Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s disease, Alzheimer ’s disease, Head Injury, and Pneumonia

Despite frequent occurrence among the elderly and invalidating complications, dysphagia is under – diagnosed. A literature review attempts to assess the prevalence in many pathological situations.

Oropharyngeal dysphagia is a swallowing disorder that affects 16 million people in the United States and nearly 40 million people in Europe. This disorder is common in the elderly, for those who have experienced a stroke (CVA) or with neurological diseases such as Parkinson’s disease and Alzheimer’s disease. It is a major cause of mortality and morbidity due to complications it causes, such as malnutrition and aspiration pneumonia.

Four researchers (Swiss, English, Australian and Dutch) decided to review the epidemiology of oropharyngeal dysphagia in five pathological situations: after a stroke, in Parkinson’s disease and Alzheimer’s, traumatic brain injury and pneumonia. For this they have reviewed all the international literature on the subject until January 2014, so that is 1207 publications identified. Thirty-three met inclusion criteria: 24 in stroke, 6 in Parkinson’s disease, 2 in traumatic brain injury and 1 in pneumonia. No relevant studies of dysphagia in Alzheimer’s disease were identified.

Result, the prevalence of oropharyngeal dysphagia varies depending on the evaluation method used (sip of water test, videofluoroscopy, questionnaires, other methods) but also of the severity of the underlying disease. It is observed in 8-80% of subjects who experienced a stroke. His presence is also more common in the days following stroke and when the damaged brain area concerns the innervation of muscles of the tongue and pharynx, larynx (Wallenberg syndrome). In half of the studies, the prevalence of dysphagia after stroke was observed in 30 to 50%. Regarding Parkinson’s disease, the presence of dysphagia is found in 11-81% of subjects. Its frequency increases with the severity of the disease. After a brain injury, 27-30% of patients suffer from dysphagia. Finally, 91.7% of patients with pneumonia suffer from dysphagia. Beyond these conditions, the authors reported a prevalence of 40% of dysphagia in controls, not suffering from pathologies targeted by the study. This indicates they believe that even apparently healthy subjects at risk of dysphagia.

For the authors, the heterogeneity of estimates highlights the urgent need for better dysphagia management starting with a reliable, standardized, and validated method for oropharyngeal dysphagia identification. Moreover, they recommend routine screening of populations at risk to improve early care of patients and clinical situations.

Source : A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease, Head Injury, and Pneumonia. Takizawa C, Gemmell E, Kenworthy J, Speyer R. Dysphagia. 2016 Mar 12