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Published in: European Archives of Oto-Rhino-Laryngology 5/2021

01-05-2021 | Amyotrophic Lateral Sclerosis | Miscellaneous

The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson’s disease

Authors: Ole Schlickewei, Julie Cläre Nienstedt, Ulrike Frank, Odette Fründt, Monika Pötter-Nerger, Christian Gerloff, Carsten Buhmann, Frank Müller, Susanne Lezius, Jana-Christiane Koseki, Christina Pflug

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2021

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Abstract

Purpose

Dysphagia is common in patients with Parkinson’s disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD.

Methods

In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively.

Results

PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of ≥ 6 presented a sensitivity of 58% and specificity of 82%.

Conclusions

The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications.
Literature
1.
go back to reference Pflug C, Bihler M, Emich K, Niessen A, Nienstedt JC, Flugel T, Koseki JC, Plaetke R, Hidding U, Gerloff C, Buhmann C (2018) Critical dysphagia is common in parkinson disease and occurs even in early stages: a prospective cohort study. Dysphagia 33:41–50PubMed Pflug C, Bihler M, Emich K, Niessen A, Nienstedt JC, Flugel T, Koseki JC, Plaetke R, Hidding U, Gerloff C, Buhmann C (2018) Critical dysphagia is common in parkinson disease and occurs even in early stages: a prospective cohort study. Dysphagia 33:41–50PubMed
2.
go back to reference Kalf JG, de Swart BJ, Bloem BR, Munneke M (2012) Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 18:311–315PubMed Kalf JG, de Swart BJ, Bloem BR, Munneke M (2012) Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat Disord 18:311–315PubMed
3.
go back to reference Takizawa C, Gemmell E, Kenworthy J, Speyer R (2016) A Systematic review of the prevalence of oropharyngeal dysphagia in stroke, parkinson's disease, alzheimer's disease, head injury, and pneumonia. Dysphagia 31:434–441PubMed Takizawa C, Gemmell E, Kenworthy J, Speyer R (2016) A Systematic review of the prevalence of oropharyngeal dysphagia in stroke, parkinson's disease, alzheimer's disease, head injury, and pneumonia. Dysphagia 31:434–441PubMed
4.
go back to reference Leow LP, Huckabee ML, Anderson T, Beckert L (2010) The impact of dysphagia on quality of life in ageing and Parkinson's disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire. Dysphagia 25:216–220PubMed Leow LP, Huckabee ML, Anderson T, Beckert L (2010) The impact of dysphagia on quality of life in ageing and Parkinson's disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire. Dysphagia 25:216–220PubMed
5.
go back to reference Izaola O, Gomez Hoyos E, Lopez JJ, Ortola A, Torres B, Primo D, Castro A, De Luis Roman DA (2018) The 10-item eating assessment tool is associated with nutritional status, mortality and hospital stay in elderly individuals requiring hospitalization with acute diseases. Nutr Hosp 35:827–832PubMed Izaola O, Gomez Hoyos E, Lopez JJ, Ortola A, Torres B, Primo D, Castro A, De Luis Roman DA (2018) The 10-item eating assessment tool is associated with nutritional status, mortality and hospital stay in elderly individuals requiring hospitalization with acute diseases. Nutr Hosp 35:827–832PubMed
6.
go back to reference Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK (2013) Malnutrition in a sample of community-dwelling people with Parkinson's disease. PLoS ONE 8:e53290PubMedPubMedCentral Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK (2013) Malnutrition in a sample of community-dwelling people with Parkinson's disease. PLoS ONE 8:e53290PubMedPubMedCentral
7.
go back to reference Fall PA, Saleh A, Fredrickson M, Olsson JE, Granerus AK (2003) Survival time, mortality, and cause of death in elderly patients with Parkinson's disease: a 9-year follow-up. Mov Disord 18:1312–1316PubMed Fall PA, Saleh A, Fredrickson M, Olsson JE, Granerus AK (2003) Survival time, mortality, and cause of death in elderly patients with Parkinson's disease: a 9-year follow-up. Mov Disord 18:1312–1316PubMed
8.
go back to reference Gorell JM, Johnson CC, Rybicki BA (1994) Parkinson's disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990. Neurology 44:1865–1868PubMed Gorell JM, Johnson CC, Rybicki BA (1994) Parkinson's disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990. Neurology 44:1865–1868PubMed
9.
go back to reference Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rosler A, Shaker R, Warnecke T, Sieber CC, Volkert D (2016) Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 11:189–208PubMedPubMedCentral Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rosler A, Shaker R, Warnecke T, Sieber CC, Volkert D (2016) Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 11:189–208PubMedPubMedCentral
10.
go back to reference Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A (2016) Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia. Acta Otorhinolaryngol Ital 36:395–402PubMedPubMedCentral Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A (2016) Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia. Acta Otorhinolaryngol Ital 36:395–402PubMedPubMedCentral
11.
go back to reference Langmore SE, Schatz K, Olsen N (1988) Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2:216–219PubMed Langmore SE, Schatz K, Olsen N (1988) Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2:216–219PubMed
12.
go back to reference Buhmann C, Flugel T, Bihler M, Gerloff C, Niessen A, Hidding U, Nienstedt JC, Pflug C (2019) Is the Munich dysphagia Test-Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Parkinsonism Relat Disord 61:138–143PubMed Buhmann C, Flugel T, Bihler M, Gerloff C, Niessen A, Hidding U, Nienstedt JC, Pflug C (2019) Is the Munich dysphagia Test-Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Parkinsonism Relat Disord 61:138–143PubMed
13.
go back to reference Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ (2008) Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol 117:919–924PubMed Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ (2008) Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol 117:919–924PubMed
14.
go back to reference Plowman EK, Tabor LC, Robison R, Gaziano J, Dion C, Watts SA, Vu T, Gooch C (2016) Discriminant ability of the eating assessment tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 28:85–90PubMed Plowman EK, Tabor LC, Robison R, Gaziano J, Dion C, Watts SA, Vu T, Gooch C (2016) Discriminant ability of the eating assessment tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 28:85–90PubMed
15.
go back to reference Regan J, Lawson S, De Aguiar V (2017) The eating assessment tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia 32:714–720PubMed Regan J, Lawson S, De Aguiar V (2017) The eating assessment tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia 32:714–720PubMed
16.
go back to reference Lechien JR, Cavelier G, Thill MP, Huet K, Harmegnies B, Bousard L, Blecic S, Vanderwegen J, Rodriguez A, Dequanter D (2019) Validity and reliability of the French version of eating assessment tool (EAT-10). Eur Arch Otorhinolaryngol 276:1727–1736PubMed Lechien JR, Cavelier G, Thill MP, Huet K, Harmegnies B, Bousard L, Blecic S, Vanderwegen J, Rodriguez A, Dequanter D (2019) Validity and reliability of the French version of eating assessment tool (EAT-10). Eur Arch Otorhinolaryngol 276:1727–1736PubMed
17.
go back to reference Zaretsky E, Steinbach-Hundt S, Pluschinski P, Grethel I, Hey C (2018) Validation of the German version of eating assessment tool for head and neck cancer patients. Laryngorhinootologie 97:480–486PubMed Zaretsky E, Steinbach-Hundt S, Pluschinski P, Grethel I, Hey C (2018) Validation of the German version of eating assessment tool for head and neck cancer patients. Laryngorhinootologie 97:480–486PubMed
18.
go back to reference Farahat M, Mesallam TA (2015) Validation and cultural adaptation of the arabic version of the eating assessment tool (EAT-10). Folia Phoniatr Logop 67:231–237PubMed Farahat M, Mesallam TA (2015) Validation and cultural adaptation of the arabic version of the eating assessment tool (EAT-10). Folia Phoniatr Logop 67:231–237PubMed
19.
go back to reference Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedPubMedCentral Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedPubMedCentral
20.
go back to reference Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170PubMed Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170PubMed
21.
go back to reference Hoehn MM (1987) Parkinson's disease: progression and mortality. Adv Neurol 45:457–461PubMed Hoehn MM (1987) Parkinson's disease: progression and mortality. Adv Neurol 45:457–461PubMed
22.
go back to reference Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D (2009) Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 73:1738–1745PubMedPubMedCentral Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, Weintraub D (2009) Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology 73:1738–1745PubMedPubMedCentral
23.
go back to reference Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord 25:2649–2653PubMed Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord 25:2649–2653PubMed
24.
go back to reference Langmore SE, Schatz K, Olson N (1991) Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol 100:678–681PubMed Langmore SE, Schatz K, Olson N (1991) Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol 100:678–681PubMed
25.
go back to reference Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98PubMed Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98PubMed
26.
go back to reference Neubauer PD, Rademaker AW, Leder SB (2015) The Yale Pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia 30:521–528PubMed Neubauer PD, Rademaker AW, Leder SB (2015) The Yale Pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia 30:521–528PubMed
27.
go back to reference Tye CB, Gardner PA, Dion GR, Simpson CB, Dominguez LM (2020) Impact of Fiberoptic Endoscopic Evaluation of Swallowing Outcomes and Dysphagia Management in Neurodegenerative Diseases. Laryngoscope Tye CB, Gardner PA, Dion GR, Simpson CB, Dominguez LM (2020) Impact of Fiberoptic Endoscopic Evaluation of Swallowing Outcomes and Dysphagia Management in Neurodegenerative Diseases. Laryngoscope
28.
go back to reference Park JH, Kang SW, Lee SC, Choi WA, Kim DH (2010) How respiratory muscle strength correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J 51:392–397PubMedPubMedCentral Park JH, Kang SW, Lee SC, Choi WA, Kim DH (2010) How respiratory muscle strength correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J 51:392–397PubMedPubMedCentral
29.
go back to reference Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M (2013) Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 128:397–401PubMed Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M (2013) Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 128:397–401PubMed
30.
go back to reference Kawai S, Tsukuda M, Mochimatsu I, Enomoto H, Kagesato Y, Hirose H, Kuroiwa Y, Suzuki Y (2003) A study of the early stage of Dysphagia in amyotrophic lateral sclerosis. Dysphagia 18:1–8PubMed Kawai S, Tsukuda M, Mochimatsu I, Enomoto H, Kagesato Y, Hirose H, Kuroiwa Y, Suzuki Y (2003) A study of the early stage of Dysphagia in amyotrophic lateral sclerosis. Dysphagia 18:1–8PubMed
31.
go back to reference Robbins J (1987) Swallowing in ALS and motor neuron disorders. Neurol Clin 5:213–229PubMed Robbins J (1987) Swallowing in ALS and motor neuron disorders. Neurol Clin 5:213–229PubMed
32.
go back to reference Walker RW, Dunn JR, Gray WK (2011) Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease. Dysphagia 26:92–96PubMed Walker RW, Dunn JR, Gray WK (2011) Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease. Dysphagia 26:92–96PubMed
33.
go back to reference Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG (2012) Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 71:520–530PubMedPubMedCentral Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG (2012) Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 71:520–530PubMedPubMedCentral
34.
go back to reference Muslimovic D, Post B, Speelman JD, Schmand B (2005) Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 65:1239–1245PubMed Muslimovic D, Post B, Speelman JD, Schmand B (2005) Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 65:1239–1245PubMed
35.
go back to reference Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T, Adler CH, Shill HA, Caviness JN, Samanta JE, Sue LI, Beach TG (2013) Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol 72:614–623PubMedPubMedCentral Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T, Adler CH, Shill HA, Caviness JN, Samanta JE, Sue LI, Beach TG (2013) Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol 72:614–623PubMedPubMedCentral
36.
go back to reference Troche MS, Brandimore AE, Okun MS, Davenport PW, Hegland KW (2014) Decreased cough sensitivity and aspiration in Parkinson disease. Chest 146:1294–1299PubMedPubMedCentral Troche MS, Brandimore AE, Okun MS, Davenport PW, Hegland KW (2014) Decreased cough sensitivity and aspiration in Parkinson disease. Chest 146:1294–1299PubMedPubMedCentral
37.
go back to reference Fontana GA, Pantaleo T, Lavorini F, Benvenuti F, Gangemi S (1998) Defective motor control of coughing in Parkinson's disease. Am J Respir Crit Care Med 158:458–464PubMed Fontana GA, Pantaleo T, Lavorini F, Benvenuti F, Gangemi S (1998) Defective motor control of coughing in Parkinson's disease. Am J Respir Crit Care Med 158:458–464PubMed
38.
go back to reference Ebihara S, Saito H, Kanda A, Nakajoh M, Takahashi H, Arai H, Sasaki H (2003) Impaired efficacy of cough in patients with Parkinson disease. Chest 124:1009–1015PubMed Ebihara S, Saito H, Kanda A, Nakajoh M, Takahashi H, Arai H, Sasaki H (2003) Impaired efficacy of cough in patients with Parkinson disease. Chest 124:1009–1015PubMed
39.
go back to reference Zheng Z, Wu Z, Liu N, Chen P, Hou P, Wang X, Fu Y, Liang W, Chen R (2016) Silent aspiration in patients with exacerbation of COPD. Eur Respir J 48:570–573PubMed Zheng Z, Wu Z, Liu N, Chen P, Hou P, Wang X, Fu Y, Liang W, Chen R (2016) Silent aspiration in patients with exacerbation of COPD. Eur Respir J 48:570–573PubMed
40.
go back to reference Clayton NA, Carnaby GD, Peters MJ, Ing AJ (2014) Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol 16:615–623PubMed Clayton NA, Carnaby GD, Peters MJ, Ing AJ (2014) Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol 16:615–623PubMed
41.
go back to reference Cordier R, Joosten A, Clave P, Schindler A, Bulow M, Demir N, Arslan SS, Speyer R (2017) Evaluating the psychometric properties of the eating assessment tool (EAT-10) using rasch analysis. Dysphagia 32:250–260PubMed Cordier R, Joosten A, Clave P, Schindler A, Bulow M, Demir N, Arslan SS, Speyer R (2017) Evaluating the psychometric properties of the eating assessment tool (EAT-10) using rasch analysis. Dysphagia 32:250–260PubMed
42.
go back to reference Kean J, Brodke DS, Biber J, Gross P (2018) An introduction to item response theory and rasch analysis of the eating assessment tool (EAT-10). Brain Impair 19:91–102PubMed Kean J, Brodke DS, Biber J, Gross P (2018) An introduction to item response theory and rasch analysis of the eating assessment tool (EAT-10). Brain Impair 19:91–102PubMed
43.
go back to reference Nienstedt JC, Bihler M, Niessen A, Plaetke R, Potter-Nerger M, Gerloff C, Buhmann C, Pflug C (2019) Predictive clinical factors for penetration and aspiration in Parkinson's disease. Neurogastroenterol Motil 31:e13524PubMed Nienstedt JC, Bihler M, Niessen A, Plaetke R, Potter-Nerger M, Gerloff C, Buhmann C, Pflug C (2019) Predictive clinical factors for penetration and aspiration in Parkinson's disease. Neurogastroenterol Motil 31:e13524PubMed
44.
go back to reference Wilmskoetter J, Bonilha H, Hong I, Hazelwood RJ, Martin-Harris B, Velozo C (2019) Construct validity of the Eating Assessment Tool (EAT-10). Disabil Rehabil 41:549–559PubMed Wilmskoetter J, Bonilha H, Hong I, Hazelwood RJ, Martin-Harris B, Velozo C (2019) Construct validity of the Eating Assessment Tool (EAT-10). Disabil Rehabil 41:549–559PubMed
45.
go back to reference Leopold NA, Kagel MC (1997) Pharyngo-esophageal dysphagia in Parkinson's disease. Dysphagia 12:11–18 discussion 19–20PubMed Leopold NA, Kagel MC (1997) Pharyngo-esophageal dysphagia in Parkinson's disease. Dysphagia 12:11–18 discussion 19–20PubMed
Metadata
Title
The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson’s disease
Authors
Ole Schlickewei
Julie Cläre Nienstedt
Ulrike Frank
Odette Fründt
Monika Pötter-Nerger
Christian Gerloff
Carsten Buhmann
Frank Müller
Susanne Lezius
Jana-Christiane Koseki
Christina Pflug
Publication date
01-05-2021

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