MDT-PD May Not Effectively Identify Aspiration Risk in Parkinson Disease

The Munich dysphagia test–Parkinson disease (MDT-PD), a 26-question self-reported screening tool to detect dysphagia in patients with Parkinson disease (PD), failed to detect aspiration or trouble swallowing in patients with PD, according to a recent study published in Parkinsonism and Related Disorders.

In this study, researchers clinically examined 119 outpatient participants with PD as part of a controlled, cross-sectional, and observational study. Participants were evaluated with the MDT-PD to compare their self-reported results with the one swallowing question (NMS-3; ‘difficulty swallowing food or drink or problems with choking within the last month’; dichotomous response) within the nonmotor symptom questionnaire for PD (NMSQuest), with the penetration-aspiration scale (PAS) rating defined by flexible endoscopic evaluation of swallowing (FEES).

Weighted participants’ MDT-PD sum scores were returned and converted into 3 categories of (1) no dysphagia, (2) dysphagia, and (3) at risk for aspiration. Participants’ FEES results were classified into the following 3 PAS groups for comparison with the 3 MDT-PD groups: (1) without severe pathological findings (PAS 1–2), (2) penetration (PAS 3–5), and (3) aspiration (PAS 6–8). The dichotomous NMS-3 was classified into 2 subgroups of (1) subjective dysphagia and (2) no subjective dysphagia.

Analysis of FEES responses showed 81 participants classified as PAS 1–2, 8 as PAS 3–5, and 30 as PAS 6–8. MDT-PD results showed that 50% of the 38 participants with FEES scores of “penetration” or “aspiration” were grouped as “no dysphagia” by MDT-PD (false negatives). Of 81 patients with no severe pathological findings in FEES, 20% or 16 were categorized as having dysphagia and 22% or 18 as being at risk for aspiration by the MDT-PD (false positives).

Comparing the FEES findings with NMS-3 results revealed similar discrepancies. Positive predictive value was worse for the MDT-PD vs the NMS-3 (31% vs 48%). Lastly, area under the curve was not significant for either MDT-PD variation and was poor for the NMS-3 (0.65).

That the study researchers did not perform intra-rater judgments on PAS scores is listed as a limitation, although the researchers surmised that this limitation has little effect on their findings.

In conclusion, the researchers noted that “MDT-PD is not suitable for detecting aspiration in PD patients and, therefore, cannot be considered as a screening tool for aspiration. However, at present, there is no alternative validated screening tool that can reliably detect aspiration in [patients with] PD. A readjustment of the MDT-PD is urgently needed.”

Reference

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? [published online October 31, 2018]. Parkinsonism Relat Disord. doi:10.1016/j.parkreldis.2018.10.031