Thursday, September 29, 2022

Parkinson’s And Aspiration Pneumonia

How Can Aspiration Pneumonia Be Prevented

The Connection between Parkinsons and Pneumonia

If you are bed-bound and at risk of aspiration, keeping the head end of the bed raised at an angle of 30° may help.

If you have swallowing difficulties, reduced sensitivity to irritants at the back of your throat, or some other condition that makes you prone to aspiration, feeding through a nasogastric tube may reduce the risk.

What You Can Expect

Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.

Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.

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The Lee Silverman Voice Treatment

The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.

  • Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
  • Improvements have been shown to last up to two years following treatment.
  • LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .

LSVT® Guidelines

  • Must be administered four days a week for four consecutive weeks.
  • On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
  • Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
  • Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
  • If available in your area, participate in a speech group whose focus is on thinking loud.
  • A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.

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Incidence And Mortality Trends Of Aspiration Pneumonia In Parkinson 1979

Akbar U, Dham B, He Y, Hack N, Wu S, Troche M, Tighe P, Nelson E, Friedman JH, Okun MS.Incidence and mortality trends of aspiration pneumonia in Parkinson, 1979-2010., Parkinsonism Relat Disord. 2015 Sep 21:1082-6. doi: 10.1016/j.parkreldis.2015.06.020. Epub 2015 Jul 2.

As hypothesized the authors found that the incidence of aspiration pneumonia is greater for PWP than those without PD and has increased across the last three decades but the mortality has decreased significantly by about 30%. As PWP aged the incidence of aspiration pneumonia also increased. Notably the mortality in PWP from aspiration pneumonia was greatly reduced from prior studies and was less than those who dont have PD. This finding is likely due to increased awareness of swallowing difficulties in PWP and possibly earlier detection and initiation of treatment. Both groups also had a reduction in mortality likely due to improved medical care, better antibiotics, and increased awareness of aspiration pneumonia as medical care typically improves with time. There were multiple limitations of this study which were clearly addressed in the article but as the authors discussed it is very important to look at large epidemiological estimates of disease information to improve detection, treatment, long term care options, and patient survival.

Definition Of Demographics And Confounders

(PDF) Risk and mortality of aspiration pneumonia in Parkinsons disease ...

We defined age, sex, residential region, and household income in reference to the index date. We also defined the presence of comorbidities according to previous diagnoses up to two years before the index date. The defined comorbidities included diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, cancer, tuberculosis, peripheral arterial disease, atrial fibrillation, chronic kidney disease, dyslipidemia, cerebrovascular disease, dementia, chronic obstructive pulmonary disease, and seizure disorder,. Information on medications, including anticoagulants, antihypertensive agents, oral hypoglycemic agents, insulin, benzodiazepines, and antipsychotics was collected from the prescription records within two years from the index date. The list of co-medications is provided in Supplementary Table . Modified Charlson comorbidity index scores were calculated from the previous diagnosis within a year before the index date. These diagnoses include diagnoses of myocardial infection, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, rheumatologic disease, peptic ulcer disease, diabetes without chronic complications, diabetes with chronic complications, hemiplegia, renal disease, any malignancy including leukemia and lymphoma, mild liver disease, moderate or severe liver disease, metastatic solid tumor, and AIDS.

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How Can I Make Chewing And Swallowing Easier

The way you sit, the foods you eat, and how you eat can affect your ability to swallow. To use your posture to make chewing and swallowing easier, you can:

  • Sit upright at a 90-degree angle.
  • Tilt your head slightly forward.
  • Stay seated or standing for 15-20 minutes after you eat a meal.

When you eat:

If you don’t make enough saliva:

  • Drink plenty of fluids.
  • Every once in a while, suck on ice pops, ice chips, lemon ice, or lemon-flavored water to add to your saliva. That’ll help you swallow more often.

If chewing is difficult or tiring:

  • Cut back on or stop eating foods you have to chew, and eat more soft things.
  • Puree your food in a blender.
  • If thin liquids make you cough, thicken them with a liquid thickener. You can also use thicker liquids instead of thin ones, like nectars instead of juices and cream soups instead of plain broths.

Apda In Your Community

APDAUncategorizedDeath in Parkinsons Disease

This article was written at the request of a Parkinsons patient who wanted to know how patients die from PD.

Most patients die with Parkinsons Disease and not from it. The illnesses that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies.

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What Does Kill People With Parkinsons

While no one dies directly from Parkinsons, you may be asking yourself what does typically cause death in Parkinsons patients. The two of the biggest causes of death for people with Parkinsons are Falls and Pneumonia:

Falls Parkinsons patients are typically at an increased risk of falls due to postural instability and other symptoms of Parkinsons. This poses a great risk to those with PD because falls are the leading cause of injury-related deaths among those 65 years or older according to the CDC. It is important to take precautions to limit the risk of falling in your home. This can be done by wearing special grip socks to prevent slipping or installing handrails in high-risk areas like the shower or staircase. In addition, you should talk with your doctor about getting a physical therapy evaluation periodically to strengthen your balance reflexes and help you develop other strategies to keep you safe in the home.

How Is Aspiration Pneumonia Treated

How do you prevent aspiration pneumonia?

Aspiration pneumonia is treated primarily with antibiotics. The choice of antibiotics depends on several things, including any allergies to penicillin and where the pneumonia was acquired. Hospital-acquired infections must be treated with antibiotics that are effective against many types of bacteria.

Even though aspiration pneumonitis isnt an infection, your provider may start antibiotic therapy, depending on the clinical situation and underlying medical conditions.

Additional treatment might include oxygen therapy or, in life-threatening cases, mechanical ventilation. Mechanical ventilation means that a machine is breathing for you.

Preventing further aspiration is an important part of treatment, since every episode of aspiration can lead to inflammation or infection.

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What Symptoms Can Be Expected In Advanced Pd

  • Pain 86%
  • Shortness of breath 54%
  • Problems in swallowing 40%14

In an analysis of 339 death certificates and medical notes in the UK, pneumonia was found to be a terminal event in 45%.13

Caregiver distress with choking and the risk of choking to death is also mentioned in a separate study in to experiences regarding all stages of PD.4

In a survey of symptoms and their association with quality of life, in those patients with advanced disease, uncontrolled pain, anxiety and hallucinations were significantly associated with poor quality of life.9

Seizures are also noted in a description of the last phase of Parkinsonian syndromes,15 and in retrospective studies of PD patients overall.16,17

These above symptoms often occur on the background of weight loss, pain, and cognitive impairment. It is important therefore to note which medications given at the end of life may exacerbate these symptoms, and which should be considered in anticipation of them.

Stage One Of Parkinsons Disease

In stage one, the earliest stage, the symptoms of PD are mild and only seen on one side of the body , and there is usually minimal or no functional impairment.

The symptoms of PD at stage one may be so mild that the person doesnt seek medical attention or the physician is unable to make a diagnosis. Symptoms at stage one may include tremor, such as intermittent tremor of one hand, rigidity, or one hand or leg may feel more clumsy than another, or one side of the face may be affected, impacting the expression.

This stage is very difficult to diagnose and a physician may wait to see if the symptoms get worse over time before making a formal diagnosis.

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The Last Year Of Life In Parkinsons Disease

The study also examined nearly 45,000 hospitalizations in people with terminal Parkinsons, meaning their end-of-life period.

Of those with terminal PD, the most common reasons for being in the hospital were:

  • Infection
  • Heart disease
  • Lung disease that was not from an infection

Less common causes for hospitalization were problems related to the stomach or intestines, muscles, nervous system, or endocrine system .

It is not surprising that infection was the most common hospitalization before death, as people with Parkinsons are vulnerable to developing a number of infections as a result of their disease. For example, bladder dysfunction in Parkinsons increases a persons risk of developing urinary tract infections, which can become life-threatening if not detected and treated promptly.

In addition, research suggests that aspiration pneumonia is 3.8 times more common in people with Parkinsons as compared to the general population. It has also been consistently reported to be the main cause of death in people with Parkinsons.

Aspiration pneumonia results from underlying swallowing difficulties, which leads to stomach contents being inhaled into the lungs. Immobilization and rigidity, which can impair phlegm removal, also contribute to the development of pneumonia in people with Parkinsons.

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Does Parkinsons Affect Your Lifespan

Parkinsons research and treatments have come a long way, so much so that the average life span of a person with Parkinsons is the same or near the same as someone without Parkinsons disease. However, the lifespan of a person can vary widely based upon that persons health choices, such as their diet, exercise routine, if they have a history of smoking and many other factors. So, for most people with Parkinsons, as long as you focus on managing your Parkinsons disease and make healthy choices your lifespan should not be shortened.

Cough Sensitivity And Aspiration Pneumonia In Parkinsons Disease

S. Tomita, T. Oeda, S. Takaya, M. Kohsaka, K. Park, A. Umemura, Y. Mori, T. Ishihara, S. Nomoto, M. Tahara, K. Yamamoto, H. Sawada

Session Time: 1:45pm-3:15pm

Location: Agora 3 West, Level 3

Objective: We hypothesized that decreased cough sensitivity is crucial to the development of aspiration pneumonia in Parkinsons disease . We examined the relationship between cough sensitivity and aspiration pneumonia, and brain regions that are associated with a decrease cough sensitivity in PD.

Background: Although aspiration pneumonia is the most common cause of death in PD, however the pathogenesis of aspiration pneumonia is not fully validated.

Method: We recruited 127 patients with PD . We evaluated cough sensitivity using citric acid induced cough test and regional cerebral blood flow using I-123 IMP-SPECT. The concentration of citric acid that induced cough was compared between patients with and without the history of aspiration pneumonia and healthy controls . Among patients without the history of aspiration pneumonia, the interval from the cough test to the development of aspiration pneumonia in 18 months was compared between patients with and without a decrease in cough sensitivity using survival time analysis. Furthermore, rCBF were compared between the two groups using voxel-wise analysis.

Decreased cough sensitivity attributes aspiration pneumonia and it might be associated with cortical dysfunction in the left angular gyrus in PD.

To cite this abstract in AMA style:

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Progression And Management Of Dysphagia In Pd

Unlike stroke, dysphagia in PRD degenerates with disease progression. Although their swallowing dysfunction is assessed by using VFSS or FEES, rehabilitation is required for determining PD patients’ quality of life. A transdisciplinary approach, including physicians, nurses, physical therapists, speech pathologists, and nutritionists, is required for long-term management.

Two specific questionnaires have been developed to detect dysphagia in PD: the swallowing disturbance questionnaire and the Munich Dysphagia test-Parkinson’s disease . The SDQ containing 15 questions is more basic and an easier screening test for asking about specific symptoms with dysphagia and their frequencies. The MDT-PD can detect the beginning of oropharyngeal symptoms and the risk of laryngeal penetration or aspiration. It consists of 26 items divided into 4 categories: difficulty in swallowing food and liquids, difficulty in swallowing independent of food intake, further swallowing-specific and associated problems, swallowing-specific health questions.

Primary Outcome: Swallow Safety

Clinton seizures, pneumonia, dementia, Parkinson’s Disease explained by tertiary syphilis

The PA scale is a clinically relevant, validated, and ordinal measure, where 1 indicates the safest swallow and 8 indicates the least safe swallow, or silent aspiration.22 The scale measures whether or not material entered the airway and if it entered the airway, whether the residue remained or was expelled. The PA scale score served as the primary outcome variable calculated as the group comparison between baseline and posttreatment assessments during the swallowing of the 3-oz sequential bolus.

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Stages And Progression Of Lewy Body Dementia

Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts.

If you or someone you know has recently been diagnosed with Lewy body dementia , you might be wondering what to expect as the disease progresses.

Like with Alzheimers disease, Lewy body dementia is marked by early, middle, and later stages. Its what happens during these stages that makes the two different.

This article explains the stages and progression of Lewy body dementia as it proceeds through three stages.

What Causes Aspiration Pneumonia

Pneumonia from aspiration can occur when your defenses are impaired and the aspirated contents have a large amount of harmful bacteria.

You can aspirate and develop pneumonia if your food or drink goes down the wrong way. This may happen even if you can swallow normally and have a regular gag reflex. In that case, most of the time youll be able to prevent this by coughing. Those who have impaired coughing ability, however, may not be able to. This impairment may be due to:

  • neurological disorders

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Swallowing Quality Of Life Measure

The Swallowing Quality of Life Questionnaire was used to evaluate the participants’ quality of life as related to swallowing function.2325 This tool includes questions regarding both the oral and pharyngeal phases of swallowing as well as appetite, eating duration, and other factors affecting swallowing function.

A Final Word Of Encouragement And Advice For Parkinsons Disease

Parkinson

So, is Parkinsons fatal? Can you die from Parkinsons? The answer is no. Being diagnosed with Parkinsons is scary but it is not a death sentence. There are many things you can do to manage the symptoms of Parkinsons to help minimize any risks associated with its symptoms and live a full happy life. So, lets get out there and fight back against Parkinsons!

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Breathing & Respiratory Difficulties

Some people with Parkinsons disease may experience shortness of breath. There is no clear cause underlying respiratory dysfunction in PD, its frequency or the effect that medications have on respiration. Several reasons for shortness of breath in PD include:

  • Wearing off is a common experience among people with PD who have been taking levodopa for several years. These occur when the medication benefit wears off and PD symptoms return before the next dose.
  • Respiratory dyskinesia refers to an occurrence of irregular and rapid breathing when levodopa medications reach their peak effect. These may accompanied by involuntary body movements, typically experienced as dyskinesia.
  • Anxiety is a common symptom of PD that may also exacerbate shortness of breath, whether by itself or as a consequence of wearing off of the medication.
  • Aspirationpneumonia is a pneumonia that develops after food or liquid goes down the wrong pipe. Advanced PD can increase the risk of swallowing difficulties, choking and aspiration pneumonia.
  • Non-PD health issues include conditions such as asthma, allergies, lung disease, heart disease and other conditions that may cause shortness of breath.

Traditional Dysphagia Assessments And Therapies In Stroke

More than 50% of stroke survivors experience dysphagia however, most of them recover their swallowing function within a week . The proportion of stroke survivors with dysphagia at 6 months is reported to be approximately 11-13% . Constant awareness and review of swallowing are needed after stroke because of the diverse course of the symptoms over the six subsequent months. The assessment and management of dysphagia are important for minimizing the risk of food and liquid aspiration as well as pneumonia.

Screening for dysphagia includes the water-swallowing test and repetitive saliva-swallowing test. To assess the swallowing dysfunction in detail and detect silent aspiration, a video fluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing should be used. A VFSS provides information on bolus flow, the movement of each organ, and the anatomy . A FEES can be performed even at the bedside and is able to detect silent saliva aspiration.

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