Michelle S Troche1, Michael S Okun2, John C Rosenbek3, Lori J Altmann4, Christine M Sapienza5. 1. Department of Speech, Language, and Hearing Sciences, University of Florida, USA; Center for Movement Disorders and Neurorestoration, University of Florida, USA; Brain Rehabilitation Research Center, Malcom Randall VA, Gainesville, FL, USA. Electronic address: michi81@phhp.ufl.edu. 2. Department of Neurology, University of Florida, USA; Center for Movement Disorders and Neurorestoration, University of Florida, USA. 3. Department of Speech, Language, and Hearing Sciences, University of Florida, USA; Center for Movement Disorders and Neurorestoration, University of Florida, USA; Brain Rehabilitation Research Center, Malcom Randall VA, Gainesville, FL, USA. 4. Department of Speech, Language, and Hearing Sciences, University of Florida, USA. 5. Brain Rehabilitation Research Center, Malcom Randall VA, Gainesville, FL, USA; Department of Communication Sciences and Disorders, Jacksonville University, Jacksonville, FL, USA.
Abstract
BACKGROUND: Aspiration pneumonia is a leading cause of death in persons with Parkinson's disease (PD). Despite this, the mechanisms underlying dysphagia in this population are unclear. To date, researchers have not investigated the effects of varying cognitive demand on objective measures of swallowing safety. This study assessed whether swallowing safety could be disrupted by increasing cognitive demands during the task of swallowing. METHODS: Twenty participants with moderate PD and dysphagia were tested while completing a novel dual task experimental paradigm under videofluoroscopy. In the dual task condition, participants swallowed 10 cc of thin liquid barium while completing a digits forward task. RESULTS: Four females and 16 males completed the study. Results revealed differential effects to swallowing safety based on baseline measures of cognitive flexibility and attention. Participants with mild impairment in cognitive flexibility and attention demonstrated cognitive-motor interference with worsening of both swallowing and cognitive performance. In contrast, participants who were most impaired in the domains of cognitive flexibility and attention improved swallowing safety in the dual task condition. Additionally, decreased swallow timing durations existed in the dual task condition compared to the single task condition. CONCLUSIONS: The results of this study support the hypothesis that supramedullary drive can influence the swallowing plan. Additionally, this study highlights the need for cognitive taxing during swallowing evaluations.
BACKGROUND:Aspiration pneumonia is a leading cause of death in persons with Parkinson's disease (PD). Despite this, the mechanisms underlying dysphagia in this population are unclear. To date, researchers have not investigated the effects of varying cognitive demand on objective measures of swallowing safety. This study assessed whether swallowing safety could be disrupted by increasing cognitive demands during the task of swallowing. METHODS: Twenty participants with moderate PD and dysphagia were tested while completing a novel dual task experimental paradigm under videofluoroscopy. In the dual task condition, participants swallowed 10 cc of thin liquid barium while completing a digits forward task. RESULTS: Four females and 16 males completed the study. Results revealed differential effects to swallowing safety based on baseline measures of cognitive flexibility and attention. Participants with mild impairment in cognitive flexibility and attention demonstrated cognitive-motor interference with worsening of both swallowing and cognitive performance. In contrast, participants who were most impaired in the domains of cognitive flexibility and attention improved swallowing safety in the dual task condition. Additionally, decreased swallow timing durations existed in the dual task condition compared to the single task condition. CONCLUSIONS: The results of this study support the hypothesis that supramedullary drive can influence the swallowing plan. Additionally, this study highlights the need for cognitive taxing during swallowing evaluations.
Authors: JoAnne Robbins; Gary Gensler; Jacqueline Hind; Jeri A Logemann; Anne S Lindblad; Diane Brandt; Herbert Baum; David Lilienfeld; Steven Kosek; Donna Lundy; Karen Dikeman; Marta Kazandjian; Gary D Gramigna; Susan McGarvey-Toler; Patricia J Miller Gardner Journal: Ann Intern Med Date: 2008-04-01 Impact factor: 25.391
Authors: Robert D Salazar; Xiaolin Ren; Terry D Ellis; Noor Toraif; Olivier J Barthelemy; Sandy Neargarder; Alice Cronin-Golomb Journal: Neuropsychology Date: 2017-04-17 Impact factor: 3.295