Sensitivity and specificity of the EAT-10 and SDQ-DP in identifying the risk of dysphagia in Parkinson's disease

Abstract

Background The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications.

Objective To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD.

Methods Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy.

Results EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%.

Conclusion The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.

Resumo

Antecedentes A identificação precoce de risco para disfagia nos pacientes com doença de Parkinson (DP) é fundamental para a prevenção de complicações nutricionais e pulmonares.

Objetivo Analisar a sensibilidade e especificidade dos questionários Swallowing Disturbance Questionnaire (SDQ-PD) e Eating Assessment Tool (EAT-10) para a identificação do risco de disfagia em pacientes com DP nos estágios iniciais e intermediários da doença.

Métodos Participaram 29 pacientes com DP. Foi realizado a aplicação dos questionários EAT-10 e SDQ-PD e o exame de videofluoroscopia da deglutição. Para a classificação da presença e gravidade da disfagia foi utilizada a escala Dysphagia Outcome and Severity Scale e, para identificação da presença de penetração/aspiração, a escala Penetration-Aspiration Scale (PAS). Na análise estatística, calcularam-se a sensibilidade e a especificidade dos questionários de risco EAT-10 e SDQ-DP e o valor preditivo positivo, o valor preditivo negativo e a acurácia.

Resultados A análise do EAT-10 para identificar o risco de penetração/aspiração revelou sensibilidade de 71.42% e especificidade de 45.45%; para identificar a presença de disfagia, a sensibilidade foi de 47,61% e a especificidade de 12.5%. Em relação ao questionário SDQ-PD, para identificar risco de penetração/aspiração, a sensibilidade foi de 28.57% e a especificidade de 68.18% e, para identificar a presença de disfagia, a sensibilidade foi de 20% e a especificidade de 44.44%.

Conclusão O questionário SDQ-PD revelou baixa sensibilidade e baixa especificidade para identificar presença de disfagia e/ou penetração/aspiração em pacientes com DP em estágios iniciais e intermediários para essa amostra. O EAT-10 revelou boa sensibilidade na indicação de risco de penetração/aspiração, apesar de baixa especificidade.

Keywords

Deglutition - Deglutition Disorders - Parkinson Disease - Respiratory Aspiration

Palavras-chave

Deglutição - Transtornos de Deglutição - Doença de Parkinson - Aspiração Respiratória

Authors' Contributions

AP: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, validation, visualization, writing – original draft, writing – review & editing; FPC: data curation, investigation, methodology, resources, software, validation, visualization, writing – original draft, writing – review & editing; VNS: formal analysis, methodology, resources, software, validation, visualization, writing – original draft, writing – review & editing; CGSS: investigation, methodology, resources, validation, visualization, writing – original draft; LFM: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing – review & editing.

Publication History

Received: 01 June 2023

Accepted: 12 October 2023

Article published online:
07 February 2024

• References

• 1 Simons JA. Swallowing Dysfunctions in Parkinson's Disease. Int Rev Neurobiol 2017; 134: 1207-1238
• 2 Suttrup I, Warnecke T. Dysphagia in Parkinson's Disease. Dysphagia 2016; 31 (01) 24-32
• 3 Nienstedt JC, Bihler M, Niessen A. et al. Predictive clinical factors for penetration and aspiration in Parkinson's disease. Neurogastroenterol Motil 2019; 31 (03) e13524
• 4 Pflug C, Bihler M, Emich K. et al. Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study. Dysphagia 2018; 33 (01) 41-50
• 5 Kalf JG, de Swart BJM, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 2012; 18 (04) 311-315
• 6 Schlickewei O, Nienstedt JC, Frank U. et al. The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson's disease. Eur Arch Otorhinolaryngol 2021; 278 (05) 1661-1668
• 7 Manor Y, Giladi N, Cohen A, Fliss DM, Cohen JT. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease. Mov Disord 2007; 22 (13) 1917-1921
• 8 Evatt ML, Chaudhuri KR, Chou KL. et al. Dysautonomia rating scales in Parkinson's disease: sialorrhea, dysphagia, and constipation–critique and recommendations by movement disorders task force on rating scales for Parkinson's disease. Mov Disord 2009; 24 (05) 635-646
• 9 Branco LL, Trentin S, Augustin Schwanke CH, Gomes I, Loureiro F. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study. J Aging Res 2019; 2019: 7984635
• 10 Gong S, Gao Y, Liu J. et al. The prevalence and associated factors of dysphagia in Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13: 1000527
• 11 Umemoto G, Furuya H. Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders. Intern Med 2020; 59 (01) 7-14
• 12 Daniel SE, Lees AJ. Parkinson's Disease Society Brain Bank, London: overview and research. J Neural Transm Suppl 1993; 39: 165-172
• 13 Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17 (05) 427-442
• 14 Carod-Artal FJ, Martínez-Martin P, Kummer W, Ribeiro LdaS. Psychometric attributes of the SCOPA-COG Brazilian version. Mov Disord 2008; 23 (01) 81-87
• 15 Martínez-Martín P, Gil-Nagel A, Gracia LM, Gómez JB, Martínez-Sarriés J, Bermejo F. The Cooperative Multicentric Group. Unified Parkinson's Disease Rating Scale characteristics and structure. Mov Disord 1994; 9 (01) 76-83
• 16 Belafsky PC, Mouadeb DA, Rees CJ. et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008; 117 (12) 919-924
• 17 Gonçalves MIR, Remaili CB, Behlau M. Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10. CoDAS 2013; 25 (06) 601-604
• 18 Ayres A, Ghisi M, Rieder Cde M, Manor Y, Olchik MR. Translation and cultural adaptation of swallowing disturbance questionnaire for brazilian portuguese. Rev CEFAC 2016; 18: 828-834
• 19 Martin-Harris B, Brodsky MB, Michel Y. et al. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia 2008; 23 (04) 392-405
• 20 Cichero JAY, Lam P, Steele CM. et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia 2017; 32 (02) 293-314
• 21 O'Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia 1999; 14 (03) 139-145
• 22 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996; 11 (02) 93-98
• 23 Borders JC, Brates D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia 2020; 35 (04) 583-597
• 24 Mu L, Sobotka S, Chen J. et al; Arizona Parkinson's Disease Consortium. Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol 2013; 72 (07) 614-623
• 25 Mu L, Sobotka S, Chen J. et al; Arizona Parkinson's Disease Consortium. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 2012; 71 (06) 520-530
• 26 Fabbri M, Coelho M, Abreu D. et al. Dysphagia predicts poor outcome in late-stage Parkinson's disease. Parkinsonism Relat Disord 2019; 64: 73-81
• 27 Pitts LL, Cox A, Morales S, Tiffany H. A Systematic Review and Meta-analysis of Iowa Oral Performance Instrument Measures in Persons with Parkinson's Disease Compared to Healthy Adults. Dysphagia 2022; 37 (01) 99-115
• 28 Plowman EK, Tabor LC, Robison R. et al. Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 2016; 28 (01) 85-90
• 29 Regan J, Lawson S, De Aguiar V. The Eating Assessment Tool-10 Predicts Aspiration in Adults with Stable Chronic Obstructive Pulmonary Disease. Dysphagia 2017; 32 (05) 714-720
• 30 Giraldo-Cadavid LF, Gutiérrez-Achury AM, Ruales-Suárez K. et al. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study. Dysphagia 2016; 31 (03) 398-406
• 31 Rofes L, Arreola V, Mukherjee R, Clavé P. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil 2014; 26 (09) 1256-1265
• 32 Zhang P-P, Yuan Y, Lu D-Z. et al. Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia 2022;
• 33 Cardoso AR, Guimarães I, Santos H. et al. Cross-cultural adaptation and validation of the Swallowing Disturbance Questionnaire and the Sialorrhea Clinical Scale in Portuguese patients with Parkinson's disease. Logoped Phoniatr Vocol 2021; 46 (04) 163-170
• 34 Simons JA, Fietzek UM, Waldmann A, Warnecke T, Schuster T, Ceballos-Baumann AO. Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease. Parkinsonism Relat Disord 2014; 20 (09) 992-998
• 35 Buhmann C, Flügel T, Bihler M. et al. Is the Munich dysphagia Test-Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration?. Parkinsonism Relat Disord 2019; 61: 138-143
• 36 Cosentino G, Avenali M, Schindler A. et al. A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. J Neurol 2022; 269 (03) 1335-1352
• 37 Felipini LMG, da Silva NR, Berretin-Felix G, dos Santos CF. Tradução e adaptação transcultural para a língua portuguesa do Brasil dos questionários “Quality of Life in Swallowing Disorders (SWAL-QOL)” e “Quality of Care in Swallowing Disorders (SWAL-CARE)” para idosos com disfagia neurogênica. Tradterm. 2022; 41: 100-126
• 38 McHorney CA, Bricker DE, Kramer AE. et al; Conceptual Foundation and Item Development. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia 2000; 15 (03) 115-121
• 39 Kiyani SA, Butt AK. Dysphagia; Awareness & Knowledge of Medical Practitioners and Understanding of Role of SLP in its Assessment & Management. Journal Riphah College of Rehabilitation Sciences. 2014; 2 (01) 25-29