DYSPHAGIA IN NEURODEGENERATIVE DISEASES: SWALLOWING PROFILES AND NUTRITIONAL RISK

The PhD dissertation focuses on the topic of dysphagia in neurodegenerative diseases. The first aim was to investigate the frequency of dysphagia in 55 patients with different stages of Huntington’s disease through an instrumental assessment of swallowing. Dysphagia was found in 30% of the patients in the early stage, in 90% of patients in the moderate stage, and in all patients in the advanced stage. Diagnostic accuracy of a neurological clinical scale was investigated and a cut-off was identified to guide the neurologists in the referral to the swallowing team. A second study analyzed the association between maximum tongue pressure and signs of dysphagia during fiberoptic endoscopic evaluation of swallowing in patients with Amyotrophic Lateral Sclerosis. Results showed that patients with residue in the pyriform sinus had lower maximum tongue pressure. Measuring maximum tongue pressure in patients with Amyotrophic Lateral Sclerosis may provide additional information on swallowing function and may potentially represent a marker for eating-related fatigue. Chapter 4 describes the development and validation of the Mealtime Assessment Scale (MAS), a clinical protocol to assess swallowing safety and efficacy during meal. Finally, the association between dysphagia and risk of malnutrition was investigated in 162 patients with neurodegenerative diseases (Huntington’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis). Age, type of oral intake, residue in the valleculae with semisolids, penetration with liquids, swallowing safety during meal, number of masticatory cycles, and oral phase duration were significantly associated with risk of malnutrition in three neurodegenerative diseases, but only age and swallowing safety during the meal were independent predictors of malnutrition risk. Clinical implications of the studies are discussed.