019) Predictors of penetration-aspiration in Parkinson’s disease patients with dysphagia: a retrospective analysis. Ann Otol Rhinol Laryngol 128:728–735. https://doi.org/10.1177/0003489419841398
doi: 10.1177/0003489419841398 pubmed: 30939890
Nagaya M, Kachi T, Yamada T, Igata A (1998) Videofluorographic study of swallowing in Parkinson’s disease. Dysphagia 13:95–100. https://doi.org/10.1007/PL00009562
doi: 10.1007/PL00009562 pubmed: 9513304
Argolo N, Sampaio M, Pinho P et al (2015) Swallowing disorders in Parkinson’s disease: impact of lingual pumping. Int J Lang Commun Disord 50:659–664. https://doi.org/10.1111/1460-6984.12158
doi: 10.1111/1460-6984.12158 pubmed: 25652413
Argolo N, Sampaio M, Pinho P et al (2015) Videofluoroscopic predictors of penetration-aspiration in Parkinson’s disease patients. Dysphagia 30:751–758. https://doi.org/10.1007/s00455-015-9653-y
doi: 10.1007/s00455-015-9653-y pubmed: 26492880
Wakasugi Y, Yamamoto T, Oda C et al (2017) Effect of an impaired oral stage on swallowing in patients with Parkinson’s disease. J Oral Rehabil 44:756–762. https://doi.org/10.1111/joor.12536
doi: 10.1111/joor.12536 pubmed: 28644574
Schiffer BL, Kendall K (2019) Changes in timing of swallow events in Parkinson’s disease. Ann Otol Rhinol Laryngol 128:22–27. https://doi.org/10.1177/0003489418806918
doi: 10.1177/0003489418806918 pubmed: 30328706
Hammer MJ, Murphy CA, Abrams TM (2013) Airway somatosensory deficits and dysphagia in Parkinson’s disease. J Parkinsons Dis 3:39–44. https://doi.org/10.3233/JPD-120161
doi: 10.3233/JPD-120161 pubmed: 23555331 pmcid: 3613252
Suntrup S, Teismann I, Wollbrink A et al (2013) Magnetoencephalographic evidence for the modulation of cortical swallowing processing by transcranial direct current stimulation. Neuroimage 83:346–354. https://doi.org/10.1016/j.neuroimage.2013.06.055
doi: 10.1016/j.neuroimage.2013.06.055 pubmed: 23800793
Warnecke T, Suttrup I, Schröder JB et al (2016) Levodopa responsiveness of dysphagia in advanced Parkinson’s disease and reliability testing of the FEES-Levodopa-test. Park Relat Disord 28:100–106. https://doi.org/10.1016/j.parkreldis.2016.04.034
doi: 10.1016/j.parkreldis.2016.04.034
Grosso M, Duce V, Fattori B et al (2015) The value of oro-pharyngo-esophageal scintigraphy in the management of patients with aspiration into the tracheo-bronchial tree and consequent dysphagia. North Am J Med Sci 7:533–536. https://doi.org/10.4103/1947-2714.170628
doi: 10.4103/1947-2714.170628
Mamolar Andrés S, Santamarina Rabanal ML, Granda Membiela CM et al (2017) Swallowing disorders in Parkinson’s disease. Acta Otorrinolaringol (English Ed) 68:15–22. https://doi.org/10.1016/j.otoeng.2017.01.003
doi: 10.1016/j.otoeng.2017.01.003
Jones CA, Hoffman MR, Lin L et al (2018) Identification of swallowing disorders in early and mid-stage Parkinson’s disease using pattern recognition of pharyngeal high-resolution manometry data. Neurogastroenterol Motil 30:e13236. https://doi.org/10.1111/nmo.13236
doi: 10.1111/nmo.13236 pubmed: 29143418
Ertekin C, Pehlivan M, Aydoǧdu I et al (1995) An electrophysiological investigation of deglutition in man. Muscle Nerve 18:1177–1186. https://doi.org/10.1002/mus.880181014
doi: 10.1002/mus.880181014 pubmed: 7659112
Cosentino G, Tassorelli C, Prunetti P et al (2020) Reproducibility and reaction time of swallowing as markers of dysphagia in parkinsonian syndromes. Clin Neurophysiol 131:2200–2208. https://doi.org/10.1016/j.clinph.2020.06.018
doi: 10.1016/j.clinph.2020.06.018 pubmed: 32702534
Kim J, Watts CR (2020) A comparison of swallow-related submandibular contraction amplitude and duration in people with Parkinson’s disease and healthy controls. Int J Speech Lang Pathol. https://doi.org/10.1080/17549507.2020.1766566
doi: 10.1080/17549507.2020.1766566 pubmed: 32466679
Alfonsi E, Merlo IM, Ponzio M et al (2010) An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry 81:54–60. https://doi.org/10.1136/jnnp.2009.174698
doi: 10.1136/jnnp.2009.174698 pubmed: 19762326
Alfonsi E, Restivo DA, Cosentino G et al (2017) Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders. Front Pharmacol. https://doi.org/10.3389/fphar.2017.00080
doi: 10.3389/fphar.2017.00080 pubmed: 28275351 pmcid: 5319993
Su A, Gandhy R, Barlow C, Triadafilopoulos G (2017) Clinical and manometric characteristics of patients with Parkinson’s disease and esophageal symptoms. Dis Esophagus 30:1–6. https://doi.org/10.1093/dote/dow038
doi: 10.1093/dote/dow038 pubmed: 28575243
Blais P, Bennett MC, Gyawali CP (2019) Upper esophageal sphincter metrics on high-resolution manometry differentiate etiologies of esophagogastric junction outflow obstruction. Neurogastroenterol Motil 31:e13558. https://doi.org/10.1111/nmo.13558
doi: 10.1111/nmo.13558 pubmed: 30815910
Taira K, Fujiwara K, Fukuhara T et al (2021) Evaluation of the pharynx and upper esophageal sphincter motility using high-resolution pharyngeal manometry for Parkinson’s disease. Clin Neurol Neurosurg 201:106447. https://doi.org/10.1016/j.clineuro.2020.106447
doi: 10.1016/j.clineuro.2020.106447 pubmed: 33421742
Bassotti G, Germani U, Pagliaricci S et al (1998) Esophageal manometric abnormalities in Parkinson’s disease. Dysphagia 13:28–31. https://doi.org/10.1007/PL00009546
doi: 10.1007/PL00009546 pubmed: 9391227
Castell JA, Johnston BT, Colcher A et al (2001) Manometric abnormalities of the oesophagus in patients with Parkinson’s disease. Neurogastroenterol Motil 13:361–364. https://doi.org/10.1046/j.1365-2982.2001.00275.x
doi: 10.1046/j.1365-2982.2001.00275.x pubmed: 11576395
Monte FS, da Silva-Júnior FP, Braga-Neto P et al (2005) Swallowing abnormalities and dyskinesia in Parkinson’s disease. Mov Disord 20:457–462. https://doi.org/10.1002/mds.20342
doi: 10.1002/mds.20342 pubmed: 15625689
Broadfoot CK, Abur D, Hoffmeister JD et al (2019) Research-based updates in swallowing and communication dysfunction in parkinson disease: implications for evaluation and management. Perspect ASHA Spec Interes Groups 4:825–841. https://doi.org/10.1044/2019_pers-sig3-2019-0001
doi: 10.1044/2019_pers-sig3-2019-0001
Martin-Harris B, Jones B (2008) The videofluorographic swallowing study. Phys Med Rehabil Clin N Am 19:769–785. https://doi.org/10.1016/j.pmr.2008.06.004
doi: 10.1016/j.pmr.2008.06.004 pubmed: 18940640 pmcid: 2586156
Coelho M, Marti MJ, Tolosa E et al (2010) Late-stage Parkinson’s disease: the Barcelona and Lisbon cohort. J Neurol 257:1524–1532. https://doi.org/10.1007/s00415-010-5566-8
doi: 10.1007/s00415-010-5566-8 pubmed: 20411272
Lim A, Leow LP, Huckabee ML et al (2008) A pilot study of respiration and swallowing integration in Parkinson’s disease: “On” and “Off” levodopa. Dysphagia 23:76–81. https://doi.org/10.1007/s00455-007-9100-9
doi: 10.1007/s00455-007-9100-9 pubmed: 17602261
Michou E, Hamdy S, Harris M et al (2014) Characterization of corticobulbar pharyngeal neurophysiology in dysphagic patients with Parkinson’s disease. Clin Gastroenterol Hepatol 12:2037-2045.e4. https://doi.org/10.1016/j.cgh.2014.03.020
doi: 10.1016/j.cgh.2014.03.020 pubmed: 24681075
Suttrup I, Warnecke T (2016) Dysphagia in Parkinson’s disease. Dysphagia 31:24–32. https://doi.org/10.1007/s00455-015-9671-9
doi: 10.1007/s00455-015-9671-9 pubmed: 26590572
Rosenbek JC, Robbins JA, Roecker EB et al (1996) A penetration-aspiration scale. Dysphagia 11:93–98. https://doi.org/10.1007/BF00417897
doi: 10.1007/BF00417897
O’Neil KH, Purdy M, Falk J, Gallo L (1999) The dysphagia outcome and severity scale. Dysphagia 14:139–145. https://doi.org/10.1007/PL00009595
doi: 10.1007/PL00009595 pubmed: 10341109
Crary MA, Carnaby Mann GD, Groher ME (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86:1516–1520. https://doi.org/10.1016/j.apmr.2004.11.049
doi: 10.1016/j.apmr.2004.11.049
Pitts T, Troche M, Mann G et al (2010) Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease. Chest 138:1426–1431. https://doi.org/10.1378/chest.10-0342
doi: 10.1378/chest.10-0342 pubmed: 20705802
Silverman EP, Carnaby G, Singletary F et al (2016) Measurement of voluntary cough production and airway protection in parkinson disease. Arch Phys Med Rehabil 97:413–420. https://doi.org/10.1016/j.apmr.2015.10.098
doi: 10.1016/j.apmr.2015.10.098 pubmed: 26551228
Hegland KW, Okun MS, Troche MS (2014) Sequential voluntary cough and aspiration or aspiration risk in Parkinson’s disease. Lung 192:601–608. https://doi.org/10.1007/s00408-014-9584-7
doi: 10.1007/s00408-014-9584-7 pubmed: 24792231 pmcid: 4740922
Moreau C, Devos D, Baille G et al (2016) Are upper-body axial symptoms a feature of early Parkinson’s disease? PLoS One 11:1–13. https://doi.org/10.1371/journal.pone.0162904
doi: 10.1371/journal.pone.0162904
Fuh JL, Lee RC, Wang SJ et al (1997) Swallowing difficulty in Parkinson’s disease. Clin Neurol Neurosurg 99:106–112. https://doi.org/10.1016/S0303-8467(97)00606-9
doi: 10.1016/S0303-8467(97)00606-9 pubmed: 9213054
Johnston BT, Castell JA, Stumacher S et al (1997) Comparison of swallowing function in Parkinson’s disease and progressive supranuclear palsy. Mov Disord 12:322–327. https://doi.org/10.1002/mds.870120310
doi: 10.1002/mds.870120310 pubmed: 9159726
Ws Coriolano Md, R Belo L, Carneiro D, G Asano A, et al (2012) Swallowing in patients with Parkinson's disease: a surface electromyography study. Dysphagia 27(4):550-555. https://doi.org/10.1007/s00455-012-9406-0
doi: 10.1007/s00455-012-9406-0
Lee KD, Koo JH, Song SH et al (2015) Central cholinergic dysfunction could be associated with oropharyngeal dysphagia in early Parkinson’s disease. J Neural Transm 122:1553–1561. https://doi.org/10.1007/s00702-015-1427-z
doi: 10.1007/s00702-015-1427-z pubmed: 26199040
Ellerston JK, Heller AC, Houtz DR, Kendall KA (2016) Quantitative measures of swallowing deficits in patients with Parkinson’s disease. Ann Otol Rhinol Laryngol 125:385–392. https://doi.org/10.1177/0003489415617774
doi: 10.1177/0003489415617774 pubmed: 26602905
Wang C-M, Shieh W-Y, Weng Y-H et al (2017) Non-invasive assessment determine the swallowing and respiration dysfunction in early Parkinson’s disease. Parkinsonism Relat Disord 42:22–27. https://doi.org/10.1016/j.parkreldis.2017.05.024
doi: 10.1016/j.parkreldis.2017.05.024 pubmed: 28606443
Lee WH, Lim MH, Nam HS et al (2019) Differential kinematic features of the hyoid bone during swallowing in patients with Parkinson’s disease. J Electromyogr Kinesiol 47:57–64. https://doi.org/10.1016/j.jelekin.2019.05.011
doi: 10.1016/j.jelekin.2019.05.011 pubmed: 31128338
Leow LP, Huckabee M-L, Anderson T, Beckert L (2010) The Impact of dysphagia on quality of life in ageing and Parkinson’s disease as measured by the Swallowing Quality of Life (SWAL-QOL) questionnaire. Dysphagia 25:216–220. https://doi.org/10.1007/s00455-009-9245-9
doi: 10.1007/s00455-009-9245-9 pubmed: 19680723
Manor Y, Balas M, Giladi N et al (2009) Anxiety, depression and swallowing disorders in patients with Parkinson’s disease. Parkinsonism Relat Disord 15:453–456. https://doi.org/10.1016/j.parkreldis.2008.11.005
doi: 10.1016/j.parkreldis.2008.11.005 pubmed: 19071054
Plowman-Prine EK, Sapienza CM, Okun MS et al (2009) The relationship between quality of life and swallowing in Parkinson’s disease. Mov Disord 24:1352–1358. https://doi.org/10.1002/mds.22617
doi: 10.1002/mds.22617 pubmed: 19425089 pmcid: 3614344
Van Hooren MRA, Baijens LWJ, Vos R et al (2016) Voice- and swallow-related quality of life in idiopathic Parkinson’s disease. Laryngoscope 126:408–414. https://doi.org/10.1002/lary.25481
doi: 10.1002/lary.25481 pubmed: 26153234
Barone P, Antonini A, Colosimo C et al (2009) The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 24:1641–1649. https://doi.org/10.1002/mds.22643
doi: 10.1002/mds.22643 pubmed: 19514014
Han M, Ohnishi H, Nonaka M et al (2011) Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Park Relat Disord 17:437–439. https://doi.org/10.1016/j.parkreldis.2011.03.006
doi: 10.1016/j.parkreldis.2011.03.006
Miller N, Noble E, Jones D, Burn D (2006) Hard to swallow: dysphagia in Parkinson’s disease. Age Ageing 35:614–618. https://doi.org/10.1093/ageing/afl105
doi: 10.1093/ageing/afl105 pubmed: 17047007
Lorefält B, Granérus AK, Unosson M (2006) Avoidance of solid food in weight losing older patients with Parkinson’s disease. J Clin Nurs. https://doi.org/10.1111/j.1365-2702.2005.01454.x
doi: 10.1111/j.1365-2702.2005.01454.x pubmed: 17038101
White H, King L (2014) Enteral feeding pumps: efficacy, safety, and patient acceptability. Med Devices (Auckl)7:291-298. https://doi.org/10.2147/MDER.S50050 . PMID: 25170284; PMCID: PMC4146327
Carneiro D, Coriolano Md Ws, Belo LR et al (2014) Quality of life related to swallowing in Parkinson’s disease. Dysphagia 29:578–582. https://doi.org/10.1007/s00455-014-9548-3
doi: 10.1007/s00455-014-9548-3 pubmed: 24952632
McHorney CA, Bricker DE, Kramer AE et al (2002) The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I conceptual foundation and item development. Dysphagia 15:115–121
doi: 10.1007/s004550010012
Storch A, Schneider CB, Wolz M et al (2013) Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology 80:800–809. https://doi.org/10.1212/WNL.0b013e318285c0ed
doi: 10.1212/WNL.0b013e318285c0ed pubmed: 23365054
Silbergleit AK, Lewitt P, Junn F et al (2012) Comparison of dysphagia before and after deep brain stimulation in Parkinson’s disease. Mov Disord 27:1763–1768. https://doi.org/10.1002/mds.25259
doi: 10.1002/mds.25259 pubmed: 23115021
Wang C-M, Tsai T-T, Wang S-H, Wu Y-R (2020) Does the M.D. Anderson Dysphagia Inventory correlate with dysphagia-limit and the Unified Parkinson Disease Rating Scale in early-stage Parkinson’s disease? J Formos Med Assoc 119:247–253. https://doi.org/10.1016/j.jfma.2019.05.005
doi: 10.1016/j.jfma.2019.05.005 pubmed: 31133522
Müller J, Wenning GK, Verny M et al (2001) Progression of dysarthria and dysphagia in postmortem-confirmed parkinsonian disorders. Arch Neurol 58:259–264. https://doi.org/10.1001/archneur.58.2.259
doi: 10.1001/archneur.58.2.259 pubmed: 11176964
Lo RY, Tanner CM, Albers KB et al (2009) Clinical features in early Parkinson disease and survival. Arch Neurol 66:1353–1358. https://doi.org/10.1001/archneurol.2009.221
doi: 10.1001/archneurol.2009.221 pubmed: 19901166
Goh KH, Acharyya S, Ng SYE et al (2016) Risk and prognostic factors for pneumonia and choking amongst Parkinson’s disease patients with dysphagia. Park Relat Disord 29:30–34. https://doi.org/10.1016/j.parkreldis.2016.05.034
doi: 10.1016/j.parkreldis.2016.05.034
Morgante L, Salemi G, Meneghini F et al (2000) Parkinson disease survival: a population-based study. Arch Neurol 57:507–512. https://doi.org/10.1001/archneur.57.4.507
doi: 10.1001/archneur.57.4.507 pubmed: 10768625
Auyeung M, Tsoi TH, Mok V et al (2012) Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson’s disease patients. J Neurol Neurosurg Psychiatry 83:607–611. https://doi.org/10.1136/jnnp-2011-301590
doi: 10.1136/jnnp-2011-301590 pubmed: 22362919
Hussain J, Allgar V, Oliver D (2018) Palliative care triggers in progressive neurodegenerative conditions: an evaluation using a multi-centre retrospective case record review and principal component analysis. Palliat Med 32:716–725. https://doi.org/10.1177/0269216318755884
doi: 10.1177/0269216318755884 pubmed: 29400144
Robbins J, Gensler G, Hind J et al (2008) Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial. Ann Intern Med 148:509–518. https://doi.org/10.7326/0003-4819-148-7-200804010-00007
doi: 10.7326/0003-4819-148-7-200804010-00007 pubmed: 18378947 pmcid: 2364726
Ebihara S, Saito H, Kanda A et al (2003) Impaired efficacy of cough in patients with Parkinson disease. Chest 124:1009–1015. https://doi.org/10.1378/chest.124.3.1009
doi: 10.1378/chest.124.3.1009 pubmed: 12970031
El-Solh AA (2011) Association between pneumonia and oral care in nursing home residents. Lung 2011189(3):173-180. https://doi.org/10.1007/s00408-011-9297-0 . Epub 2011 Apr 30. PMID: 21533635
El-Solh AA, Pietrantoni C, Bhat A et al (2004) Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest. https://doi.org/10.1378/chest.126.5.1575
doi: 10.1378/chest.126.5.1575 pubmed: 15539730
Lee JH, Lee KW, Kim SB et al (2016) The functional dysphagia scale is a useful tool for predicting aspiration pneumonia in patients with Parkinson disease. Ann Rehabil Med 40:440–446. https://doi.org/10.5535/arm.2016.40.3.440
doi: 10.5535/arm.2016.40.3.440 pubmed: 27446780 pmcid: 4951362
Malmgren A, Hede GW, Karlström B et al (2011) Indications for percutaneous endoscopic gastrostomy and survival in old adults. Food Nutr Res 55:1–6. https://doi.org/10.3402/fnr.v55i0.6037
doi: 10.3402/fnr.v55i0.6037
Cereda E, Cilia R, Klersy C et al (2014) Swallowing disturbances in Parkinson’s disease: a multivariate analysis of contributing factors. Park Relat Disord 20:1382–1387. https://doi.org/10.1016/j.parkreldis.2014.09.031
doi: 10.1016/j.parkreldis.2014.09.031
Schröder JB, Marian T, Claus I et al (2019) Substance P saliva reduction predicts pharyngeal dysphagia in Parkinson’s disease. Front Neurol 10:1–5. https://doi.org/10.3389/fneur.2019.00386
doi: 10.3389/fneur.2019.00386

Auteurs

Giuseppe Cosentino (G)

Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy.
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

Micol Avenali (M)

Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy. micol.avenali@mondino.it.
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy. micol.avenali@mondino.it.
ORCID: 0000-0002-7880-9921

Antonio Schindler (A)

Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.

Nicole Pizzorni (N)

Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.

Cristina Montomoli (C)

Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.

Giovanni Abbruzzese (G)

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Angelo Antonini (A)

Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.

Filippo Barbiera (F)

Azienda Sanitaria Provinciale Agrigento-UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera. Presidio Ospedaliero di Sciacca (AG), Sciacca, Agrigento, Italy.

Marco Benazzo (M)

Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

Eduardo Elias Benarroch (EE)

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Giulia Bertino (G)

Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

Emanuele Cereda (E)

Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Pere Clavè (P)

Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.

Pietro Cortelli (P)

IRCCS Istituto di Scienze Neurologiche, Bologna, Italy.
DIBINEM, University of Bologna, Bologna, Italy.

Roberto Eleopra (R)

Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Chiara Ferrari (C)

Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.

Shaheen Hamdy (S)

Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Salford Royal Hospital, Salford, UK.

Maggie-Lee Huckabee (ML)

Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand.

Leonardo Lopiano (L)

Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.

Rosario Marchese Ragona (R)

ENT Department, University of Padova, Padua, Italy.

Stefano Masiero (S)

Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy.

Emilia Michou (E)

Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.

Antonio Occhini (A)

Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

Claudio Pacchetti (C)

Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.

Ronald F Pfeiffer (RF)

Department of Neurology, Oregon Health and Science University, Portland, OR, USA.

Domenico A Restivo (DA)

Department of Neurology, Garibaldi Hospital, Catania, Italy.

Mariangela Rondanelli (M)

Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy.

Giovanni Ruoppolo (G)

Department of Sense Organs, Sapienza University of Rome, Rome, Italy.

Giorgio Sandrini (G)

Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy.

Anthony H V Schapira (AHV)

Department of Clinical and Movement Neurosciences, UCL, Queen Square Institute of Neurology, London, UK.

Fabrizio Stocchi (F)

University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy.

Eduardo Tolosa (E)

Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII), University of Barcelona, Barcelona, Spain.

Francesca Valentino (F)

Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.

Mauro Zamboni (M)

Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Verona, Italy.

Roberta Zangaglia (R)

Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.

Mario Zappia (M)

Department GF Ingrassia, University of Catania, Catania, Italy.

Cristina Tassorelli (C)

Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100, Pavia, Italy.
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.

Enrico Alfonsi (E)

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques de l'appareil buccodentaire et de l'appareil digestif › Phénomènes physiologiques de l'appareil digestif › Déglutition › A multinational consensus on dysphagia in...
questionsmedicales.fr › Maladies oto-rhino-laryngologiques › Maladies du pharynx › Troubles de la déglutition › A multinational consensus on dysphagia in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A multinational consensus on dysphagia in...
questionsmedicales.fr › Régions géographiques › Europe › Italie › A multinational consensus on dysphagia in...
questionsmedicales.fr › Maladies du système nerveux › Maladies neurodégénératives › Maladie de Parkinson › A multinational consensus on dysphagia in...
questionsmedicales.fr › Diagnostic › Pronostic › A multinational consensus on dysphagia in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › A multinational consensus on dysphagia in...