23 June 2011
Kalf JG, Bloem BR, Munneke M
Drooling as symptom of Parkinson's disease (PD) has thus far been poorly
defined. This uncertainty is reflected by high variations in published
prevalence rates.
The aim of this study was to investigate the
prevalence of saliva loss versus accumulation of saliva as a possible
preliminary stage, and diurnal drooling versus nocturnal drooling. In
addition, we evaluated the association between drooling severity and the
severity of facial and oral motor disorders.
We collected age, disease
duration, UPDRS III and Hoehn & Yahr stage from 104 consecutive
outpatients with PD. Diurnal and nocturnal drooling was evaluated with a
validated questionnaire (ROMP-saliva). A speech pathologist, blinded
for drooling severity, rated facial expression, involuntary mouth
opening and difficulty with nose breathing and also interviewed patients
about sleeping position and nose-breathing during the night.
Thirty
patients (29%) had no complaints with saliva control ('non-droolers'),
45 patients (43%) experienced accumulation of saliva or only nocturnal
drooling ('pre-droolers'), and 29 (28%) had diurnal drooling (24 of
which also drooled during the night; 'droolers'). The droolers had
longer disease duration (10 vs. 7 years, p = 0.01) and drooling was
independently associated with involuntary mouth opening (OR = 2.0; 95%
CI 1.02-3.99) and swallowing complaints (OR = 1.2; 95% CI 1.03-1.31).
Diurnal drooling-defined as dribbling of saliva while awake-is present
in about 28% of PD patients. This is less than usually reported. Diurnal
drooling typically appeared later in the disease course.
The
association with oral motor behavior should encourage the development of
behavioral treatment approaches.
