帕金森病吞咽障碍的研究进展

doi:10.3969/j.issn.1006-9771.2018.00.001

摘要/Abstract

摘要： 吞咽障碍可发生在帕金森病的任何时期,导致严重并发症,是预后的不良因素。其机制尚不明确。临床中常用吞咽障碍问卷(SDQ)和慕尼黑帕金森病吞咽障碍测试(MDT-PD)进行帕金森病吞咽障碍的初筛。而非运动症状问卷(NMSQ)低估了帕金森病吞咽障碍发生率,统一帕金森病评定量表(UPDRS)也存在类似的不足。吞咽造影检查(VFSE)和内镜吞咽检查(VESS)被认为是评价吞咽障碍的金标准。此外,高分辨率测压可检测帕金森病患者并发的食管吞咽障碍,甚至可以识别帕金森病的隐性吞咽障碍。肌电图可对吞咽障碍患者进行客观、定量诊断。目前临床多根据临床症状选择方案,缺乏系统化管理。治疗包括药物治疗、脑深部电刺激(DBS)、吞咽训练、经颅磁刺激等。早期识别、及时处理、预防相关并发症将有利于改善帕金森病患者生活质量,降低吸入性肺炎发生率。

关键词: 帕金森病, 吞咽障碍, 康复, 评估, 综述

Abstract: Dysphagia commonly occurs in Parkinson's disease (PD) at any stage, which may result in serious complications. The mechanism is uncertain. Swallowing Disturbance Questionnaire (SDQ) and Munich Dysphagia Test-Parkinson's Disease (MDT-PD) are often used for screening dysphagia in PD patients. But Non-motor Symptoms Questionnaire (NMSQ) and Unified Parkinson's Disease Rating Scale (UPDRS) underestimate the severity of dysphagia in PD patients. Videofluoroscopic Swallowing Examination (VFSE) and Videoendoscoptic Swallowing Study (VESS) are the gold standards for the dysphagia. There is no systemic management yet. Interventions includes medication, deep brain stimulation, etc. Early diagnosis and management facilitate to decrease the complications.

Key words: Parkinson's disease, dysphagia, rehabilitation, assessment, review

中图分类号:

R742.5

黄佩玲, 方伯言, 公维军. 帕金森病吞咽障碍的研究进展[J]. 《中国康复理论与实践》, 2018, 24(7): 787-790.

HUANG Pei-ling, FANG Bo-yan, GONG Wei-jun. Progress of Dysphagia in Parkinson's Disease (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(7): 787-790.

参考文献

[1] Lee JM, Derkinderen P, Kordower JH, et al.The search for a peripheral biopsy indicator of α-synuclein pathology for Parkinson disease[J]. J Neuropathol Exp Neurol, 2017, 76(1): 2-15.
[2] Chen W, Xu ZM, Wang G, et al.Non-motor symptoms of Parkinson's disease in China: a review of the literature[J]. Parkinsonism Relat Disord, 2012, 18(5): 446-452.
[3] Han M, Ohnishi H, Nonaka M, et al.Relationship between dysphagia and depressive states in patients with Parkinson's disease[J]. Parkinsonism Relat Disord, 2011, 17(6): 437-439.
[4] Kalf JG, de Swart BJ, Bloem BR, et al. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis[J]. Parkinsonism Relat Disord, 2012, 18(4): 311-315.
[5] Plowman-Prine EK, Sapienza CM, Okun MS, et al.The relationship between quality of life and swallowing in Parkinson's disease[J]. Mov Disord, 2009, 24(9): 1352-1358.
[6] Suttrup I, Warnecke T.[Dysphagia in Parkinson's Disease: Pathophysiology, Diagnosis and Therapy][J]. [in German]. Fortschr Neurol Psychiatr, 2016, 84(Suppl 1): S18-S23.
[7] Suntrup S, Teismann I, Bejer J, et al.Evidence for adaptive cortical changes in swallowing in Parkinson's disease[J]. Brain, 2013, 136(Pt 3): 726-738.
[8] Lee KD, Koo JH, Sun HS, et al.Central cholinergic dysfunction could be associated with oropharyngeal dysphagia in early Parkinson's disease[J]. J Neural Transm (Vienna), 2015, 122(11): 1553-1561.
[9] Warnecke T, Suttrup I, Schröder JB, et al.Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-Levodopa-test[J]. Parkinsonism Relat Disord, 2016, 28: 100-106.
[10] Troche MS, Brandimore AE, Foote KD, et al.Swallowing and deep brain stimulation in Parkinson's disease: a systematic review[J]. Parkinsonism Relat Disord, 2013, 19(9): 783-788.
[11] Troche MS, Brandimore AE, Foote KD, et al.Swallowing outcomes following unilateral STN vs. GPi surgery: a retrospective analysis[J]. Dysphagia, 2014, 29(4): 425-431.
[12] Kim YH, Oh BM, Jung IY, et al.Spatiotemporal characteristics of swallowing in Parkinson's disease[J]. Laryngoscope, 2015, 125(2): 389-395.
[13] Mu L, Chen J, Sobotka S, et al.Alpha-synuclein pathology in sensory nerve terminals of the upper aerodigestive tract of Parkinson's disease patients[J]. Dysphagia, 2015, 30(4): 404-417.
[14] Mu L, Sobotka S, Chen J, et al.Parkinson disease affects peripheral sensory nerves in the pharynx[J]. J Neuropathol Exp Neurol, 2013, 72(7): 614-623.
[15] Martin-Harris B, Brodsky MB, Michel Y, et al.Breathing and swallowing dynamics across the adult lifespan[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(9): 762-770.
[16] Owolabi LF, Nagoda M, Babashani M.Pulmonary function tests in patients with Parkinson's disease: a case-control study[J]. Niger J Clin Pract, 2016, 19(1): 66-70.
[17] Gross R, Atwood-Cw J, Ross SK, et al.The coordination of breathing and swallowing in Parkinson's disease[J]. Dysphagia, 2008, 23(2): 136-145.
[18] Troche MS, Huebner I, Rosenbek JC, et al.Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease[J]. Dysphagia, 2011, 26(3): 218-224.
[19] Troche MS, Okun MS, Rosenbek JC, et al.Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial[J]. Neurology, 2010, 75(21): 1912-1919.
[20] Müller J, Wenning GK, Verny M, et al.Progression of dysarthria and dysphagia in postmortem-confirmed parkinsonian disorders[J]. Arch Neurol, 2001, 58(2): 259-264.
[21] Noyce AJ, Silveira-Moriyama L, Gilpin P, et al.Severe dysphagia as a presentation of Parkinson's disease[J]. Mov Disord, 2012, 27(3): 457-458.
[22] Ws Coriolano Md, R Belo L, Carneiro D, et al. Swallowing in patients with Parkinson's disease: a surface electromyography study[J]. Dysphagia, 2012, 27(4): 550-555.
[23] Leow LP, Beckert L, Anderson T, et al.Changes in chemosensitivity and mechanosensitivity in aging and Parkinson's disease[J]. Dysphagia, 2012, 27(1):106-114.
[24] Sung HY, Joong-Seok Kim MD, Kwang-Soo Lee MD, et al. The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson's disease[J]. Mov Disord, 2010, 25(14): 2361-2368.
[25] Simons JA, Fietzek UM, Waldmann A, et al.Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease[J]. Parkinsonism Relat Disord, 2014, 20(9): 992-998.
[26] Manor Y, Giladi N, Cohen A, et al.Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease[J]. Mov Disord, 2007, 22(13): 1917-1921.
[27] Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, et al.The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire[J]. Mov Disord, 2010, 25(6): 704-709.
[28] Boot JA, Ray Chaudhuri K.Oropharyngeal dysphagia in Parkinson's disease: comments on paper by Kalf et al[J]. Parkinsonism Relat Disord, 2013, 19(2): 275.
[29] Suttrup I, Warnecke T.Dysphagia in Parkinson's disease[J]. Dysphagia, 2016, 31(1): 24-32.
[30] Lin CW, Chang YC, Chen WS, et al.Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia[J]. Arch Phys Med Rehabil, 2012, 93(11): 2080-2084.
[31] Ellerston JK, Heller AC, Houtz DR, et al.Quantitative measures of swallowing deficits in patients with Parkinson's disease[J]. Ann Otol Rhinol Laryngol, 2016, 125(5): 385-392.
[32] Warnecke T, Hamacher C, Oelenberg S, et al.Off and on state assessment of swallowing function in Parkinson's disease[J]. Parkinsonism Relat Disord, 2014, 20(9): 1033-1034.
[33] Ertekin C.Electrophysiological evaluation of oropharyngeal dysphagia in Parkinson's disease[J]. J Mov Disord, 2014, 7(2): 31-56.
[34] Abbruzzese G, Marchese R, Avanzino L, et al.Rehabilitation for Parkinson's disease: current outlook and future challenges[J]. Parkinsonism Relat Disord, 2016, 22(Suppl 1): S60-S64.
[35] Lengerer S, Kipping J, Rommel N, et al.Deep-brain-stimulation does not impair deglutition in Parkinson's disease[J]. Parkinsonism Relat Disord, 2012, 18(7): 847-853.
[36] Kulneff L, Sundstedt S, Olofsson K, et al.Deep brain stimulation-effects on swallowing function in Parkinson's disease[J]. Acta Neurol Scand, 2013, 127(5): 329-336.
[37] Silbergleit AK, Lewitt P, Junn F, et al.Comparison of dysphagia before and after deep brain stimulation in Parkinson's disease[J]. Mov Disord, 2012, 27(14): 1763-1768.
[38] Xie T, Vigil J, MacCracken E, et al. Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD[J]. Neurology, 2015, 84(4): 415-420.
[39] Termsarasab P, Tse W.Deep brain stimulation and oropharyngeal dysfunction in Parkinson's disease: a case report[J]. Parkinsonism Relat Disord, 2015, 21(1): 79-80.
[40] Sharkawi AE, Ramiget L, Logemann JA, et al.Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study[J]. J Neurol Neurosurg Psychiatry, 2002, 72(1): 31-36.
[41] Manor Y, Mootanah R, Freud D, et al.Video-assisted swallowing therapy for patients with Parkinson's disease[J]. Parkinsonism Relat Disord, 2013, 19(2): 207-211.
[42] Miyasaki JM.Treatment of advanced Parkinson disease and related disorders[J]. Continuum (Minneap Minn), 2016, 22(4): 1104-1116.
[43] Barwood CH, Murdoch BE. rTMS as a treatment for neurogenic communication and swallowing disorders[J]. Acta Neurol Scand, 2013, 127(2): 77-91.