TY - JOUR A1 - Frank, Ulrike A1 - Radtke, Julia A1 - Nienstedt, Julie Cläre A1 - Pötter-Nerger, Monika A1 - Schönwald, Beate A1 - Buhmann, Carsten A1 - Gerloff, Christian A1 - Niessen, Almut A1 - Flügel, Till A1 - Koseki, Jana-Christiane A1 - Pflug, Christina T1 - Dysphagia screening in Parkinson's Disease BT - a diagnostic accuracy cross-sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS) JF - Neurogastroenterology and motility N2 - Background Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES). Methods Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared. Key Results Inter-rater reliability of GUSS ratings was high (r(s) = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50%, and specificity of 51.35% (PPV 28%, NPV 73%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97% sensitivity and 35.71% specificity (PPV 75%, NPV 33.33%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (r(s) = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant. Conclusions and Inferences The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination. KW - aspiration KW - dysphagia KW - FEES KW - Gugging Swallowing Screen KW - Parkinson' s disease Y1 - 2021 U6 - https://doi.org/10.1111/nmo.14034 SN - 1350-1925 SN - 1365-2982 VL - 33 IS - 5 PB - Wiley CY - Hoboken ER - TY - JOUR A1 - Vogel, Annemarie A1 - Claus, Inga A1 - Ahring, Sigrid A1 - Gruber, Doreen A1 - Haghikia, Aiden A1 - Frank, Ulrike A1 - Dziewas, Rainer A1 - Ebersbach, Georg A1 - Gandor, Florin A1 - Warnecke, Tobias T1 - Endoscopic characteristics of dysphagia in multiple system atrophy JF - Movement disorders : official journal of the Movement Disorder Society N2 - Background Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. Objective This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. Methods Fifty-seven patients with MSA (median, 64 [interquartile range (IQR): 59-71] years; 35 women) underwent flexible endoscopic evaluation of swallowing using a specific MSA-flexible endoscopic evaluation of swallowing task protocol. Findings were compared with an age-matched cohort of 57 patients with PD (median, 67 [interquartile range: 60-73] years; 28 women). In a subcohort, subjective dysphagia was assessed using the Swallowing Disturbance Questionnaire and correlated to endoscopy findings. Results Patients with MSA predominantly showed symptoms suggestive of oral-phase disturbance (premature spillage, 75.4%, piecemeal deglutition, 75.4%). Pharyngeal-phase symptoms occurred less often (pharyngeal residues, 50.9%; penetration/aspiration, 28.1%). In contrast, pharyngeal symptoms were the most common finding in PD (pharyngeal residues, 47.4%). Oral symptoms occurred less frequently in PD (premature spillage, 15.8%, P < 0.001; piecemeal deglutition, 1.8%, P < 0.01). Patients with MSA had a greater risk for oral-phase disturbances with increased disease severity (P < 0.05; odds ratio, 3.15). Patients with MSA showed a significantly higher intraindividual interswallow variability compared with PD. When correlating Swallowing Disturbance Questionnaire scores with endoscopy results, its cutoff, validated for PD, was not sensitive enough to identify patients with MSA with dysphagia. We developed a subscore for identifying dysphagia in MSA and calculated a new cutoff (sensitivity 85%, specificity 100%). Conclusions In contrast with patients with PD, patients with dysphagic MSA more frequently present with oral-phase symptoms and a significantly higher intraindividual interswallow variability. A novel Swallowing Disturbance Questionnaire MSA subscore may be a valuable tool to identify patients with MSA with early oropharyngeal dysphagia. KW - multiple system atrophy KW - dysphagia KW - FEES KW - Swallowing Disturbance Questionnaire KW - SDQ Y1 - 2022 U6 - https://doi.org/10.1002/mds.28854 SN - 0885-3185 SN - 1531-8257 VL - 37 IS - 3 SP - 535 EP - 544 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Schlickewei, Ole A1 - Nienstedt, Julie Cläre A1 - Frank, Ulrike A1 - Fründt, Odette A1 - Pötter-Nerger, Monika A1 - Gerloff, Christian A1 - Buhmann, Carsten A1 - Müller, Frank A1 - Lezius, Susanne A1 - Koseki, Jana-Christiane A1 - Pflug, Christina T1 - The ability of the eating assessment tool‑10 to detect penetration and aspiration in Parkinson’s disease JF - European archives of oto-rhino-laryngology and head & neck N2 - Purpose: Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. Methods: In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. Results: PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of >= 6 presented a sensitivity of 58% and specificity of 82%. Conclusions: The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications. KW - Parkinson's disease KW - dysphagia KW - questionnaire KW - screening Y1 - 2020 U6 - https://doi.org/10.1007/s00405-020-06377-x SN - 0937-4477 SN - 1434-4726 VL - 278 IS - 5 SP - 1661 EP - 1668 PB - Springer CY - Berlin ER -