Pathophysiology of diurnal drooling in Parkinson's disease
Identifieur interne : 002A10 ( Main/Corpus ); précédent : 002A09; suivant : 002A11Pathophysiology of diurnal drooling in Parkinson's disease
Auteurs : Johanna G. Kalf ; Marten Munneke ; Lenie Van Den Engel-Hoek ; Bert J. De Swart ; George F. Borm ; Bastiaan R. Bloem ; Machiel J. ZwartsSource :
- Movement Disorders [ 0885-3185 ] ; 2011-08-01.
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- KwdEn :
Abstract
Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society
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DOI: 10.1002/mds.23720
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Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Johanna G. Kalf MSc</name><affiliations><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</json:string><json:string>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Marten Munneke PhD</name><affiliations><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</json:string><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, IQ Healthcare, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Lenie van den Engel‐Hoek MSc</name><affiliations><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Bert J. de Swart PhD</name><affiliations><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>George F. Borm PhD</name><affiliations><json:string>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Bastiaan R. Bloem MD, PhD</name><affiliations><json:string>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Machiel J. Zwarts MD, PhD</name><affiliations><json:string>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>drooling</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hypomimia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dysphagia</value></json:item></subject><articleId><json:string>MDS23720</json:string></articleId><language><json:string>eng</json:string></language><abstract>Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. 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Bloem was supported by a ZonMw VIDI research grant (number 016.076.352).</note><note type="content">*Full financial disclosures and author roles may be found in the online version of this article.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Pathophysiology of diurnal drooling in Parkinson's disease</title><author><persName><forename type="first">Johanna G.</forename><surname>Kalf</surname></persName><roleName type="degree">MSc</roleName><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">Marten</forename><surname>Munneke</surname></persName><roleName type="degree">PhD</roleName><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, IQ Healthcare, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">Lenie</forename><surname>van den Engel‐Hoek</surname></persName><roleName type="degree">MSc</roleName><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">Bert J.</forename><surname>de Swart</surname></persName><roleName type="degree">PhD</roleName><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">George F.</forename><surname>Borm</surname></persName><roleName type="degree">PhD</roleName><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">Bastiaan R.</forename><surname>Bloem</surname></persName><roleName type="degree">MD, PhD</roleName><note type="correspondence"><p>Correspondence: Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</p></note><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation></author><author><persName><forename type="first">Machiel J.</forename><surname>Zwarts</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-08-01"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1670">1670</biblScope><biblScope unit="page" to="1676">1676</biblScope></imprint></monogr><idno type="istex">7D62E3CABD85719E8FF1613FE6E344556F57BB31</idno><idno type="DOI">10.1002/mds.23720</idno><idno type="ArticleID">MDS23720</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>drooling</term></item><item><term>hypomimia</term></item><item><term>dysphagia</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-10-19">Received</change><change when="2011-02-24">Registration</change><change when="2011-08-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/7D62E3CABD85719E8FF1613FE6E344556F57BB31/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="90"><doi origin="wiley" registered="yes">10.1002/mds.v26.9</doi><numberingGroup><numbering type="journalVolume" number="26">26</numbering><numbering type="journalIssue">9</numbering></numberingGroup><coverDate startDate="2011-08-01">1 August 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="150" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.23720</doi><idGroup><id type="unit" value="MDS23720"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2011 Movement Disorder Society</copyright><eventGroup><event type="manuscriptReceived" date="2010-10-19"></event><event type="manuscriptRevised" date="2011-02-17"></event><event type="manuscriptAccepted" date="2011-02-24"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:3.0.1 mode:FullText" date="2011-12-16"></event><event type="publishedOnlineEarlyUnpaginated" date="2011-04-11"></event><event type="publishedOnlineFinalForm" date="2011-08-09"></event><event type="firstOnline" date="2011-04-11"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">1670</numbering><numbering type="pageLast">1676</numbering></numberingGroup><correspondenceTo>Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS23720.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="1"></count><count type="referenceTotal" number="33"></count><count type="wordTotal" number="5129"></count></countGroup><titleGroup><title type="main" xml:lang="en">Pathophysiology of diurnal drooling in Parkinson's disease<link href="#fn1"></link><link href="#fn2"></link><link href="#fn3"></link></title><title type="short" xml:lang="en">Pathophysiology of Drooling in PD</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Johanna G.</givenNames><familyName>Kalf</familyName><degrees>MSc</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1 #af3"><personName><givenNames>Marten</givenNames><familyName>Munneke</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Lenie</givenNames><familyName>van den Engel‐Hoek</familyName><degrees>MSc</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Bert J.</givenNames><familyName>de Swart</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>George F.</givenNames><familyName>Borm</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af2" corresponding="yes"><personName><givenNames>Bastiaan R.</givenNames><familyName>Bloem</familyName><degrees>MD, PhD</degrees></personName><contactDetails><email>b.bloem@neuro.umcn.nl</email></contactDetails></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Machiel J.</givenNames><familyName>Zwarts</familyName><degrees>MD, PhD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="NL" type="organization"><unparsedAffiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="NL" type="organization"><unparsedAffiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="NL" type="organization"><unparsedAffiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, IQ Healthcare, Nijmegen, The Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="NL" type="organization"><unparsedAffiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">drooling</keyword><keyword xml:id="kwd3">hypomimia</keyword><keyword xml:id="kwd4">dysphagia</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; <i>P</i> = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p><b>Funding agencies</b>: This research was supported by the Department of Rehabilitation of the Radboud University Nijmegen Medical Centre.</p></note><note xml:id="fn2"><p><b>Relevant conflicts of interest/financial disclosures</b>: Professor Bastiaan R. Bloem was supported by a ZonMw VIDI research grant (number 016.076.352).</p></note><note xml:id="fn3"><p>Full financial disclosures and author roles may be found in the online version of this article.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Pathophysiology of diurnal drooling in Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Pathophysiology of Drooling in PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Pathophysiology of diurnal drooling in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Johanna G.</namePart><namePart type="family">Kalf</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marten</namePart><namePart type="family">Munneke</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, IQ Healthcare, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lenie</namePart><namePart type="family">van den Engel‐Hoek</namePart><namePart type="termsOfAddress">MSc</namePart><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bert J.</namePart><namePart type="family">de Swart</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">George F.</namePart><namePart type="family">Borm</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence‐Based Practice Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bastiaan R.</namePart><namePart type="family">Bloem</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation><description>Correspondence: Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Machiel J.</namePart><namePart type="family">Zwarts</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-08-01</dateIssued><dateCaptured encoding="w3cdtf">2010-10-19</dateCaptured><dateValid encoding="w3cdtf">2011-02-24</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">1</extent><extent unit="references">33</extent><extent unit="words">5129</extent></physicalDescription><abstract lang="en">Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society</abstract><note type="content">*Funding agencies: This research was supported by the Department of Rehabilitation of the Radboud University Nijmegen Medical Centre.</note><note type="content">*Relevant conflicts of interest/financial disclosures: Professor Bastiaan R. Bloem was supported by a ZonMw VIDI research grant (number 016.076.352).</note><note type="content">*Full financial disclosures and author roles may be found in the online version of this article.</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>drooling</topic><topic>hypomimia</topic><topic>dysphagia</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>9</number></detail><extent unit="pages"><start>1670</start><end>1676</end><total>7</total></extent></part></relatedItem><identifier type="istex">7D62E3CABD85719E8FF1613FE6E344556F57BB31</identifier><identifier type="DOI">10.1002/mds.23720</identifier><identifier type="ArticleID">MDS23720</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2011 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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