REFERRAL CRITERIA FOR SPEECH AND LANGUAGE THERAPY ASSESSMENT OF DYSPHAGIA CAUSED BY IDIOPATHIC PARKINSONS-DISEASE

Objective - To examine the prevalence of dysphagia in idiopathic Parki nson's disease (IPD) in the outpatient setting and to determine what a ssessment criteria to use to select patients with dysphagia for referr al to speech and language therapists. Material and methods - Sixty-fou r patients with IPD and 80 age-matched controls were interviewed in cl inic about their swallowing history and an objective swallowing test a dministered. All patients were assessed over the next few weeks by an experienced speech and language therapist and dysphagia rated accordin g to a modified Rehabilitation Institute of Chicago Dysphagia Rating S cale and a novel global rating scale. The ability of various clinic cr iteria to predict patients with severe dysphagia were examined. Result s - Dysphagia for food was found in 30% of patients, significantly mor e than in controls. Swallowing speed and bolus volume were significant ly lower in patients compared with controls and were correlated with d eclining Hoehn and Yahr score. Swallowing speed fell significantly on withdrawal of medication. The therapist's global rating score and Chic ago score declined with Hoehn and Yahr score and duration of disease. However, only 10% of patients required dietary advice and none needed gastrostomy or tracheostomy. Discriminant analysis showed that various combinations of clinic selection criteria were no better than the pre sence of dysphagia for food at predicting which patients had significa nt dysphagia requiring advice from a therapist. Conclusions - Patients with idiopathic Parkinson's disease should be questioned about dyspha gia for food on a regular basis and, if present, should be referred to a speech and language therapist for further assessment and treatment. The outcome of this protocol should be tested prospectively.