Dysphagia and aspiration pneumonia are the main cause of life-threatening morbidity in Parkinson's disease (PD). Impaired airway clearance leads to penetration of foreign material which "seeds" the subglottic airways resulting in a high prevalence of aspiration pneumonia. Mortality rates of aspiration pneumonia can approach 40%. There is a compelling need for strategies to enhance the screening of airway protective behaviors in patients with neurodegenerative disease. While screening tools currently exist to assess aspiration risk in clinical settings they primarily assess swallow function. Importantly, swallow screening measures are unable to assess corrective airway protection modalities and therefore give limited information as to an individual's ability to defend his or her airway, should aspiration occur. The R21 will comprise a comparison of two different devices for capturing peak cough airflow data to the more costly and technically demanding "gold standard" pneumotachograph protocol in the assessment of cough airflow measures in healthy participants and individuals with PD. First, cough peak flow data will be collected from each of the three devices produced by healthy controls and individuals with PD. Next, we will define the cough ranges produced within the healthy control and PD groups across elicited weak, moderate and strong coughs to determine the devices'ability to measure airflow change. Intra and inter - reliability of the devices for the measurement of cough will be completed. Participants with PD will be recruited from the University of Florida Movement Disorders Center. The acceptability of each device will be measured by a calculated total score based on visual analogue scales of perception of task difficulty, discomfort, pain, and ease of use. Separate scales will be administered to participants and clinicians. Comparison of meter acceptability will be conducted using ANOVA. The comparability of the devices for expressing expiratory peak airflow in healthy control vs. PD sample will be reviewed using receiver operator curves (ROC). Area under the curve will be calculated (AUROC) and compared for the different devices using hypothesis testing. The R33 aims follow the R21 phase to determine if cough peak airflow can predict the presence and severity of airway penetration as defined by PA scores made from videofluoroscopic assessment of sequential swallows completed by a cohort of participants with PD. Participants will undergo measurement of peak cough airflows using the device selected during the R21 portion and receive an assessment of swallowing function under videofluoroscopy. Subsequent statistical analyses will determine the relationship, if any, between measures of peak cough airflow and P-A scores for participants with PD. Statistical modeling procedures will provide a preliminary predictive equation of risk for airway compromise.
Some reports suggest that 100% of persons with Parkinson's disease (PD) will develop dysphagia. Aspiration pneumonia is of particular concern for individuals with neurodegenerative disease processes, where swallow is frequently impaired. There is a compelling need for strategies to enhance the screening of cough / airway protective behaviors in patients with neurodegenerative disease.
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|Silverman, Erin P; Carnaby-Mann, Giselle; Pitts, Teresa et al. (2014) Concordance and discriminatory power of cough measurement devices for individuals with Parkinson disease. Chest 145:1089-96|