Dysphagia is one of the most common and important complications in Huntington’s Disease (HD), frequently leading to aspiration pneumonia and mortality. Objective estimates of prevalence using instrumental diagnostics and data on neural correlates of dysphagia in HD are scarce or lacking entirely. Similarly, its correlation with other clinical markers is still not fully known.
We aimed at defining clinical risk factors and neural correlates for compromised swallowing safety in HD more precisely.
34 HD subjects (16f, Shoulson & Fahn stage I-IV, 2 pre-manifest) underwent a full clinical-neurological exam including the cranial nerves, the UHDRS total motor score and the Mini-Mental State Examination (MMSE). Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed by a trained Speech and Language Therapist. 26 subjects additionally underwent a high-resolution anatomical MRI scan (T1, 3 Tesla MRI Siemens Prisma). Moreover, we correlated clinical and atrophy (MRI) measures with swallowing safety levels as judged by the validated Penetration-Aspiration Scale.
FEES showed penetration or aspiration in 70.6%. Using partial correlation, no significant correlations were found between swallowing safety and any of the clinical markers after correcting for disease duration and CAG repeat length. Voxel-based morphometry demonstrated atrophy in a network of parieto-thalamo-cerebellar areas related to sensorimotor communication, notably excluding striatum, associated with compromised swallowing safety.
Our results characterize dysphagia in HD as a disorder of communication between sensory and motor networks involved in swallowing. This fact and high rates of silent aspiration argue in favor of instrumental swallowing evaluation early in the disease.

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