Review
Prevalence of oropharyngeal dysphagia in Parkinson’s disease: A meta-analysis

https://doi.org/10.1016/j.parkreldis.2011.11.006Get rights and content

Abstract

Dysphagia is a potentially harmful feature, also in Parkinson’s disease (PD). As published prevalence rates vary widely, we aimed to estimate the prevalence of oropharyngeal dysphagia in PD in a meta-analysis.

We conducted a systematic literature search in February 2011 and two independent reviewers selected the papers. We computed the estimates of the pooled prevalence weighted by sample size.

Twelve studies were suitable for calculating prevalence rates. Ten studies provided an estimate based on subjective outcomes, which proved statistically heterogeneous (p < 0.001), with a pooled prevalence estimate with random effect analysis of 35% (95% CI 28–41). Four studies provided an estimate based on objective measurements, which were statistically homogeneous (p = 0.23), with a pooled prevalence estimate of 82% (95% CI 77–87). In controls the pooled subjective prevalence was 9% (95% CI 2–17), while the pooled objective prevalence was 23% (95% CI 13–32). The pooled relative risk was 3.2 for both subjective outcomes (95% CI 2.32–4.41) and objective outcomes (95% CI 2.08–4.98). Clinical heterogeneity between studies was chiefly explained by differences in disease severity.

Subjective dysphagia occurs in one third of community-dwelling PD patients. Objectively measured dysphagia rates were much higher, with 4 out of 5 patients being affected. This suggests that dysphagia is common in PD, but patients do not always report swallowing difficulties unless asked. This underreporting calls for a proactive clinical approach to dysphagia, particularly in light of the serious clinical consequences.

Introduction

Dysphagia is a problematic and sometimes dangerous feature of Parkinson’s disease (PD). Oropharyngeal dysphagia can have a negative impact on the quality of life [1], [2], and increases the risk of aspiration pneumonia, which is often the cause of death in PD [3], [4]. Knowing the actual prevalence of dysphagia as a function of disease severity is imperative, because this would alert clinicians to the need for timely assessment and treatment. Prevalence rates are available for hypokinetic dysarthria (70%) and drooling (56%) [5], [6], [7], which like dysphagia are known to be oral-motor disorders associated with PD. Unfortunately, prevalence rates for dysphagia are less apparent, with widely varying estimates [8]. We therefore performed a meta-analysis to estimate the prevalence of oropharyngeal dysphagia in PD.

Section snippets

Search strategy

We conducted a systematic PubMed literature search in February 2011 with the following search strategy: (“parkinson disease” [MeSH Terms] OR (“parkinson” [All Fields] AND “disease” [All Fields]) OR “parkinson disease” [All Fields] OR (“parkinson’s” [All Fields] AND “disease” [All Fields]) OR “parkinson’s disease” [All Fields]) AND (“deglutition disorders” [MeSH Terms] OR (“deglutition” [All Fields] AND “disorders” [All Fields]) OR “deglutition disorders” [All Fields] OR “dysphagia” [All

Results

The first search strategy revealed 350 articles, of which seven met the selection criteria [10], [11], [12], [13], [14], [15], [16], [17]. The second search revealed 274 articles, of which four were eligible for inclusion [18], [19], [20], [21], based on our criteria. Five studies were excluded, four because the diagnostic assessment or diagnosis of dysphagia was not clearly described [22], [23], [24], [25] and one because the study patients’ disease severity was limited to Hoehn & Yahr stage

Discussion

This meta-analysis shows that oropharyngeal dysphagia is prevalent in at least a third of PD patients, with prevalence rates depending on disease severity and assessment technique. Overall, PD patients are three times more likely to have swallowing disorders than healthy controls. This estimate seems robust, as the observed risk ratio was identical for both the subjective and objective assessments.

The studies which used subjective data were clinically and statistically heterogeneous. One

Acknowledgement

This research was supported by the department of Rehabilitation of the Radboud University Nijmegen Medical Centre and Prof. Bloem was supported by a ZonMw VIDI research grant (number 016.076.352).

References (46)

  • E.K. Plowman-Prine et al.

    The relationship between quality of life and swallowing in Parkinson’s disease

    Mov Disord

    (2009)
  • M.K. Beyer et al.

    Causes of death in a community-based study of Parkinson’s disease

    Acta Neurol Scand

    (2001)
  • A.K. Ho et al.

    Speech impairment in a large sample of patients with Parkinson’s disease

    Behav Neurol

    (1998)
  • J.G. Kalf et al.

    Prevalence of speech impairments in Parkinson’s disease

    Mov Disord

    (2009)
  • J.G. Kalf et al.

    Prevalence and definition of drooling in Parkinson’s disease: a systematic review

    J Neurol

    (2009)
  • M. Egger et al.

    Sytematic reviews in health care: meta-analysis in context

    (2001)
  • L.L. Edwards et al.

    Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology

    Neurology

    (1992)
  • L. Hartelius et al.

    Speech and swallowing symptoms associated with Parkinson’s disease and multiple sclerosis: a survey

    Folia Phoniatr Logop

    (1994)
  • H. Nilsson et al.

    Quantitative assessment of oral and pharyngeal function in Parkinson’s disease

    Dysphagia

    (1996)
  • C. Coates et al.

    Dysphagia in Parkinson’s disease

    Eur Neurol

    (1997)
  • C.E. Clarke et al.

    Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson’s disease

    Acta Neurol Scand

    (1998)
  • N. Miller et al.

    Swallowing problems in Parkinson disease: frequency and clinical correlates

    J Neurol Neurosurg Psychiatr

    (2009)
  • R.W. Walker et al.

    Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson’s disease

    Dysphagia

    (2011)
  • Cited by (362)

    • Anaesthesia and Parkinson disease

      2024, Praticien en Anesthesie Reanimation
    View all citing articles on Scopus
    View full text