Dysphagia (2016) 31:434–441

DOI 10.1007/s00455-016-9695-9

ORIGINAL ARTICLE

A Systematic Review of the Prevalence of Oropharyngeal

Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease,
Head Injury, and Pneumonia
Claire Takizawa1 • Elizabeth Gemmell2 • James Kenworthy2 • Renée Speyer3,4

Received: 7 January 2015 / Accepted: 1 February 2016 / Published online: 12 March 2016
Ó Springer Science+Business Media New York 2016

Abstract Oropharyngeal dysphagia is a common condition
after stroke, Parkinson’s disease (PD), and Alzheimer’s dis-
ease (AD), and can cause serious complications including
malnutrition, aspiration pneumonia, and premature mortality.
Despite its high prevalence among the elderly and associated
serious complications, dysphagia is often overlooked and
under-diagnosed in vulnerable patient populations. This sys-
tematic review aimed to improve understanding and aware-
ness of the prevalence of dysphagia in susceptible patient
populations. MEDLINE, EMBASE, the Cochrane library,
PROSPERO, and disease-specific websites were systemati-
cally searched for studies reporting oropharyngeal dysphagia
prevalence or incidence in people with stroke, PD, AD, trau-
matic brain injury, and community-acquired pneumonia, from
the USA, Canada, France, Germany, Italy, Spain, UK, Japan,
China, and regional studies. The quality of study descriptions
were assessed based on STROBE guidelines. A total of 1207
publications were identified and 33 met inclusion criteria: 24
in stroke, six in PD, two in traumatic brain injury, and one in
patients with traumatic brain injury. Dysphagia was reported
in 8.1–80 % of stroke patients, 11–81 % of PD, 27–30 % of
traumatic brain injury patients, and 91.7 % of patients with
community-acquired pneumonia. No relevant studies of dys-
phagia in AD were identified. This review demonstrates that
dysphagia is highly prevalent in these populations, and high-
lights discrepancies between studies, gaps in dysphagia
research, and the need for better dysphagia management
starting with a reliable, standardized, and validated method for
oropharyngeal dysphagia identification.
Keywords Oropharyngeal dysphagia
Stroke

Epidemiology
Parkinson’s disease
Head injury

Electronic supplementary material The online version of this Introduction

article (doi:10.1007/s00455-016-9695-9) contains supplementary
material, which is available to authorized users.
Oropharyngeal dysphagia is a swallowing disorder that
& Elizabeth Gemmell affects over 16 million people in the USA and over 40
elizabethadkins@phmr.com million people in Europe [1]. Oropharyngeal dysphagia
Claire Takizawa (OD) is a common condition in the elderly, after stroke, and
claire.x.takizawa@gmail.com in neurological diseases including Parkinson’s disease and
1
Alzheimer’s disease. OD is a major cause of mortality and
Nestle Health Science, Avenue de Nestlé 55, 1008 Vevey,
Switzerland
morbidity these patient populations due to serious compli-
2
cations including malnutrition and aspiration pneumonia [2–
PHMR Limited, Berkeley Works, Berkeley Grove, London
NW1 8XY, UK
6], and is associated with social and psychological burden
3
that significantly reduce quality of life for both patients and
School of Public Health, Tropical Medicine and
caregivers. Despite its high prevalence among the elderly
Rehabilitation Sciences, James Cook University, Townsville,
QLD 4811, Australia and associated serious complications, OD is under-diag-
4 nosed and often overlooked in the clinical assessment of
Department of Otorhinolaryngology and Head and Neck
Surgery, Leiden University Medical Center, 2333 ZA Leiden, elderly patients. Given the ageing population and increasing
ZH, The Netherlands numbers of people affected by these disorders, early

123
C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
identification and management of OD should be a priority to
reduce the risk of serious complications and improve out-
comes in vulnerable patient populations.
This systematic review aimed to gain a comprehensive
knowledge of the published data on OD epidemiology in
stroke patients and other susceptible patient populations
including people with Parkinson’s disease, Alzheimer’s
disease, traumatic brain injuries, and community-acquired
pneumonia in the elderly ([65 years old).
Although these disorders are not the only causes of
dysphagia, they reflect the broad spectrum of neurological
causes of dysphagia in the elderly, including cerebrovascular
disease (stroke), neurodegenerative disease causing Alzhei-
mer’s disease and Parkinson’s disease, and traumatic brain
injury which is associated with high rates of dysphagia (Sura
et al. 2012). Pneumonia is a serious consequence of dys-
phagia and a major cause of morbidity and mortality in the
elderly, therefore improving understanding of the prevalence
of dysphagia in people with pneumonia is also important to
highlight the need for better management of dysphagia to
prevent development of this serious condition.
Materials and Methods
Search Strategy and Selection Criteria
Following a predefined protocol, we searched for studies
reporting OD prevalence or incidence in patients with
stroke, Parkinson’s disease, Alzheimer’s disease, traumatic
brain injury, and community-acquired pneumonia, pub-
lished in English, before January 2014. Studies from the
USA, Canada, France, Germany, Italy, Spain, UK, Japan,
China, and global and regional studies were included. We
searched MEDLINE, EMBASE, Medline In-Process Cita-
tions and Daily Updates (OvidSP), the Cochrane Library,
and PROSPERO (the International prospective register of
systematic reviews), and hand searched article bibliogra-
phies and the following disease-specific websites for rele-
vant articles: the Dysphagia Journal, the Dysphagia
Research Society, and the International Society for Phar-
macoeconomics and Outcomes Research digest. Search
strategies are shown in Online resource appendix 1.
Studies of OD in patients with stroke, Parkinson’s disease,
traumatic brain injury, community-acquired pneumonia
among the elderly (C65 years), and Alzheimer’s disease were
included. Patients with other causes of dysphagia or oeso-
phageal dysphagia were excluded. Included settings were
acute inpatient care, long-term care institutions, nursing
homes, and community care settings. Epidemiological stud-
ies, registry studies, database studies, retrospective, prospec-
tive, and observational studies, with any interventions or
comparators, were included. Non-English publications and
435
publications indexed as editorials, letters, case reports, com-
mentaries, legal cases, newspaper articles, or patient educa-
tion hand-outs were excluded. Publications that did not report
prevalence of dysphagia and the number of patients with
dysphagia were not included.
Data Extraction and Reporting
Two reviewers screened the titles, abstracts, and key words
of all citations retrieved. Full manuscripts of studies judged
to be relevant by either reviewer were assessed for inclu-
sion or exclusion. Qualitative outcome data were extracted
by one reviewer and recorded in a standardized data
extraction table. The variables extracted from each study
are summarized in Table 1 and Online resource Table 2.
Quality Assessment
The quality of reporting of all included studies was assessed
based on the STROBE statement checklist [7]. Four areas
were assessed for quality: study design and setting, study
participants, outcomes, and eligibility criteria. Studies were
assigned a score of 1 for each area assessed when they
contained the information listed in the checklist and could be
replicated using the information provided, giving a total
quality assessment score out of 4 (Online resource Table 1).
All studies were included in this review irrespective of
quality, but the limitations of studies with quality scores
below 4 were taken into account when discussing results.
Results
Study Selection and Study Characteristics
The searches yielded 1207 publications after de-duplica-
tion; after screening, 129 full manuscripts were reviewed
for inclusion, and 33 met the inclusion criteria (Fig. 1).
Study characteristics are summarized in Table 1 and
Online resource Table 2.
The 33 included articles ranged in size from 15 to 90,201
subjects, with 58 % (19 studies) containing fewer than 100
patients. The majority of studies were carried out in the USA
(17 studies), and in hospital (16 studies) and tertiary care
settings (10 studies). The most commonly used methods to
define dysphagia were water swallow tests (10 studies),
videofluoroscopic swallowing study methods (VFSS, 8
studies), and ‘bedside assessments’ (7 studies). Nine studies
were considered to be of acceptable quality across all four
criteria (Table 1). The majority of studies reported the
prevalence of dysphagia, and nine studies reported the
incidence of dysphagia [11, 18, 27, 28, 32–34] (stroke) [13]
(Parkinson’s disease) and [39] (traumatic brain injury).
123
 436

123
Table 1 Characteristics of included studies that were considered to be of acceptable quality in all areas assessed
Study Underlying Country Design Setting Mean age (years) OD or ‘dysphagia’? % with dysphagia (n/N) Dysphagia definition/
condition assessment method

Crary et al. Stroke US Prospective cohort Tertiary 59.2 (SD 15.2) Dysphagia 41 % (26/63) MASA score and the
2013 [8] care Functional Oral Intake
Scale
Falsetti et al. Stroke Italy Prospective cohort Hospital 79.4 (range 58–91) OD 41 % (62/151) Swallow 5 and 20 ml of
2009 [9] water, with pulse
oximetry and observation
of signs of oral-facial
apraxia or penetration/
aspiration
Gonzalez- Stroke US Database case Hospital Cal White 73.2 (SD 13.1), 75 % dysphagia, 15 % Cal: White 12.4 % (5497), ICD-9 code 787.2 for
Fernandez control Black 66.3 (SD 14.6), aspiration pneumonia, Black 13.6 % (667), dysphagia or 507.0 for
et al. 2008 Asian 70.7 (SD 13.5); 11 % feeding tube Asian 17.7 % (901); aspiration pneumonia, or
[10] NY White 73.5 (SD 12.8), NY: White 8.2 % (2385), the presence of a feeding
Black 65.8 (SD 14.5), Black 8.1 % (502), Asian tube in the absence of a
Asian 69.4 (SD 13.2) 12 % (100) diagnosis of coma
Kopey et al. Stroke US Retrospective Tertiary 52.5 (SD 14.4) OD 32 % (72/233)a Three-sip test
2010 [11] records study care
Martino et al. Stroke Canada Randomized trial Stroke unit 68.6 (SD 14.3) Dysphagia 45.3 % (141/311) TOR-BSST and VFSS
2009 [12] 59.2 % acute and
38.5 % rehabilitation
patients
Auyeung et al. PD China Prospective cohort Secondary 62.2 (SD 10.6) Dysphagia 60 % (102/171)? Patient report of choking on
2012 [13] care swallowing
Barichella PD Italy Prospective single- Outpatient 67.8 (SD 9.2) Dysphagia 11 % (23/208) Swallowing disturbance
et al. 2013 centre cross- primary questionnaire
[14] sectional cohort care
Almirall et al. Community- Spain Case–Control Hospital 81.22 (SE ± 0.77) OD 91.7 % (33/36) cases The volume–viscosity
2013 [15] acquired 40.7 % (29/72) controls swallow test
pneumonia
OD oropharyngeal dysphagia, PD Parkinson’s disease, SD standard deviation, SE standard error, Cal California, NY New York, MASA Mann Assessment of Swallowing Ability, VFSS
Videofluoroscopic Swallowing Study, TOR-BSST The Toronto Bedside Swallowing Screening Test
a
Studies that reported incidence rather than prevalence
C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
Fig. 1 Flow-diagram of the
number of studies screened,
included and excluded at each
stage
Patient Populations
Stroke
Twenty-four studies of dysphagia in stroke patients were
included, reporting dysphagia in 8.1–80 % of patients [8–
12, 16–34]. In the studies considered to be accept-
able quality in all criteria assessed, dysphagia prevalence
estimates ranged from 8.1 to 45.3 %, and one study
reported dysphagia incidence of 32 % (Table 1). Eight
studies used water swallowing tests to detect dysphagia,
which yielded slightly lower dysphagia rates than the five
studies that used VFSS (29–57 vs. 35–67 %, respectively).
Three studies used a bedside assessment method, reporting
dysphagia in 8 % [34], 43 % [21], and 55 % [32] of
patients. A detailed description of what ‘bedside assess-
ment’ entailed was reported only by Teasell et al. (evalu-
ation of level of consciousness, voice quality, evidence of
coughing or choking, oral motor control, control of the
bolus in the oral phase, and evidence of a delay in the
swallowing reflex) [32]. Alternative methods for detecting
dysphagia were used in the remaining studies, which
437
reported a range of dysphagia frequencies using screening
tools (38 %) [17], (45.3 %) [12], chart reviews (64 %)
[30], and direct questioning of patients (27 %) [18].
Parkinson’s Disease
Six studies of patients with Parkinson’s disease met the
inclusion criteria, reporting dysphagia prevalence estimates
from 11 to 81 % (Table 1) [13, 14, 35–38]. Two studies
were considered to be of acceptable quality across all cri-
teria assessed. One used a swallowing disturbance ques-
tionnaire and reported dysphagia prevalence of 11 % [14],
the other used patient reports of choking on swallowing as
a sign of dysphagia, reporting dysphagia incidence of 60 %
over a mean of 11 years follow-up [13]. In the remaining
four studies, one used a comprehensive screening
methodology (swallowing symptom questionnaire, water
swallowing test, and VFSS) finding severe dysphagia in
13 % of patients; two studies used the Chicago Assessment
Scale [41], reporting disparate prevalence estimates of
30 % [36] and 81 %; [37] and the final study was a
chart review study, based on diagnosis of dysphagia by the
123
438 C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
attending physician, finding that 20 % of Parkinson’s
patients with dementia and 45 % of those without dementia
had dysphagia [35].
Traumatic Brain Injury
Two studies of traumatic brain injury met the inclusion
criteria [39, 40]. One study used VFSS to diagnose dys-
phagia, finding dysphagia incidence of 30 % [39]. The
second was a chart review study, which found that 27 % of
patients had dysphagia; however, they did not describe
clearly the methods used to diagnose dysphagia [40]. Both
studies scored only 1/4 in the quality assessment.
Community-Acquired Pneumonia
One study of elderly patients with community-acquired
pneumonia met the inclusion criteria, and was found to be
of acceptable quality across all areas assessed (Table 1)
[15]. This study used the volume–viscosity swallow test to
detect dysphagia [42], finding that 91.7 % of elderly
patients with community-acquired pneumonia and 40.3 %
of elderly control patients had dysphagia.
Alzheimer’s Disease
No studies of dysphagia in Alzheimer’s disease met the
inclusion criteria.
Discussion
Based on the evidence identified, this systematic review
demonstrates that dysphagia is a frequent condition after
stroke. Evidence was also found to indicate that dysphagia
is frequent in patients with Parkinson’s disease, traumatic
brain injury, and community-acquired pneumonia. Sur-
prisingly, no relevant studies of dysphagia in Alzheimer’s
disease were identified, which suggests a low awareness of
OD in Alzheimer’s disease and gap in current research that
is particularly concerning in our ageing population.
Dysphagia epidemiological estimates varied widely
within the studies of stroke and PD patients. This is likely
to reflect differences in the severity of the stroke or PD,
and differences in defining OD such as the use of different
assessment tools focussing on different aspects of OD
(e.g. patient self-report vs. VFS rating by a physician), the
different psychometric properties of tools used (validity/
reliability), different choices of variables even when using
the same tool, and different intra- and/or inter-rater reli-
ability per variable (e.g. visuoperceptual variables in
video recordings).
123
Stage of Underlying Condition
Comparison of dysphagia frequency between studies is com-
plicated by differences in the stage of the underlying condition.
Stroke patients are a heterogeneous group; the size and location
of the stroke, and the duration since the stroke, have a major
influence on whether patients develop dysphagia [43]. In this
systematic review, the highest dysphagia prevalence of 80 %
was found in a study of patients with Wallenburg syndrome, a
condition resulting from infarction of the medulla oblongata
[31]. The high rates of dysphagia after this type of stroke were
not surprising, as damage to this brain region impairs inner-
vation to the muscles of the tongue, pharynx, and larynx. In
agreement, another included study found that stroke severity
was an independent predictor for dysphagia [20]. Two studies
demonstrated that dysphagia was more common immediately
after a stroke than 1–3 months later [12, 19], in line with studies
showing that stroke patients commonly recover from dyspha-
gia over the days to weeks following a stroke [6].
Similarly, several studies reported a positive relationship
between worsening Parkinson’s disease and dysphagia [36–
38]. However, one small retrospective chart review study
found that dysphagia prevalence was higher in Parkinson’s
disease patients without dementia than in those with
dementia (40 vs. 20 %) [35]. This may be because dysphagia
is underreported in patients with dementia, and patients in the
later stages of Parkinson’s disease may require tube feeding,
which will mask the signs of dysphagia.
Both studies of traumatic brain injury found that swal-
lowing dysfunction was associated with cognitive deficits
[39, 40], indicating that patients with more severe injuries
were more likely to develop dysphagia.
The study of patients with community-acquired pneu-
monia found that 9 out of 10 patients had OD, and sug-
gested that it should be considered an independent risk
factor for community-acquired pneumonia [15]. Interest-
ingly, 40 % of control subjects also had OD, demonstrating
that even apparently healthy elderly people are highly
susceptible to this condition.
Defining OD
In the studies included in this systematic review, various
methods were used to evaluate the presence of dysphagia,
which will have had a major influence on epidemiological
estimates due to their differing sensitivities and specificities.
For example, notably low prevalence of dysphagia
(8.1–17.8 %) was found in a large retrospective database
study of stroke patients, which used International Classifi-
cation of Diseases, Ninth Revision (ICD-9) codes to identify
dysphagia [10]. In this study, the authors acknowledged that
the use of ICD-9 codes may have resulted in underestimation
of the prevalence of dysphagia because dysphagia is often
C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
diagnosed by the speech-language pathologist or nurse, and
may not be reflected in the diagnostic coding. In addition,
because coding for dysphagia does not affect reimbursement
for the institution, it is less likely to have been recorded. In
the remaining four stroke studies judged to be of good
quality, between 32 and 45.3 % of patients were reported to
have dysphagia. Of the 24 stroke studies identified, 11
reported estimates between 30 and 50 %.
In the studies of Parkinson’s disease judged to be of
good quality, the use of a swallowing disturbance ques-
tionnaire [14] and patient reports of choking on swallowing
[13] resulted in disparate reports of dysphagia (11 and
60 %, respectively). This is likely because while one study
reported dysphagia prevalence at baseline [14], the other
reported dysphagia incidence over a mean of 11 years
follow-up, and will therefore have included subjects with
more advanced Parkinson’s disease [13].
Studies that used less sensitive methods will not have
identified patients who aspirated without clinically overt
signs (‘silent aspirators’), and will therefore have under-
estimated the prevalence of OD. The subjective nature of
methods used to evaluate dysphagia was illustrated in two
studies of Parkinson’s disease, which both used the Chi-
cago Assessment Scale [44]; however, they reported dis-
parate prevalences of 30 % [36] and 81 % [37]. Coates
et al. [37] commented that although they reported a high
prevalence, most patients were mildly affected, which may
therefore account for the higher prevalence estimate.
Limitations
Seven of the included studies specifically focused on OD,
whereas the majority of studies only required evidence of
impaired swallowing as a sign of dysphagia. Although
studies specifically investigating oesophageal dysphagia
were excluded, this lack of detail limits interpretation of
the findings of this review and highlights the need for a
standardized, validated method for detecting OD.
To explore the epidemiology of OD, we included studies
reporting both incidence and prevalence; however, this can
have important implications for interpretation of findings.
The majority of studies reporting incidence were of stroke
patients who developed dysphagia within hours/days post-
stroke, and did not find different frequencies of dysphagia
to those that reported prevalence in acute stroke patients
(27–57 vs. 8.2–80 %, respectively). Therefore, the wide
range of estimates are likely to be due to methodological
discrepancies rather than the differences between incidence
rate and prevalence.
This review was limited by the study country. However, the
countries included were chosen to cover a range of different
geographies and cultures, and to include the regions that are
most active in this field based on our previous experience.
439
As we were not able to assess study quality using a
validated standardized tool, we developed a rating system
based on the STROBE checklist. Due to study design,
many of the studies included had some degree of selection
bias because patients who were referred for further
assessment for dysphagia had already shown signs of
swallowing problems, and were therefore not truly repre-
sentative of the whole patient population.
In conclusion, despite the many discrepancies regarding
dysphagia definition and stage of underlying disease, this
systematic review identified considerable evidence that dys-
phagia is highly prevalent in these patient populations,
affecting 8.1–80 % of stroke patients, 11–60 % of Parkin-
son’s disease patients, 91 % of elderly community-acquired
pneumonia patients, and approximately 30 % of patients with
brain injuries. This review also identified the gap in current
research of OD in Alzheimer’s disease and the need for further
high-quality research in Parkinson’s disease, traumatic brain
injury, and community-acquired pneumonia to elucidate more
accurate estimates of OD frequency in these populations. The
wide range of dysphagia estimates illustrate how current
understanding of OD prevalence is limited by the variety of
methods used to detect dysphagia, and emphasize the need for
an reliable, standardized, and validated method for detecting
OD. Given the high prevalence, serious associated compli-
cations, and costs to healthcare, systematic screening of at-risk
populations, such as acute stroke patients, should be central to
healthcare strategies to improve early intervention and clinical
outcomes in these patient populations.
Acknowledgments CT determined the study concept and design.
JK contributed to the searches, selected the references, and carried out
the data extraction and quality assessment. JK and EG carried out the
analysis and interpretation of the data, with input from CT and RS.
EG drafted the manuscript with critical revision for important intel-
lectual content from CT and RS. We would also like to acknowledge
Sheila Ubamadu who carried out the systematic searches.
Funding This work was funded by Nestlé Health Science.
Compliance with Ethical Standards
Disclosures Claire Takizawa is an employee of Nestlé Health Sci-
ence. Elizabeth Gemmell and at the time of submission James Ken-
worthy, are employed by PHMR Ltd. and Nestle Health Science
funded the research that is reported in this paper. Renée Speyer has
received funding from industry Nestlé Health Science, Fresenius-
Kabi, Nutricia, Speech Pathology Australia, the European Society for
Swallowing Disorders, and the Korean Dysphagia Society.
References
1. Rofes L, Arreola V, Almirall J, Cabré M, Campins L, Garcı́a-
Peris P, et al. Diagnosis and management of oropharyngeal
dysphagia and its nutritional and respiratory complications in the
elderly. Gastroenterol Res Pract. 2011. doi:10.1155/2011/818979.
123
440 C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia
2. Stechmiller JK. Early nutritional screening of older adults: review
of nutritional support. J Infus Nurs. 2003;26:170–7.
3. Marik PE, American College of Chest Physicians. Aspiration
pneumonia and dysphagia in the elderly. Chest. 2003;124:328–36.
4. Johnston BT, Li Q, Castell JA, Castell DO. Swallowing and
esophageal function in Parkinson’s disease. Am J Gastroenterol.
1995;90:1741–6.
5. Kalia M. Dysphagia and aspiration pneumonia in patients with
Alzheimer’s disease. Metabolism. 2003;52:36–8.
6. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J.
2006;82:383–91.
7. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC,
Vandenbroucke JP. Strengthening the Reporting of Observational
Studies in Epidemiology (STROBE) statement: guidelines for
reporting observational studies. BMJ. 2007;335:806–8.
8. Crary MA, Carnaby GD, Sia I, Khanna A, Waters MF. Sponta-
neous swallowing frequency has potential to identify dysphagia
in acute stroke. Stroke. 2013;44:3452–7.
9. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A,
et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis,
and clinical predictors in patients admitted to a neurorehabilita-
tion unit. J Stroke Cerebrovasc Dis. 2009;18:329–35.
10. Gonzalez-Fernandez M, Kuhlemeier KV, Palmer JB. Racial
disparities in the development of dysphagia after stroke: analysis
of the California (MIRCal) and New York (SPARCS) inpatient
databases. Arch Phys Med Rehabil. 2008;89:1358–65.
11. Kopey SA, Chae J, Vargo MM. Does a 3-sip test detect dysphagia
in acute stroke rehabilitation patients? PM R. 2010;2:822–8.
12. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner
DL, et al. The Toronto Bedside Swallowing Screening Test
(TOR-BSST): development and validation of a dysphagia
screening tool for patients with stroke. Stroke. 2009;40:555–61.
13. Auyeung M, Tsoi TH, Mok V, Cheung CM, Lee CN, Li R, et al.
Ten year survival and outcomes in a prospective cohort of new
onset Chinese Parkinson’s disease patients. J Neurol Neurosurg
Psychiatry. 2012;83:607–11.
14. Barichella M, Cereda E, Madio C, Iorio L, Pusani C, Cancello R,
et al. Nutritional risk and gastrointestinal dysautonomia symp-
toms in Parkinson’s disease outpatients hospitalised on a sched-
uled basis. Br J Nutr. 2013;110:347–53.
15. Almirall J, Rofes L, Serra-Prat M, Icart R, Palomera E, Arreola
V, et al. Oropharyngeal dysphagia is a risk factor for community-
acquired pneumonia in the elderly. Eur Respir J. 2013;41:923–8.
16. Barer DH. The natural history and functional consequences of
dysphagia after hemispheric stroke. J Neurol Neurosurg Psychi-
atry. 1989;52:236–41.
17. Bravata DM, Daggett VS, Woodward-Hagg H, Damush T, Plue
L, Russell S, et al. Comparison of two approaches to screen for
dysphagia among acute ischemic stroke patients: nursing
admission screening tool versus National Institutes of Health
stroke scale. J Rehabil Res Dev. 2009;46:1127–34.
18. Brody RA, Touger-Decker R, VonHagen S, Maillet JO. Role of
registered dietitians in dysphagia screening. J Am Diet Assoc.
2000;100:1029–37.
19. Cecconi E, Palumbo M, Suardelli M, Di Clemente L, Toscano M,
Bertora P, et al. Post-stroke dysphagia: clinical, cognitive and
neuroanatomical correlates. Cerebrovasc Dis. 2010;29:294.
20. Cecconi E, Campiglio L, Toscano M, Petolicchio B, Capiluppi E,
Bertora PL, et al. Leukoaraiosis and stroke severity as indepen-
dent predictors of post-stroke dysphagia. Eur J Neurol.
2011;18:38.
21. Chumbler N. Demographic and clinical risk factors for dysphagia
in acute stroke patients. Stroke. 2009;40:e276.
123
22. Cola MG, Daniels SK, Corey DM, Lemen LC, Romero M,
Foundas AL. Relevance of subcortical stroke in dysphagia.
Stroke. 2010;41:482–6.
23. Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R,
Miller L, Silliman S. Dysphagia, nutrition, and hydration in
ischemic stroke patients at admission and discharge from acute
care. Dysphagia. 2012;28:69–76.
24. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg
LA, Foundas AL. Aspiration in patients with acute stroke. Arch
Phys Med Rehabil. 1998;79:14–9.
25. Daniels SK, Schroeder MF, McClain M, Corey DM, Rosenbek
JC, Foundas AL. Dysphagia in stroke: development of a standard
method to examine swallowing recovery. J Rehabil Res Dev.
2006;43:347–56.
26. Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Foundas
AL, Rosenbek JC. Defining and measuring dysphagia following
stroke. Am J Speech Lang Pathol. 2009;18:74–81.
27. Finestone HM, Greene-Finestone LS, Wilson ES, Teasell RW.
Malnutrition in stroke patients on the rehabilitation service and at
follow-up: prevalence and predictors. Arch Phys Med Rehabil.
1995;76:310–6.
28. Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke.
BMJ. 1987;295:411–4.
29. Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF,
Myint PK. Effect of dysphasia and dysphagia on inpatient mor-
tality and hospital length of stay: a database study. J Am Geriatr
Soc. 2009;57:2101–6.
30. Heckert KD, Komaroff E, Adler U, Barrett AM. Postacute ree-
valuation may prevent dysphagia-associated morbidity. Stroke.
2009;40:1381–5.
31. Stolzenburg J, Herrmann O, Hacke W, Gaugel D, Ringleb PA.
Prevalence and outcome of dysphagia in patients with Wallen-
berg’s syndrome. Stroke. 2009;40:e105–276.
32. Teasell R, Foley N, Fisher J, Finestone H. The incidence, man-
agement, and complications of dysphagia in patients with
medullary strokes admitted to a rehabilitation unit. Dysphagia.
2002;17:115–20.
33. Turner-Lawrence DE, Peebles M, Price MF, Singh SJ, Asimos
AW. A feasibility study of the sensitivity of emergency physician
dysphagia screening in acute stroke patients. Ann Emerg Med.
2009;54:344–8.
34. Young EC, Durant-Jones L. Developing a dysphagia program in an
acute care hospital: a needs assessment. Dysphagia. 1990;5:
159–65.
35. Bine JE, Frank EM, McDade HL. Dysphagia and dementia in
subjects with Parkinson’s disease. Dysphagia. 1995;10:160–4.
36. Clarke CE, Gullaksen E, Macdonald S, Lowe F. Referral criteria
for speech and language therapy assessment of dysphagia caused
by idiopathic Parkinson’s disease. Acta Neurol Scand. 1998;97:
27–35.
37. Coates C, Bakheit AM. Dysphagia in Parkinson’s disease. Eur
Neurol. 1997;38:49–52.
38. Lam K, Lam FKY, Lau KK, Chan YK, Kan EYL, Woo J, et al.
Simple clinical tests may predict severe oropharyngeal dysphagia
in Parkinson’s disease. Mov Disord. 2007;22:640–4.
39. Field LH, Weiss CJ. Dysphagia with head injury. Brain Inj.
1989;3:19–26.
40. Winstein CJ. Neurogenic dysphagia. Frequency, progression, and
outcome in adults following head injury. Phys Ther. 1983;63:1992–7.
41. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W,
Smout AJPM. Chicago classification criteria of esophageal
motility disorders defined in high resolution esophageal pressure
topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65.
C. Takizawa et al.: A Systematic Review of the Prevalence of Oropharyngeal Dysphagia 441

42. Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat Claire Takizawa PharmD
M. Accuracy of the volume-viscosity swallow test for clinical
screening of oropharyngeal dysphagia and aspiration. Clin Nutr. Elizabeth Gemmell PhD
2008;27:806–15. James Kenworthy MSc
43. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell
R. Dysphagia after stroke: incidence, diagnosis, and pulmonary Renée Speyer PhD
complications. Stroke. 2005;36:2756–63.
44. Kennedy G, Pring T, Fawcus R. No place for motor speech acts in
the assessment of dysphagia Intelligibility and swallowing diffi-
culties in stroke and Parkinson’s disease patients. Eur J Disord
Commun. 1993;28:213–26.

123