Progression of dysarthria and dysphagia in postmortem-confirmed Parkinsonian disorders

Background: Dysarthria and dysphagia are known to occur in parkinsonian syn dromes such as Parkinson disease (PD), dementia with Lewy bodies (DLB), cor ticobasal degeneration (CBD), multiple system atrophy (MSA), and progressiv e supranuclear palsy (PSP). Differences in the evolution of these symptoms have not been studied systematically in postmortem-confirmed cases. Objective: To study differences in the evolution of dysarthria and dysphagi a in postmortem-confirmed parkinsonian disorders. Patients and Methods: Eighty-three pathologically confirmed cases (PD, n = 17; MSA, n = 15; DLB, n = 14; PSP, n = 24; and CBD, n = 13) formed the basi s for a multicenter clinicopathological study organized by the National Ins titute of Neurological Disorders and Stroke, Bethesda, Md. Cases with enoug h clinicopathological documentation for the purpose of the study were selec ted from research and neuropathological files of 7 medical centers in 4 cou ntries (Austria, France, England, and the United States). Results: Median dysarthria latencies were short in PSP and MSA (24 months e ach), intermediate in CBD and DLB (40 and 42 months), and long in PD (84 mo nths). Median dysphagia latencies were intermediate in PSP (42 months), DLB (43 months), CBD (64 months), and MSA (67 months), and long in PD (130 mon ths). Dysarthria or dysphagia within 1 year of disease onset was a distingu ishing feature for atypical parkinsonian disorders (APDs) (specificity, 100 %) but failed to further distinguish among the APDs. Survival time after on set of a complaint of dysphagia was similar in PD, MSA, and PSP (15 to 24 m onths, P = .7) and latency to a complaint of dysphagia was highly correlate d with total survival time (p = 0.88; P < .001) in all disorders. Conclusions: Latency to onset of dysarthria and dysphagia clearly different iated PD from the APDs, but did not help distinguish different APDs. Surviv al after onset of dysphagia was similarly poor among all parkinsonian disor ders. Evaluation and adequate treatment of patients with PD who complain of dysphagia might prevent or delay complications such as aspiration pneumoni a, which in turn may improve quality of life and increase survival time.