La rieducazione della disfagia nella malattia di Parkinson.

Dysphagia frequently occurs in Parkinson’s Disease (PD) although patients may be unaware of swallow difficulties. The prevalence is about 40-82%. Several abnormalities in the various phases of swallowing have been described and include abnormal bolus formation, prolonged oropharyngeal transit time and oesophagus motility impairment. These troubles are not necessarily correlated with either severity of motor deficit or disease progression. Dysphagia can lead to ‘silent aspiration’ thus enhancing the risk of pneumonia which represents the main cause of mortality in PD patients. The management of dysphagic patients requires an accurate outlining of swallow phase alterations. Although videofluorography represents the diagnostic gold-standard, the collection of clinical history and the functional assessment are mandatory steps in the care pathway. Dopaminergic treatments may be effective at improving symptoms related to oral dysfunctions, but pharyngeal and oesophageal impairments are drug-resistant . Treatments such as behavioural interventions and diet modification are recommended for treatment of dysphagia in PD. Rehabilitation interventions, based on speech and language principles, are often applied, but no trial has so far considered the efficacy of these approaches for dysphagia management in PD.