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Drooling in Parkinson’s Disease: Evidence of a Role for Divided Attention

Authors
  • Reynolds, Hannah1
  • Miller, Nick2
  • Walker, Richard3, 4
  • 1 Queen Elizabeth Hospital, South Tyneside NHS Foundation Trust, Department of Speech and Language Therapy, Sheriff Hill, Gateshead, NE9 6SX, UK , Sheriff Hill (United Kingdom)
  • 2 Newcastle University, Newcastle University Institute for Ageing, Speech and Language Sciences, George VI Building, Newcastle upon Tyne, NE1 7RU, UK , Newcastle upon Tyne (United Kingdom)
  • 3 Northumbria Health NHS Foundation Trust, North Tyneside District Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK , North Shields (United Kingdom)
  • 4 Newcastle University, Institute of Health and Society, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK , Newcastle upon Tyne (United Kingdom)
Type
Published Article
Journal
Dysphagia
Publisher
Springer US
Publication Date
May 21, 2018
Volume
33
Issue
6
Pages
809–817
Identifiers
DOI: 10.1007/s00455-018-9906-7
Source
Springer Nature
Keywords
License
Yellow

Abstract

Drooling is a frequently reported symptom in Parkinson’s Disease (PD) with significant psychosocial impact and negative health consequences including silent aspiration of saliva with the associated risk of respiratory infections. It is suggested that in PD drooling is associated with inefficient oropharyngeal swallowing which reduces the effective clearance of saliva rather than hyper-salivation. This is compounded by unintended mouth opening and flexed posture increasing anterior loss of saliva. It is reported to occur most frequently during cognitively distracting concurrent tasks suggesting an impact from divided attention in a dual-task situation. However, this supposition has not been systematically examined. This study assessed whether frequency of saliva swallows reduced, and drooling severity and frequency increased, when people with PD engaged in a cognitively distracting task. 18 patients with idiopathic PD reporting daytime drooling on the Unified Parkinson’s Disease Rating Scale (UPDRS) were recruited. They completed the Radboud Oral Motor Inventory for PD saliva questionnaire and the Montreal Cognitive Assessment. UPDRS drooling score, disease stage, duration, gender, and age were recorded. Swallow frequency and drooling severity and frequency were measured at rest and during a distracting computer-based language task. There was no significant difference between drooling severity at rest and during distraction (Wilcoxon signed rank test z = − 1.724, p = 0.085). There was a significant difference between at rest and distraction conditions for both drooling frequency (Wilcoxon signed rank test z = − 2.041, p = 0.041) and swallow frequency (Wilcoxon signed rank test z = − 3.054, p = 0.002). Participants swallowed less frequently and drooled more often during the distraction task. The frequency of saliva swallows and drooling are affected by divided attention in a dual-task paradigm. Further studies are needed to explore the exact role of attention in saliva management and the clinical applications in assessment and treatment.

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