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Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment

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Abstract

Screening assessments for dysphagia are essential in neurodegenerative disease. Yet there are no purpose-built tools to quantify swallowing deficits at bedside or in clinical trials. A quantifiable, brief, easy to administer assessment that measures the impact of dysphagia and predicts the presence or absence of aspiration is needed. The Clinical Assessment of Dysphagia in Neurodegeneration (CADN) was designed by a multidisciplinary team (neurology, neuropsychology, speech pathology) validated against strict methodological criteria in two neurodegenerative diseases, Parkinson’s disease (PD) and degenerative ataxia (DA). CADN comprises two parts, an anamnesis (part one) and consumption (part two). Two-thirds of patients were assessed using reference tests, the SWAL-QOL symptoms subscale (part one) and videofluoroscopic assessment of swallowing (part two). CADN has 11 items and can be administered and scored in an average of 7 min. Test–retest reliability was established using correlation and Bland–Altman plots. 125 patients with a neurodegenerative disease were recruited; 60 PD and 65 DA. Validity was established using ROC graphs and correlations. CADN has sensitivity of 79 and 84% and specificity 71 and 69% for parts one and two, respectively. Significant correlations with disease severity were also observed (p < 0.001) for PD with small to large associations between disease severity and CADN scores for DA. Cutoff scores were identified that signal the presence of clinically meaningful dysphagia symptomatology and risk of aspiration. The CADN is a reliable, valid, brief, quantifiable, and easily deployed assessment of swallowing in neurodegenerative disease. It is thus ideally suited for both clinical bedside assessment and future multicentre clinical trials in neurodegenerative disease.

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Authors and Affiliations

Authors

Contributions

A/Prof Vogel contributed to the design of the study, collection, analysis and interpretation of the data, drafting the manuscript for intellectual content. He also supervised students, led the research team, and obtained funding for the research. Ms. Rommel contributed to the design of the study, collected data, analysis and interpretation of the data, revising the manuscript for intellectual content, and supervision of students. Ms. Sauer contributed to the design of the study, data collection, analysis and interpretation, and revising the manuscript for intellectual content. Dr. Horger and Dr. Krumm contributed to data collection, analysis and interpretation, and revising the manuscript for intellectual content. Dr. Himmelbach contributed to analysis and interpretation of the data and revising the manuscript for intellectual content. Dr. Synofzik contributed to the design of the study, collection, analysis and interpretation of the data, revising the manuscript for intellectual content. He also supervised students, led the research team, and obtained funding for the research.

Corresponding author

Correspondence to Adam P. Vogel.

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Conflicts of interest

A/Prof Vogel receives funding from the National Health and Medical Research Council, Australia (Career Development Fellowship ID 1082910), is funded by Australian Research Council Grants (LP130100026, LP120200223, DP130101900), received funding from the Alexander von Humboldt Foundation and receives institutional support from The University of Melbourne. Ms Rommel: None. Ms Sauer: None. Dr. Horger: None. Dr. Krumm: None. Dr Himmelbach: None. Dr Synofzik received honoraria from Actelion pharmaceuticals, unrelated to the current study.

Ethical standards

The study received institutional approval from the Medical Ethics Board, University Hospital Tübingen, Germany (Az. 003/2015BO2). All patients, or representatives, provided written informed consent.

Funding

National Health and Medical Research Council of Australia (APV holds a Career Development Fellowship ID 1082910). The Project received funding from the Alexander von Humboldt Foundation (APV), the Center for Rare Diseases (Zentrum für Seltene Erkrankungen, ZSE) Tübingen (MS and APV) and the Fondation de l’ Ataxie Charlevoix-Saguenay (MS and APV).

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Vogel, A.P., Rommel, N., Sauer, C. et al. Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment. J Neurol 264, 1107–1117 (2017). https://doi.org/10.1007/s00415-017-8499-7

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