The impact of dysphagia in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel.

Background: Dysphagia is common in advanced phases of Parkinson disease (PD), and is a risk factor for aspiration pneumonia. Nonetheless, dysphagia has been poorly investigated in PD patients treated with levodopa-carbidopa intestinal gel (LCIG). We aimed to analyze the impact of dysphagia on mortality in LCIG treated patients and its relationship with other PD disability milestones.
Methods: We retrospectively evaluated 95 consecutive PD patients treated with LCIG. Kaplan-Meier and log-rank test were used to compare mortality in patients with dysphagia from others. Cox regression was used to estimate the impact of dysphagia, age, disease duration, and Hoehn and Yahr (H&Y) on mortality in the entire cohort. Finally, univariate and multivariate regression analyses were used to estimate the association between dysphagia and age, disease duration, H&Y, hallucinations, and dementia.
Results: A significantly higher mortality rate was observed in patients with dysphagia. In the Cox model, dysphagia was the only feature significantly associated with mortality (95%CI 2.780-20.609; p < 0.001). Univariate analyses showed a significant correlation between dysphagia and dementia (OR: 0.387; p:0.033), hallucinations (OR: 0.283; p:0.009), and H&Y score (OR: 2.680; p < 0.001); in the multivariate analysis, only the H&Y stage was associated with the presence of dysphagia (OR: 2.357; p:0.003).
Conclusion: Dysphagia significantly increased the risk of death in our cohort of LCIG-treated patients, independently from other relevant features such as age, disease duration, dementia, and hallucinations. These findings support the management of this symptom as a priority in the advanced PD stages, even in people treated with LCIG.
Competing Interests: Declaration of competing interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. DR received travel grants from Abbvie and Zambon. GI received travel grants from Lusofarmaco and Abbvie. SG reports no financial disclosures. EB reports no financial disclosures. LDC reports no financial disclosures. CL received travel grants from Bial and Merz. MZ received honoraria for lecturing and travel grants from Medtronic, Bial Pharma, and AbbVie. LL received honoraria for lecturing and travel grants from Medtronic, UCB Pharma, and AbbVie. FEP received honoraria for lecturing from Abbvie, Bial, and Zambon, and a research grant from Lundbeck. CAA received honoraria from Ralpharma and Zambon for scientific support, and speaker honoraria from Ecupharma and Bial.
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