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Pathophysiology underlying drooling in Parkinson’s disease: oropharyngeal bradykinesia

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Abstract

We aimed to investigate the association between drooling and possible etiological factors in Parkinson’s disease (PD) and to determine its effect on the quality of life. Demographic data of the 63 patients with idiopathic PD were recorded. Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) test was administered to all patients to evaluate speech, swallowing functions, and saliva control. The freezing of gait questionnaire (FOGQ) was used to evaluate gait and freezing of gait. Dynamic Parkinson gait scale (DYPAGS) was administered for the objective quantification of PD gait features. Disease severity was assessed by UPDRS and modified Hoehn & Yahr Scale. PD specific health-related quality was evaluated by PDQ-39 questionnaire. Drooling was only significantly correlated to UPDRS score; a stronger association was found between drooling and UPDRS 3 motor score; and a more significant association was determined between drooling and the bradykinesia questions of the motor part of UPDRS 3. Interestingly, no significant association was found between sialorrhea score and PDQ-39 score. Based on the results of this study, we concluded that oropharyngeal bradykinesia may be responsible for drooling in PD. In contrast to a general expectation, we did not find any adverse impact of drooling on the quality of life.

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References

  1. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, Bottacchi E, Cannas A, Ceravolo G, Ceravolo R et al (2009) The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 24:1641–1649. doi:10.1002/mds.22643

    Article  PubMed  Google Scholar 

  2. Gallagher DA, Lees AJ, Schrag A (2010) What are the most important nonmotor symptoms in patients with Parkinson’s disease and are we missing them? Mov Disord 25:2493–2500. doi:10.1002/mds.23394

    Article  PubMed  Google Scholar 

  3. Boyce HW, Bakheet MR (2005) Sialorrhea: a review of a vexing, often unrecognized sign of oropharyngeal and esophageal disease. J Clin Gastroenterol 39:89–97

    PubMed  Google Scholar 

  4. Edwards LL, Pfeiffer RF, Quigley EM, Hofman R, Balluff M (1991) Gastrointestinal symptoms in Parkinson’s disease. Mov Disord 6:151–156. doi:10.1002/mds.870060211

    Article  CAS  PubMed  Google Scholar 

  5. Leopold NA, Kagel MC (1997) Laryngeal deglutition movement in Parkinson’s disease. Neurology 48:373–376

    Article  CAS  PubMed  Google Scholar 

  6. Leopold NA, Kagel MC (1997) Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia 12:11–18 (discussion 19–20)

    Article  CAS  PubMed  Google Scholar 

  7. Hyson HC, Johnson AM, Jog MS (2002) Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. Mov Disord 17:1318–1320. doi:10.1002/mds.10276

    Article  PubMed  Google Scholar 

  8. Marks L, Turner K, O’Sullivan J, Deighton B, Lees A (2001) Drooling in Parkinson’s disease: a novel speech and language therapy intervention. Int J Lang Commun Disord/R Coll Speech Lang Ther 36(Suppl):282–287

    Article  Google Scholar 

  9. O’Sullivan JD, Bhatia KP, Lees AJ (2000) Botulinum toxin A as treatment for drooling saliva in PD. Neurology 55:606–607

    Article  PubMed  Google Scholar 

  10. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653. doi:10.1002/mds.23429

    Article  PubMed  Google Scholar 

  11. Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD (2000) Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord 6:165–170

    Article  PubMed  Google Scholar 

  12. Cremers J, Phan Ba R, Delvaux V, Garraux G (2012) Construction and validation of the dynamic parkinson gait scale (DYPAGS). Parkinsonism Relat Disord 18:759–764. doi:10.1016/j.parkreldis.2012.03.012

    Article  PubMed  Google Scholar 

  13. Kalf JG, Borm GF, de Swart BJ, Bloem BR, Zwarts MJ, Munneke M (2011) Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson’s disease. Arch Phys Med Rehabil 92:1152–1158. doi:10.1016/j.apmr.2011.02.011

    Article  PubMed  Google Scholar 

  14. Kalf JG, de Swart BJ, Borm GF, Bloem BR, Munneke M (2009) Prevalence and definition of drooling in Parkinson’s disease: a systematic review. J Neurol 256:1391–1396. doi:10.1007/s00415-009-5098-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bagheri H, Damase-Michel C, Lapeyre-Mestre M, Cismondo S, O’Connell D, Senard JM, Rascol O, Montastruc JL (1999) A study of salivary secretion in Parkinson’s disease. Clin Neuropharmacol 22:213–215

    CAS  PubMed  Google Scholar 

  16. Del Tredici K, Hawkes CH, Ghebremedhin E, Braak H (2010) Lewy pathology in the submandibular gland of individuals with incidental Lewy body disease and sporadic Parkinson’s disease. Acta Neuropathol 119:703–713. doi:10.1007/s00401-010-0665-2

    Article  PubMed  Google Scholar 

  17. Tumilasci OR, Cersosimo MG, Belforte JE, Micheli FE, Benarroch EE, Pazo JH (2006) Quantitative study of salivary secretion in Parkinson’s disease. Mov Disord 21:660–667. doi:10.1002/mds.20784

    Article  PubMed  Google Scholar 

  18. Edwards LL, Quigley EM, Pfeiffer RF (1992) Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology. Neurology 42:726–732

    Article  CAS  PubMed  Google Scholar 

  19. Umemoto G, Tsuboi Y, Kitashima A, Furuya H, Kikuta T (2011) Impaired food transportation in Parkinson’s disease related to lingual bradykinesia. Dysphagia 26:250–255. doi:10.1007/s00455-010-9296-y

    Article  PubMed  Google Scholar 

  20. Kalf JG, Munneke M, van den Engel-Hoek L, de Swart BJ, Borm GF, Bloem BR, Zwarts MJ (2011) Pathophysiology of diurnal drooling in Parkinson’s disease. Mov Disord 26:1670–1676. doi:10.1002/mds.23720

    Article  PubMed  Google Scholar 

  21. Abdo WF, van de Warrenburg BP, Burn DJ, Quinn NP, Bloem BR (2010) The clinical approach to movement disorders. Nat Rev Neurol 6:29–37. doi:10.1038/nrneurol.2009.196

    Article  PubMed  Google Scholar 

  22. Leibner J, Ramjit A, Sedig L, Dai Y, Wu SS, Ct Jacobson, Okun MS, Rodriguez RL, Malaty IA, Fernandez HH (2010) The impact of and the factors associated with drooling in Parkinson’s disease. Parkinsonism Relat Disord 16:475–477. doi:10.1016/j.parkreldis.2009.12.003

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Necip Fazil State Hospital, Kahramanmaras, Turkey

    Mehmet Karakoc

  2. Department of Neurology, Ankara Education and Research Hospital, Sukriye Mahallesi, Ulucanlar Caddesi, No: 89 Altindag, Ankara, Turkey

    Mehmet Ilker Yon

  3. Department of Neurological Sciences and Psychiatry, Institute of Health Sciences, Hacettepe University, Ankara, Turkey

    Gul Yalcin Cakmakli

  4. Department of Neurology, Develi Hatice Muammer Kocaturk State Hospital, Kayseri, Turkey

    Ersin Kasim Ulusoy

  5. Department of Neurology, Sivas Numune State Hospital, Sivas, Turkey

    Aydin Gulunay

  6. Department of Neurology, Ankara Numune Education and Research Hospital, Ankara, Turkey

    Nese Oztekin & Fikri Ak

Authors
  1. Mehmet Karakoc
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  2. Mehmet Ilker Yon
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  3. Gul Yalcin Cakmakli
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  4. Ersin Kasim Ulusoy
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  5. Aydin Gulunay
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  6. Nese Oztekin
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Correspondence to Mehmet Ilker Yon.

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We wish to confirm that there are no conflicts of interest associated with this publication, and there have been no significant financial support for this work that could have influenced its outcomes.

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Karakoc, M., Yon, M.I., Cakmakli, G.Y. et al. Pathophysiology underlying drooling in Parkinson’s disease: oropharyngeal bradykinesia. Neurol Sci 37, 1987–1991 (2016). https://doi.org/10.1007/s10072-016-2708-5

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  • DOI: https://doi.org/10.1007/s10072-016-2708-5

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