Dysphagia in Multiple System Atrophy of Cerebellar and Parkinsonian Types

Objective: This study aimed to examine the relationship between dysphagia and activities of daily living (ADL) in patients with multiple system atrophy (MSA), and to characterize dysphagia in patients with the cerebellar (MSA-C) and parkinsonian(MSA-P) types. Methods: Sixty-one MSA patients (25 males, 36 females; 40 MSA-C, 21 MSA-P; mean age, 66.3 ± 11.0) were recruited. ADL was assessed on the Barthel index. They underwent tongue pressure measurements and videofluoroscopy (VF) by swallowing barium gelatin jelly. We measured the range of tongue root and mandibular movements during oropharyngeal transit time and used the functional dysphagia scale to rate the oral and pharyngeal stages with the VF images. Results: Significant correlations were found between the ADL and the dysphagia scores (R=−0.654, p<0.001), the ADL score and the tongue pressure (R=0.600, p<0.001), and the dysphagia scores and the tongue pressure (R= −0.679, p<0.001), in the 61 patients. In addition, the oropharyngeal transit time and the tongue pressure in the MSA-C group (R=−0.457, p=0.005), the tongue root and mandibular movements and the tongue pressure in the MSA-P group (R=0.458, p=0.040; R=0.538, p=0.016; respectively) were significantly correlated. Furthermore, the MSA-P group showed a significantly longer oropharyngeal transit time than the MSA-C group (p=0.049). Conclusion: These results suggest a correlation between the degree of dysphagia and deterioration in ADL in MSA patients. MSA-P patients tended to experience problems with propelling a bolus through the oropharynx, whereas MSA-C patients incompletely form a bolus in the oral phase.