, Volume 33, Issue 1, pp 41–50 | Cite as

Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study

  • Christina PflugEmail author
  • Moritz Bihler
  • Katharina Emich
  • Almut Niessen
  • Julie Cläre Nienstedt
  • Till Flügel
  • Jana-Christiane Koseki
  • Rosemarie Plaetke
  • Ute Hidding
  • Christian Gerloff
  • Carsten Buhmann
Original Article


To assess the prevalence of dysphagia and its typical findings in unselected “real-world” Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water, biscuit, and bread). Typical findings of dysphagia like penetration and aspiration, residues, and leakage were assessed. Dysphagia was common in Parkinson patients and occurred in all, even early, disease stages. Only 5% (6/119) of patients showed a completely unremarkable deglutition. Aspiration was seen in 25% (30/119) of patients and always related to water. Residues occurred in 93% (111/119), most commonly for bread. Leakage was much less frequent and was found in only 3–18%, depending on consistency. In a significant fraction of patients, objective dysphagia was not subjectively perceived. A total of 16% of asymptomatic patients suffered from critical aspiration. Significant swallowing deficiencies already occurred in early disease. Aspiration was found in 4 of 20 (20%) patients with disease duration of less than 2 years. Seven of 57 patients (12%) with Hoehn and Yahr stage 2 suffered from severe aspiration. Given the high frequency of critical aspiration in Parkinson disease, these patients should be evaluated early for dysphagia to avoid complications and recommend an adequate therapy. FEES is a simple, cost efficient, minimally invasive method that is ideally suited for this purpose.


Deglutition Deglutition disorders Aspiration Parkinson disease Prevalence FEES 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the local ethics committee of the Medical Council Hamburg (trial number PV5089) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments; written informed consent was obtained from all persons.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Christina Pflug
    • 1
    Email author
  • Moritz Bihler
    • 2
  • Katharina Emich
    • 2
  • Almut Niessen
    • 1
  • Julie Cläre Nienstedt
    • 1
  • Till Flügel
    • 1
  • Jana-Christiane Koseki
    • 1
  • Rosemarie Plaetke
    • 3
  • Ute Hidding
    • 2
  • Christian Gerloff
    • 2
  • Carsten Buhmann
    • 2
  1. 1.Department of Voice, Speech and Hearing Disorders, Center for Clinical NeurosciencesUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Neurology, Center for Clinical NeurosciencesUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-EppendorfHamburgGermany

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