Validação do protocolo de avaliação clínica da deglutição swallowing clinical assessment score in parkinson’s disease (Scas-Pd) em comparação com o exame objetivo de videofluoroscopia

Abstract

Parkinson’s disease (PD) is one of the most prevalent degenerative neurological diseases today. PD, dementia syndromes, and motor neuron disease are expected to surpass cancer as the leading cause of death among the elderly by 2040. Diseases associated with aging can cause significant swallowing impairments, known as dysphagia. A swallowing evaluation can be conducted through Videofluoroscopy (VFD), considered the gold standard of diagnostic methods, but this evaluation is not available in every health center. The clinical evaluation of swallowing is a subjective speech therapy evaluation procedure that depends on the examiner’s knowledge in order to adequately detect signs that suggest laryngeal and tracheal aspiration/penetration. With this in mind, this project’s goal is to verify the agreement between the findings of the clinical swallowing evaluation and the objective swallowing evaluation (VFD), as an initial step in the process of validating the clinical swallowing evaluation protocol Swallowing Clinical Assessment Score in Parkinson’s Disease SCAS-PD. Application of the SCAS-PD took place concurrently with the VFS test. The interclass correlation coefficient and the Kappa 5 by 5 coefficient were calculated. The calculation was made for the area of the Receiver Operating Characteristic (ROC) curve, and for the sensitivity and specificity for detection of PA. The internal consistency of the SCAS-PD was calculated using Cronbach's alpha. 31 subjects were tested (68.8±7.6 years old). The ROC curve for the SCAS-PD differentiating between normal/functional and low, moderate and severe levels of dysphagia, AUC: 0.97; IC 95%: 0.92-1.00; sensitivity: 100% and specificity of 87.5%. The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was calculated; oral phase α = 0.73, pharyngeal phase α= 0.86, and signs of PA α = 0.95. SCAS-PD has been demonstrated to be a sensitive and specific screening tool for the detection of dysphagia and detection of the clinical signs of laryngotracheal PA.