Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism

Background Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this associatio...

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Published in:Movement disorders clinical practice (Hoboken, N.J.) N.J.), 2024-03, Vol.11 (3), p.265-275
Main Authors: Mir, Michela J., Childers, Justin T., Wheeler‐Hegland, Karen
Format: Article
Language:English
Subjects:
airway protection
Cough - complications
Deglutition
Deglutition Disorders - complications
dysphagia
dystussia
Humans
Parkinson Disease - complications
Parkinson's disease
parkinsonism
Respiratory Aspiration - complications
Respiratory System
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Summary:Background Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. Objectives We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. Methods Swallowing difficulty was described by 11 participants with APD. Penetration‐Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced‐reflex cough measures of flow, volume, and timing were analyzed. Results While most participants did not have post‐swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = −0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). Conclusions As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.
ISSN:2330-1619
2330-1619
DOI:10.1002/mdc3.13965