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Pathophysiology of diurnal drooling in Parkinson's disease§

Authors

  • Johanna G. Kalf MSc,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
    2. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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  • Marten Munneke PhD,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
    2. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice, IQ Healthcare, Nijmegen, The Netherlands
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  • Lenie van den Engel-Hoek MSc,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
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  • Bert J. de Swart PhD,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice, Department of Rehabilitation, Nijmegen, The Netherlands
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  • George F. Borm PhD,

    1. Radboud University Nijmegen Medical Centre, Nijmegen Centre of Evidence-Based Practice Department of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands
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  • Bastiaan R. Bloem MD, PhD,

    Corresponding author
    1. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
    • Department of Neurology (935), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Machiel J. Zwarts MD, PhD

    1. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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  • Funding agencies: This research was supported by the Department of Rehabilitation of the Radboud University Nijmegen Medical Centre.

  • Relevant conflicts of interest/financial disclosures: Professor Bastiaan R. Bloem was supported by a ZonMw VIDI research grant (number 016.076.352).

  • §

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose-breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society

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