パーキンソン病患者の嚥下障害を早期検出するための他覚的臨床評価実施の必要性

The importance of objective clinical evaluation in early detection of dysphagia in patients with Parkinson's disease

　本研究の目的は，パーキンソン病(Parkinson's disease：以下，PD)患者における嚥下障害の早期検出のために，自覚症状がなく他覚的所見のある患者がどの程度の割合で存在するのかを明らかにし，その各検査項目の傾向を確認することである．外来通院中のPD患者29名に対し，聖隷式嚥下質問紙とThe Mann Assessment of Swallowing Ability(MASA日本語版)を用いて評価を実施し，嚥下障害の自覚症状と他覚的所見を比較し，各項目別減点者数の検討を行った．その結果，自覚症状がない患者18名のうち，11名(61％)で他覚的所見を認めた．MASA日本語版で他覚的所見のある対象患者における各項目別減点者数の検討では，舌運動・口腔内残留・口腔内通過・咽頭期の項目で減点がみられ，先行研究に矛盾しなかった．嚥下質問紙と他覚的臨床評価を併用することはPD患者の嚥下障害の早期検出に寄与すると考えられる．

　The purpose of this study was to determine the proportion of patients with Parkinson's disease (PD) who exhibit objective findings of dysphagia without showing any subjective symptoms. In order to detect dysphagia at an early stage, we also tried to identify trends in positive subjective symptoms and objective findings. Twenty-nine PD outpatients were evaluated using the Seirei Questionnaire of Swallowing and The Mann Assessment of Swallowing Ability (MASA Japanese version) to compare their subjective symptoms and objective findings of dysphagia. The correlation between the items of subjective symptoms and objective findings was then analyzed. Eleven (61%) of the 18 patients without subjective symptoms were found to have objective findings. Patients with objective findings in the Japanese version of MASA received poor ratings in the items of tongue movement, bolus clearance, oral transit, and pharyngeal period, which was consistent with previous studies. The combined use of the swallowing questionnaire and objective clinical evaluation might contribute to the early detection of dysphagia in PD patients.