Swallowing features in Huntington’s disease: A comparison between safe versus unsafe swallowing

Introduction: Dysphagia has been reported in around 72-100% of patients with Huntington’s Disease (HD) and aspiration pneumonia is the main cause of death in this population. Despite its high prevalence, few studies have investigated dysphagia in HD and no data on which features differentiate deglutition in safe versus unsafe swallowers are currently available. Matherial & Methods: Twenty-two patients with diagnosis of HD, 10 males and 12 females with a mean age of 58.9±10.8 were enrolled. All patients underwent a fiberoptic endoscopic evaluation of swallowing (FEES) using liquid, semisolid and solid. The Penetration-Aspiration scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale and the Dysphagia Outcome and Severity Scale (DOSS) were used to score FEES. Patients with a PAS score ≥2 with at least one consistency were considered unsafe swallowers. The Test of Mastication and Swallowing Solids (TOMASS) was performed. Typical oral intake was recorded using the Functional Oral Intake Scale (FOIS). Clinical assessment was conducted using the Mann Assessment of Swallowing Ability (MASA). Meal consumption was observed and scored through the Mealtime Assessment Scale (MAS). Patients completed the Huntington’s Disease Dysphagia Scale (HDDS). Mann-Whitney test was used to compare deglutition variables between safe and unsafe swallowers. Results: Eleven patients showed a PAS score ≥2 with at least one consistency. Mean PAS score in the unsafe swallowers was 4.63±2 for liquids, 2.09±1.64 for semisolids and 1.2±0.63 for solids. No statistically significant differences were found between the two groups. Conclusions: HD patients unsafe swallowers present comparable pharyngeal residue, efficacy of oral phase, performance in meal consumption, oral intake and perception of swallowing impairment to HD safe swallowers. Lack of statistically significant differences may be due to the small sample size and the low severity of airway invasion in our unsafe swallowers group.