Abstract
The purpose of this study was to determine whether attentional resources are involved in swallowing in persons with idiopathic Parkinson’s disease, and if so, in which phase(s) of swallowing. The approach involved a dual-task, reaction time (RT) paradigm using ten participants with Parkinson’s disease. Single-task baseline measures were obtained for durations of the anticipatory phase and oropharyngeal phase of swallowing and RTs were obtained for nonword auditory stimuli. A dual-task then required participants to swallow 5 ml of water from an 8-oz. cup while listening for a target nonword presented auditorily during the anticipatory or oropharyngeal phase. Target stimuli were randomized across baseline and dual-task trials. Durations of the anticipatory and oropharyngeal phases of swallowing and RTs during baseline and dual-task trials were determined. Results showed a nonsignificant change in speed of completion for both the anticipatory phase and the oropharyngeal phase of swallowing during dual-task trials. However, there was a statistically significant increase in RT during the anticipatory phase during the dual-task condition. RT during the oropharyngeal phase remained unaffected. Given a need for additional research using more complex competing tasks, these data on attention are consistent with earlier claims of an automatic, nonresource-demanding, oropharyngeal swallowing mechanism that is preserved for persons with early-to-mid-stage Parkinson’s disease. Clinical implications of these data suggest that disruptive environmental stimuli to individuals with early-to-mid-stage Parkinson’s disease may alter feeding but have little effect on the oropharyngeal swallow.
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Brodsky MB, McNeil MR, Martin-Harris B, Palmer CV, Grayhack JP, Abbott KV. Effects of divided attention on swallowing in healthy participants. Dysphagia. doi:10.1007/s00455-011-9367-8.
Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol. 1999;277:G219–25.
Huckabee ML, Deecke L, Cannito MP, Gould HJ, Mayr W. Cortical control mechanisms in volitional swallowing: the Bereitschaftspotential. Brain Topogr. 2003;16:3–17.
Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85:938–50.
Pouderoux P, Logemann JA, Kahrilas PJ. Pharyngeal swallowing elicited by fluid infusion: role of volition and vallecular containment. Am J Physiol. 1996;270:G347–54.
Daniels SK, Foundas AL. The role of the insular cortex in dysphagia. Dysphagia. 1997;12:146–56.
Hamdy S, Rothwell JC, Aziz Q, Thompson DG. Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. Clin Sci (Colch). 2000;99:151–7.
Hamdy S, Rothwell JC, Brooks DJ, Bailey D, Aziz Q, Thompson DG. Identification of the cerebral loci processing human swallowing with H2(15)O PET activation. J Neurophysiol. 1999;81:1917–26.
Zald DH, Pardo JV. The functional neuroanatomy of voluntary swallowing. Ann Neurol. 1999;46:281–6.
Zald DH, Pardo JV. Cortical activation induced by intraoral stimulation with water in humans. Chem Senses. 2000;25:267–75.
Groves-Wright K, Boyce S, Kelchner L. Perception of wet vocal quality in identifying penetration/aspiration during swallowing. J Speech Lang Hear Res. 2009;53:620–32.
Daniels SK, Corey DM, Barnes CL, Faucheaux NM, Priestly DH, Foundas AL. Cortical representation of swallowing: a modified dual task paradigm. Percept Mot Skills. 2002;94:1029–40.
Leopold NA, Kagel MC. Swallowing, ingestion and dysphagia: a reappraisal. Arch Phys Med Rehabil. 1983;64:371–3.
Leopold NA, Kagel MC. Dysphagia—Ingestion or deglutition? A proposed paradigm. Dysphagia. 1997;12:202–6.
Miller AJ. The search for the central swallowing pathway: the quest for clarity. Dysphagia. 1993;8:185–94.
Parkinson J. An essay on the shaking palsy. London: Whittingham and Rowland; 1817.
Kahneman D. Attention and effort. Englewood Cliffs: Prentice-Hall; 1973.
Navon D, Gopher D. On the economy of the human-processing system. Psychol Rev. 1979;86:214–55.
Navon D, Miller J. Queuing or sharing? A critical evaluation of the single-bottleneck notion. Cogn Psychol. 2002;44:193–251.
Tombu M, Jolicur P. All-or-none bottleneck versus capacity sharing accounts of the psychological refractory period phenomenon. Psychol Res. 2002;66:274–86.
Tombu M, Jolicoeur P. A central capacity sharing model of dual-task performance. J Exp Psychol Hum Percept Perform. 2003;29:3–18.
Wickens CD. The structure of attentional resources. In: Nickerson R, editor. Attention and performance VIII. Englewood Cliffs: Erlbaum; 1980. p. 239–57.
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17:427–42.
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181–4.
Kiernan RJ, Mueller J, Langston JW, Van Dyke C. The neurobehavioral cognitive status examination: a brief but differentiated approach to cognitive assessment. Ann Intern Med. 1987;107:481–5.
Roper BL, Bieliauskas LA, Peterson MR. Validity of the mini-mental state examination and the neurobehavioral cognitive status examination in cognitive screening. Neuropsychiatry Neuropsychol Behav Neurol. 1996;9:54–7.
Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, Thompson AJ. The functional independence measure: a comparative validity and reliability study. Disabil Rehabil. 1995;17:10–4.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
Bonin-Guillaume S, Blin O, Hasbroucq T. An additive factor analysis of the effect of depression on the reaction time of old patients. Acta Psychol. 2004;117:1–11.
Schmidt RA, Lee TD. Motor control and learning: a behavioral emphasis, 3rd ed. Champaign: Human Kinetics; 1999.
Hollerbach S, Fitzpatrick D, Shine G, Kamath MV, Upton AR, Tougas G. Cognitive evoked potentials to anticipated oesophageal stimulus in humans: quantitative assessment of the cognitive aspects of visceral perception. Neurogastroenterol Motil. 1999;11:37–46.
Schneider W, Shiffrin RM. Controlled and automatic human information processing: I. Detection, search, and attention. Psychol Rev. 1977;84:1–66.
Camicioli R, Howieson D, Lehman S, Kaye J. Talking while walking: the effect of a dual task in aging and Alzheimer’s disease. Neurology. 1997;48:955–8.
Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N. Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res. 2005;164:541–8.
Bair N, Bobek MB, Hoffman-Hogg L, Mion LC, Slomka J, Arroliga AC. Introduction of sedative, analgesic, and neuromuscular blocking agent guidelines in a medical intensive care unit: physician and nurse adherence. Crit Care Med. 2000;28:707–13.
O’Shea S, Morris ME, Iansek R. Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys Ther. 2002;82:888–97.
Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996;77:122632.
Verghese J, Buschke H, Viola L, Katz M, Hall C, Kuslansky G, Lipton R. Validity of divided attention tasks in predicting falls in older individuals: a preliminary study (see comment). J Am Geriatr Soc. 2002;50:1572–6.
Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture. 2002;16:1–14.
Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM. Dual tasking, gait rhythmicity, and Parkinson’s disease: Which aspects of gait are attention demanding? (References). Eur J Neurosci. 2005;22:1248–56.
Cohen MD. Are we doing enough to minimize fluoroscopic radiation exposure in children? Pediatr Radiol. 2007;37:1020–4.
McLean D, Smart R, Collins L, Varas J. Thyroid dose measurements for staff involved in modified barium swallow exams. Health Phys. 2006;90:38–41.
American Speech-Language-Hearing Association. Guidelines for speech-language pathologists performing videofluoroscopic swallowing studies (Guidelines). ASHA; 2004 (Suppl 24). p. 77–92.
Goldman WP, Baty JD, Buckles VD, Sahrmann S, Morris JC. Cognitive and motor functioning in Parkinson disease: subjects with and without questionable dementia. Arch Neurol. 1998;55:674–80.
Jahanshahi M, Marsden CD. Parkinson’s disease: a self-help guide. New York: Demos Medical Publishing, Inc.; 2000.
Mir P, Matsunaga K, Gilio F, Quinn NP, Siebner HR, Rothwell JC. Dopaminergic drugs restore facilitatory premotor-motor interactions in Parkinson disease. Neurology. 2005;64:1906–12.
Fern-Pollak L, Whone AL, Brooks DJ, Mehta MA. Cognitive and motor effects of dopaminergic medication withdrawal in Parkinson’s disease. Neuropsychologia. 2004;42:1917–26.
Wylie SA, Stout JC, Bashore TR. Activation of conflicting responses in Parkinson’s disease: evidence for degrading and facilitating effects on response time. Neuropsychologia. 2005;43:1033–43.
Fahn S, Elton RL. The UPDRS Development Committee. Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne D, Goldstein M, editors. Recent developments in Parkinson’s disease. Florham Park: Macmillan Healthcare Information; 1987. p. 153–63.
Martínez-Martín P, Gil-Nagel A, Gracia LM, Gómez JB, Martínez-Sarriés J, Bermejo F. Unified Parkinson’s disease rating scale characteristics and structure. The Cooperative Multicentric Group. Mov Disord. 1994;9:76–83.
Acknowledgments
The authors thank the Mark and Evelyn Trammell Trust, Atlanta, Georgia; the Evelyn Trammell Institute for Voice and Swallowing in the Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; and the Trident Parkinson’s Support Group for their support. The authors also thank Neil Szuminsky and Pete Arvenitis for their dedication, ingenuity, and technical expertise that lead to the design and creation of the hardware and programming necessary for this research.
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Brodsky, M.B., Abbott, K.V., McNeil, M.R. et al. Effects of Divided Attention on Swallowing in Persons with Idiopathic Parkinson’s Disease. Dysphagia 27, 390–400 (2012). https://doi.org/10.1007/s00455-011-9381-x
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DOI: https://doi.org/10.1007/s00455-011-9381-x