Relationship Between EAT-10 Scores, Pharyngeal Residue Severity, and Penetration-Aspiration in Individuals With Idiopathic Parkinson's Disease: A FEES-Based Correlation and Discriminative Performance Study.

backgroundDysphagia is common in individuals with Idiopathic Parkinson's Disease (IwIPD) and affects both swallowing safety and efficiency. Pharyngeal residue and penetration-aspiration are key impairments associated with dysphagia in this population, yet their relationship across different bolus consistencies and volumes remains incompletely understood. The clinical role of patient-reported outcome measures, such as the Eating Assessment Tool-10 (EAT-10), in relation to instrumental swallowing findings also requires further investigation. This study aimed (1) to examine the relationship between pharyngeal residue and penetration-aspiration across different bolus consistencies and volumes in IwIPD, and (2) to evaluate the discriminative performance of the EAT-10 against FEES findings related to these swallowing impairments.

methodsNinety-seven IwIPD were included. Participants completed the EAT-10 and underwent Flexible Endoscopic Evaluation of Swallowing (FEES). Ten swallowing trials were conducted using boluses of varying consistencies and volumes prepared according to the International Dysphagia Diet Standardisation Initiative (IDDSI). FEES recordings were independently rated by three clinicians using the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS).

resultsLarger bolus volumes were associated with higher residue severity and PAS scores across planned within-consistency comparisons. Significant correlations were observed between PAS scores and both EAT-10 and YPRSRS scores across consistencies and volumes (ρ = 0.56-0.91, p < 0.01). The EAT-10 showed discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration across swallowing trials. Interrater reliability for YPRSRS and PAS ratings ranged from 0.58 to 0.87. Vallecular residue was highest for regular solid, while PAS scores were highest for thin liquid at 20 mL.

conclusionIn IwIPD, swallowing efficiency was strongly associated with swallowing safety across different bolus consistencies and volumes. EAT-10 scores showed discriminative performance against FEES findings; however, the EAT-10 should be interpreted as a patient-reported screening measure rather than a diagnostic test for physiological swallowing impairment. Comprehensive FEES protocols incorporating a range of bolus consistencies and volumes may support more accurate assessment and individualized dysphagia management in this population. WHAT THIS PAPER ADDS: What is already known on this subject Dysphagia is highly prevalent in individuals with Idiopathic Parkinson's Disease (IwIPD) and may involve impairments in both swallowing safety and swallowing efficiency, including pharyngeal residue, penetration, and aspiration. Bolus consistency and volume are known to influence swallowing performance. Patient-reported outcome measures, such as the Eating Assessment Tool-10 (EAT-10), are widely used in dysphagia screening, but they cannot replace instrumental swallowing assessment. What this study adds to existing knowledge This study demonstrates a strong relationship between pharyngeal residue severity and penetration-aspiration across different IDDSI-defined bolus consistencies and volumes in IwIPD. The findings show that larger bolus volumes were associated with greater pharyngeal residue severity and higher PAS scores, while swallowing outcomes varied across consistencies and anatomical residue sites. The study also shows that EAT-10 scores demonstrated discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration, while highlighting the need for cautious interpretation of EAT-10 cut-off values in this population. What are the potential or actual clinical implications of this study? The findings support the importance of evaluating both swallowing safety and swallowing efficiency during instrumental assessment in IwIPD. The EAT-10 may help guide referral decisions for further instrumental swallowing assessment, but it should not be interpreted as a diagnostic test for physiological swallowing impairment. FEES protocols incorporating a range of bolus consistencies and volumes may support more comprehensive clinical characterization of dysphagia and individualized management in this population.