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Dysphagia screening in Parkinson's Disease.

  • 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). <br /> 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. <br /> 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). AgreementBackground 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). <br /> 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. <br /> 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. <br /> 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.show moreshow less

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Author details:Ulrike FrankORCiDGND, Julia Radtke, Julie Cläre NienstedtORCiD, Monika Pötter-Nerger, Beate Schönwald, Carsten Buhmann, Christian Gerloff, Almut Niessen, Till Flügel, Jana-Christiane Koseki, Christina Pflug
DOI:https://doi.org/10.1111/nmo.14034
ISSN:1350-1925
ISSN:1365-2982
Pubmed ID:https://pubmed.ncbi.nlm.nih.gov/33217102
Title of parent work (English):Neurogastroenterology and motility
Subtitle (English):A diagnostic accuracy cross-sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS)
Publisher:Wiley
Place of publishing:Hoboken
Publication type:Article
Language:English
Date of first publication:2021/11/20
Publication year:2021
Release date:2023/01/09
Tag:FEES; Gugging Swallowing Screen; Parkinson' s disease; aspiration; dysphagia
Volume:33
Issue:5
Article number:e14034
Number of pages:8
Funding institution:transnational E-RARE grant `CCMCURE (DFG)European Commission [SFB958]; E-RARE [ERL 138397]; Canadian; Institutes for Health ResearchCanadian Institutes of Health Research; (CIHR) [PJT 153000]; the E-RARE grant `CCMCURE
Organizational units:Humanwissenschaftliche Fakultät / Strukturbereich Kognitionswissenschaften / Department Linguistik
DDC classification:4 Sprache / 41 Linguistik / 410 Linguistik
Peer review:Referiert
Publishing method:Open Access / Hybrid Open-Access
License (German):License LogoCC-BY - Namensnennung 4.0 International
External remark:Zweitveröffentlichung in der Schriftenreihe Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe ; 854
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