Deglutition Disorders, Nursing, Parkinson Disease, Quality of Life
Conditions
Brief summary
The intervention involves the identification of 140 patients (70 per group), fed throughout the duration of the study with the two different solutions indicated. The subject will be interviewed by identified and trained personnel in order to collect the information and data required by the study with frequency indicated for the individual evaluation sheets. The subject himself will be provided with all the contact and availability information of the referents of the firm for the purpose of requesting information or reporting events. The subject in the studio will be contacted weekly in order to evaluate the trend by the study referents, according to his availability, and personally interviewed by staff belonging to the research group.
Detailed description
Non-motor symptomatology in Parkinson's disease (PD) is related to the quality of life of patients . Malnutrition in the subject with Parkinson's is a still relevant variable that hesitates in sarcopenia and increased motor deficits in relation to loss of muscle mass and energy deficit. Guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) recommend monitoring and implementing interventions in the presence of weight loss or body mass. Disphagia is a syndrome common in Parkinson's patients, even in the early stages of the pathology. The study by Pflug and collaborators showed that only 5% of the patients observed were completely free from swallowing deficiency, while in 55% of subjects (66/119) aspiration or penetration of food and liquids in the airways were reported regardless of the stage of illness. Several studies, cited by Curtis and collaborators, show that the prevalence of disphagia varies between 11 and 97% of patients during the course of the disease. This condition affects both food safety, with the risk of aspiration and ab-ingestis, and malnutrition conditions, hydration deficiency, also affecting the overall survival of patients in relation to the onset of pneumonia. From a nursing point of view, great interest has the integrated nutritional indices, easy and quick-to-use tools, which manage to determine promptly the presence and risk of malnutrition and which can be used daily in the patient's evaluation. The most suitable is the Mini Nutritional Assessment (MNA), which determines the risk of malnutrition before modification of biochemical parameters. MNA has a sensitivity of 96% and a specificity of 97%. The adoption of scales that evaluate non-motorcycle-related symptoms helps to identify the sindromic dimension of the pathology, highlighting its components that impact the overall quality of life. Patients who follow a level 3 and 4 modified texture diet of the IDDSI Framework scheme frequently encounter an overall reduction in energy and protein intake, determined by the way the meal is prepared in self-production, associated with an often drastic reduction in fluid intake with consequences in both systemic and specific terms for the gastrointestinal tract. Monitoring liquids introduced by subjects with swallowing deficiency is a Grade B recommendation in the ESPEN guidelines. Disphagia is a frequent condition in the subject with Parkinson's disease, particularly in the advanced stages, recent studies begin to show a decay in the safety of swallowing and maintenance in the airway in these subjects, even in relatively early stages of the disease. Therefore, the application of a specific nutritional program for patients with swallowing problems is recommended in the prevention of malnutrition in patients with Parkinson's disease. Previous studies showed the rapid reversibility of malnutrition in hospitalized elderly subjects with cognitive and functional impairment if enrolled in a specific nutritional program. In view of the strong impact that eating difficulties have on the state of health of parkinson's disease patients suffering from disphagia, the widespread spread of dietary frailties related to the various degrees of disphagia and the importance that patients with slight difficulty swallowing or chewing do not develop further pathologies related to a nutritional deficit , it is necessary to study the effectiveness of specific nutritional programs developed to meet the person's need for nutrition The aim of the study is to improve the nursing-care management of Parkinson's disease patients with disphagia
Interventions
DIETARY_SUPPLEMENTweancare-domus
Participants belonging to the experimental group will receive at home a set of foods that allows to receive the right amount of proteins and energy in a modified texture form to be prepared by themselves or by their caregivers
Sponsors
Azienda Sanitaria Locale 3 Genovese
Milko Zanini
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Randomized nutraceutical clinical trial controlled with cross-over design on two groups
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* clinical diagnosis of FOIS-based disphagy or Smithard test (3 oz swallow test) (2 - 3) or previous FEES diagnosis * classification of the functional oral intake scale (FOIS) level of disphagy in classes 4 or 5 (or levels 2-3 on specific clinical indication) * Belonging to one of the territorial structures for the Management of Parkinson's Disease in the territory of Genoa
Exclusion criteria
* Terminally ill subjects for pathology * Subjects with severe disphagia and indication to artificial nutrition (enteral/parenteral) * Severe renal, liver and respiratory failure * Disphagy level classifications inconsistent with inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Non-motor symptomatology change (Novel Non-Motor Symptoms Scale for Parkinson's Disease - NNMS) | 4 months | Novel Non-Motor Symptoms Scale for Parkinson's Disease includes 9 domains and 30 items. Each symptom scored with respect to: Severity: 0 = None, 1 = Mild: symptoms present but causes little distress or disturbance to patient; 2 = Moderate: some distress or disturbance to patient; 3 = Severe: major source of distress or disturbance to patient. Frequency: 1 = Rarely (\<1/wk); 2 = Often (1/wk); 3 = Frequent (several times per week); 4 = Very Frequent (daily or all the time). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Suction and ab-ingestis events related to textured food change (Novel Non-Motor Symptoms Scale for Parkinson's Disease - Domain 6: Gastrointestinal tract) | 4 months | Novel Non-Motor Symptoms Scale for Parkinson's Disease - Domain 6: Gastrointestinal tract includes 3 items. Each symptom scored with respect to: Severity: 0 = None, 1 = Mild: symptoms present but causes little distress or disturbance to patient; 2 = Moderate: some distress or disturbance to patient; 3 = Severe: major source of distress or disturbance to patient. Frequency: 1 = Rarely (\<1/wk); 2 = Often (1/wk); 3 = Frequent (several times per week); 4 = Very Frequent (daily or all the time). 19\. Does the patient dribble saliva during the day? 20. Does the patient have difficulty swallowing? 21. Does the patient suffer from constipation? (Bowel action less than three times weekly) |
Other
| Measure | Time frame | Description |
|---|---|---|
| functional parameter related to malnutrition change: muscle mass | 4 months | muscle mass index (%) will be evaluate by Bioelectrical Impedance Analysis (BIA) |
| functional parameter related to malnutrition change: Body Mass Index (BMI) | 4 months | weight in kg, height in cm (weight and height will be combined to report BMI in Kg/m\^2) |
| functional parameter related to malnutrition change: arm circumference | 4 months | arm circumference in cm |
| functional parameter related to malnutrition change: biomarkers | 4 months | plasma cholinesterase concentration (U/ml) |
| functional parameter related to malnutrition change: Gait speed | 4 months | Gait speed in metres per second (m/s): the fastest gait speed in 4 metres after 3 trials was recorded. Patients may use an assistive device, if needed. |
| functional parameter related to malnutrition change: Nutritional status evaluation | 4 months | • phase angle and derived body composition data: Phase angle is a linear method of measuring the relationship between electric resistance (R) and reactance (Rc) in series or parallel circuits. It reflects cellular vitality and integrity, where normal values indicate preserved cellular activity. It is an important tool in assessing nutritional status in any situation, being superior to anthropometric and biochemical methods. |
| functional parameter related to malnutrition change: Nutritional status evaluation - MNA score | 4 months | Mini Nutritional Assessment Score (MNA):Mini Nutritional Assessment score (MNA) is probably the most widely used and best validated score in different elderly populations and settings. The tool consists of a 6-item short form screening tool (MNA-SF) included in the 18-item long form scale (MNA-LF). From 24 to 30 points: Normal nutritional status; from 17 to 23.5 points: At risk of malnutrition; Less than 17 points: Malnourished |
| functional parameter related to malnutrition change: Bolus transit time evaluation | 4 months | time of complete capture of the bolus and the reflex firing of swallowing in minutes |
| functional parameter related to malnutrition change: immunological indices | 4 months | lymphocyte count in 1 microliter (µL) of blood |
| functional parameter related to malnutrition change: grip strength | 4 months | grip strength of the hand in kg: Handgrip strength will assess using a hydraulic dynamometer. The participant will be seated, resting his or her arm on the chair arms and instructed to squeeze the dynamometer as hard as possible, with the highest score of the 3 trials recorded |
Countries
Italy
Contacts
Primary ContactAnnamaria Bagnasco, Prof
Backup ContactMilko Zanini, Dr
Outcome results
None listed