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Reflex Cough and Disease Duration as Predictors of Swallowing Dysfunction in Parkinson’s Disease

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Patients with Parkinson’s disease (PD) have progressive and pervasive disorders of airway protection. Recent work has highlighted the relationship between reflex and voluntary cough and swallowing safety. The goal of this study was to test the sensitivity and specificity of several airway protective and disease-specific factors for predicting swallowing safety outcomes in PD. Sixty-four participants (44 males) completed measures of voluntary and reflex cough, and swallowing safety. Clinical predictors included disease severity and duration, and cough airflow and sensitivity measures. ROC and Chi-square analyses identified predictors of swallowing safety (penetration–aspiration score) in PD. Disease duration significantly discriminated between patients with normal and abnormal swallowing safety (p = 0.027, sensitivity: 71 %, specificity: 55.4 %). Cough reflex sensitivity significantly discriminated between patients who penetrated above the level of the vocal folds and those with more severe penetration/aspiration (p = 0.021, sensitivity: 71.0 %, specificity 57.6 %). Urge-to-cough sensitivity (log–log linear slope) was the only variable which significantly discriminated between patients with penetration versus aspiration (p = 0.017, sensitivity: 85.7 %, specificity 73.2 %). It is important to identify the factors which influence airway protective outcomes in PD especially given that aspiration pneumonia is a leading cause of death. Results from this study highlight the ecological validity of reflex cough in the study of airway protection and this study further identifies important factors to consider in the screening of airway protective deficits in PD.

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We would like to first acknowledge the participants and caregivers who so generously gave of their time to participate in this study. We also acknowledge the support of the National Parkinson Foundation Center of Excellence at the University of Florida and of the NIH (NCATS) CTSA through the University of Florida (UL1TR000064 and KL2TR000065) awarded to Dr. Michelle S. Troche.

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Correspondence to Michelle S. Troche.

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Dr. Troche’s work was supported in part by an NIH (NCATS) CTSA through the University of Florida (UL1TR000064 and KL2TR000065). She has no other disclosures or conflicts of interest to report. Ms. Schumann has no financial disclosures to report. Dr. Brandimore’s work was supported in part by a predoctoral fellowship through the Department of Veterans Affairs. Dr. Okun serves as a consultant for the National Parkinson Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past >36 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME activities on movement disorders in the last 36 months sponsored by PeerView, Prime, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic and ANS/St. Jude, and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Dr. Hegland’s work is supported in part by the American Heart Association, National Institutes of Health and BAE defense systems.

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Troche, M.S., Schumann, B., Brandimore, A.E. et al. Reflex Cough and Disease Duration as Predictors of Swallowing Dysfunction in Parkinson’s Disease. Dysphagia 31, 757–764 (2016).

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