Investigação da pressão de língua e eficiência e segurança da deglutição nos diferentes estágios da doença de Parkinson

Abstract

Introduction: Oropharyngeal dysphagia (OD) is a common clinical condition in Parkinson's disease (PD) and can be present at any stage of evolution, whether in early-onset Parkinson's disease (PPD) or late-onset Parkinson's disease. The signs and symptoms of OD can alter the efficiency and safety of swallowing and be influenced by the diminished pressure of the tongue during the swallowing process, which can cause risks of penetration and aspiration. Objective: For article 1, the objective was to analyze isometric maximum pressure (MIP) tongue in the different stages of PD in its relationship with changes in swallowing efficiency and safety. For article 2, it was to identify whether there are changes in the efficiency and safety of swallowing that signal the presence of OD in PPD. Method: Article 1 is an analytical, cross-sectional study and article 2 is a series of cases. To obtain the data, protocols were applied to characterize the sample, self-assessment of changes in swallowing, assessment of tongue MIP using a tongue pressure peak transduction device and volume/viscosity swallowing test. The analysis was carried out by calculating simple frequency and percentage with results in terms of mean and standard deviation and submitted to analysis of variance (ANOVA). Normal distribution was evaluated using the Shapiro-Wilk test and comparisons between tongue pressure levels, final evaluation of the swallowing test, PD stage and interaction between final evaluation and stage were carried out using the Tukey test, at a significance level of 0.05. Results of article 1: 50 individuals participated, with an average age of 64.26 years (±12.27), 22 in the initial stage, 20 in the moderate stage and eight in the advanced stage. The average PIMax of the tongue was 33.82 KPa (±17.08) in which the significant interference of the PD stages in the PIMax of the tongue was identified, but without any influence on changes in swallowing efficiency and safety. Results of article 2: 12 individuals participated with an average age of 48.83 years (±5.25), six in the initial stage and six in the moderate stage and among these, only two did not show any sign of change in the efficiency and safety of swallowing. Regarding safety, changes in vocal quality were the most frequent in the volume of 5 ml in IDDSI level 0, 2 and 4 consistencies and in terms of efficiency they were: suspected pharyngeal residue and multiple swallowing in level 2 and 4 consistencies (IDDSI). Conclusion: Individuals with PD present a decrease in tongue MIP and as the disease progresses, tongue pressure tends to decrease, despite this, swallowing efficiency and safety were showed no interference in tongue MIP. It was also identified that people with PPD in less aggressive stages of the disease showed signs of changes in swallowing, due to the presence of pharyngeal residue.