Why do people with Parkinson’s disease have dysphagia?

  The motor symptoms of Parkinson’s disease are involuntary tremors of the limbs at rest, myotonia, bradykinesia, and postural balance disturbances. As the disease slowly progresses, patients may also experience a combination of reduced speech and low monotone voice, swallowing difficulties, salivation, sleep disturbances, depression or dementia. The vast majority of patients with Parkinson’s disease will eventually be confined to their homes and beds, adding a heavy burden to their families and society.  In the last 5-6 years, Prof. Braak from Germany discovered through pathological sections that Parkinson’s disease patients not only had lesions in the substantia nigra of the midbrain, but also lewy vesicles were found in the plexus and vagus nerve of the intestine. Further observation revealed that there were a large number of lewy vesicles stored in the body from top to bottom, and many patients had olfactory disorders, intestinal disorders, and sleep disorders prior to the motor disorders. Later on, there will be cognitive impairment. Now, the disease starts out in the peripheral plexus, then goes to the brainstem, and finally to the cerebral cortex. Therefore, it is a progressive disease.  Patients with Parkinson’s disease with swallowing disorders have a significantly lower quality of life, mainly in terms of salivation, difficulty in eating and choking, Edwards reported 52% of Parkinson’s disease patients have swallowing disorders compared to 6% of age-matched normal controls. Patients with swallowing disorders suffer from secondary chemical pneumonia due to inadvertent aspiration of food into the trachea, often with recurrent pulmonary infections and, in severe cases, respiratory failure or respiratory distress syndrome, eventually leading to death; mechanical asphyxia directly caused by aspiration of large pieces of less easily decomposable food into the trachea, followed by cardiac and respiratory arrest. In addition, patients may suffer from insufficient intake, resulting in water and electrolyte disorders and other nutrient deficiencies, reduced albumin, and severe wasting. Aspiration pneumonia due to swallowing dysfunction, as well as cachexia, is often another important cause of high morbidity and mortality in PD patients.  Ingestion-swallowing is the entire process of food reaching the stomach via the mouth, pharynx, and esophagus from the time it is perceived. This process is divided into 5 phases according to the position of the food block: the prior phase (cognitive phase), the preparation phase, the oral phase, the pharyngeal phase, and the esophageal phase. The latter 3 correspond to the 3 phases of the oral, pharyngeal, and esophageal phases of the swallowing action.  For patients with Parkinson’s disease who have swallowing difficulties, they can be assessed in a graded manner using the Saedo’s 7-level evaluation method for swallowing disorders, which was designed and developed by the Japanese scholar Eiichi Saedo in 1999, and was accepted by the rehabilitation community in China when Gao Huimin introduced it to China in 2001. The higher the level, the lighter the swallowing disorder. The grading criteria are clear and can guide the rehabilitation of patients at all levels. This evaluation method is widely used in the diagnosis and rehabilitation of swallowing disorders in Japan.