Longitudinal Videofluorographic Dysphagia Measures in Progressive Supranuclear Palsy

Area of Science:

• Neurology
• Swallowing Disorders
• Neurodegenerative Diseases

Background:

• Dysphagia is a critical complication of progressive supranuclear palsy (PSP), potentially leading to fatal aspiration pneumonia.
• Limited understanding exists regarding the longitudinal progression of dysphagia and its variations across different PSP clinical subtypes.

Purpose of the Study:

• To analyze the longitudinal progression of dysphagia in PSP patients across various clinical variants.
• To investigate the relationship between dysphagia progression, disease severity, and the rate of brain atrophy in PSP-affected regions.

Main Methods:

• Sixty-one PSP patients underwent serial neurological and videofluorographic examinations, alongside MRI scans.
• Key metrics included the Oral and Pharyngeal Total Sum Scores (OTSS/PTSS), Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and lingual pressure.
• Rates of change were compared across PSP variants and correlated with baseline scores, PSP Rating Scale, and regional brain atrophy rates.

Main Results:

• Dysphagia demonstrated longitudinal progression, marked by worsening OTSS and lingual pressures.
• The rate of OTSS deterioration was most rapid in PSP with predominant speech-language disorder.
• Rates of lingual pressure decline correlated with PSP Rating Scale changes, while FOIS decline correlated with OTSS and lingual pressure changes. Brain atrophy rates were linked to baseline swallowing impairment scores (OTSS, PTSS, PAS).

Conclusions:

• Swallowing difficulties and reduced lingual pressure progressively worsen in PSP patients over time.
• Variability exists in the rate of pharyngeal impairment progression across PSP variants.
• Evidence suggests a link between dysphagia progression and the rate of brain atrophy in PSP.