Accurate Dysphagia Screening Tool Needed for Patients With PD

A new study concluded that a screening tool developed for patients with Parkinson disease (PD) failed to detect aspiration in half of the study participants. The results were published in a recent issue of Parkinsonism & Related Disorders.

The Munich dysphagia test–Parkinson’s disease (MDT-PD) is a 26-question patient self-reported screening tool to detect dysphagia in patients with PD. Although dysphagia is common in this population, dysphagia-focused screening tools for individuals with PD are rare.

These findings indicate that the MDT-PD should not be considered as a screening tool for aspiration, the authors write in the study. They also highlight a need for the development of new clinical screening tools to detect aspiration in those with PD.

“It is important that a swallowing disorder with aspiration is detected as early as possible in patients with PD,” coauthor Dr Till Flügel from the University Medical Center Hamburg-Eppendorf told Annals of Long-Term Care: Clinical Care and Aging. “The MDT-PD is one of the few screening tools specifically designed for patients with PD. Unfortunately, our study shows that this instrument cannot meet the requirements in daily practice. It is important for us to communicate this so that doctors using this instrument can interpret the results accordingly.”

In the study, nearly 120 patients with PD were examined and completed the MDT-PD and the one swallowing question (NMS-3) from the nonmotor symptom questionnaire for PD (NMSQuest). Researchers compared the results with the penetration-aspiration scale (PAS) rating defined by flexible endoscopic evaluation of swallowing (FEES).

Results showed that 50% of individuals with aspiration detected by FEES were not detected by the MDT-PD and NMS-3 tools. Further, the proportion of false positives was high with both the MDT-PD and the NMS-3.

“On the one hand, the MDT-PD does not detect many patients with aspiration. On the other hand, it identifies a lot of patients without aspiration as conspicuous,” Dr Flügel pointed out.

Regarding the implications of these findings, he says that physicians should ask their patients explicitly about swallowing problems, as they usually do not report them spontaneously.

“In the case of abnormalities such as coughing or the urge to clear one’s throat during meals, weight loss or even pneumonia, further diagnostics should be carried out,” he added. “If the MDT-PD is used, more attention should be paid to the indicated complaints than to the actual result of the classification.”

—Meredith Edwards White

Reference

Buhmann C, Flügel T, Bihler M, et al. Is the Munich dysphagia Test-Parkinson’s disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Parkinsonism Relat Disord. Published online November 1, 2018. pii:S1353-8020(18)30467-X. doi:10.1016/j.parkreldis.2018.10.031.

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