Parkinsonism & related disorders · 2025
Drooling in Parkinson's disease: A potential clinical marker of disease severity.
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Igami Eriko, Nishikawa Noriko, Iwaki Hirotaka, Ueno Shin-Ichi, Takeshige-Amano Haruka, Sako Wataru, Hatano Taku, Hattori Nobutaka
Аннотация
INTRODUCTION: Drooling is a common but underrecognized non-motor symptom in Parkinson's disease (PD), associated with impaired quality of life and aspiration risk. While often managed as a peripheral issue, it may reflect broader systemic involvement. This study aimed to evaluate the prevalence and clinical significance of drooling in PD, focusing on its relationship with motor, non-motor, cognitive, and autonomic domains.
METHODS: We conducted a cross-sectional study involving 513 Japanese PD patients. Drooling severity was assessed using Item 2 of the MDS-UPDRS Part II. Motor and non-motor symptoms were evaluated using the MDS-UPDRS Parts I-IV, MMSE, MoCA-J, FAB, PDSS-2, JESS, and PDQ-39. Cardiac sympathetic innervation and dopaminergic integrity were assessed using MIBG myocardial scintigraphy and DaT SPECT, respectively. Multivariable regression analysis was performed with adjustment for age, sex, and disease duration.
RESULTS: Drooling was observed in 66.5 % of participants, with 28.1 % categorized as severe. Droolers had significantly worse scores in motor and non-motor assessments, poorer sleep quality and quality of life, and greater cognitive deficits. They also exhibited lower heart-to-mediastinum ratios on MIBG and reduced striatal z-scores on DaT SPECT. These associations remained significant after adjustment for covariates.
CONCLUSION: Drooling in PD is linked to broader clinical and imaging abnormalities and may reflect widespread neurodegeneration beyond oropharyngeal dysfunction. These findings support the potential utility of drooling as a clinical marker of disease severity and suggest that it warrants greater attention in both research and clinical practice.
METHODS: We conducted a cross-sectional study involving 513 Japanese PD patients. Drooling severity was assessed using Item 2 of the MDS-UPDRS Part II. Motor and non-motor symptoms were evaluated using the MDS-UPDRS Parts I-IV, MMSE, MoCA-J, FAB, PDSS-2, JESS, and PDQ-39. Cardiac sympathetic innervation and dopaminergic integrity were assessed using MIBG myocardial scintigraphy and DaT SPECT, respectively. Multivariable regression analysis was performed with adjustment for age, sex, and disease duration.
RESULTS: Drooling was observed in 66.5 % of participants, with 28.1 % categorized as severe. Droolers had significantly worse scores in motor and non-motor assessments, poorer sleep quality and quality of life, and greater cognitive deficits. They also exhibited lower heart-to-mediastinum ratios on MIBG and reduced striatal z-scores on DaT SPECT. These associations remained significant after adjustment for covariates.
CONCLUSION: Drooling in PD is linked to broader clinical and imaging abnormalities and may reflect widespread neurodegeneration beyond oropharyngeal dysfunction. These findings support the potential utility of drooling as a clinical marker of disease severity and suggest that it warrants greater attention in both research and clinical practice.