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Dysphagia in Parkinson Disease: Part I – Pathophysiology and Diagnostic Practices

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Abstract

Purpose of Review

Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions.

Recent Findings

Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hallmark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations.

Summary

Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.

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Funding

This work was supported by the National Institute on Deafness and other Communication Disorders of the National Institutes of Health, United States: R01DC018584 (Ciucci); R01DC014358 (Ciucci); 1K76AG068590 (Rogus-Pulia); T32DC009401 (Krasko), the University of Wisconsin-Madison, and the William S. Middleton Veteran Affairs Hospital in Madison, WI; GRECC article no. 2023-XXX. 

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  1. Department of Surgery, Division of Otolaryngology—Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA

    Denis Michael Rudisch, Maryann N. Krasko & Michelle R. Ciucci

  2. Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA

    Denis Michael Rudisch, Maryann N. Krasko & Michelle R. Ciucci

  3. Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI, 53705, USA

    Ryan Burdick, Courtney K. Broadfoot & Nicole Rogus-Pulia

  4. Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA

    Ryan Burdick, Courtney K. Broadfoot & Nicole Rogus-Pulia

  5. Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA

    Michelle R. Ciucci

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Dr. Michelle R. Ciucci is on the board of directors of the National Foundation of Swallowing Disorders (NFOSD) and receives no compensation as member of the board of directors.

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Rudisch, D.M., Krasko, M.N., Burdick, R. et al. Dysphagia in Parkinson Disease: Part I – Pathophysiology and Diagnostic Practices. Curr Phys Med Rehabil Rep 11, 176–187 (2023). https://doi.org/10.1007/s40141-023-00392-9

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