Understanding the EAT-10 Questionnaire
The EAT-10, or Eating Assessment Tool-10, is a short, patient-reported survey designed to screen for swallowing difficulties, also known as dysphagia. In Parkinson's disease (PD), dysphagia is a significant and potentially dangerous non-motor symptom that can lead to malnutrition, dehydration, and aspiration pneumonia. The tool helps healthcare providers, such as speech-language pathologists and neurologists, to quickly identify patients who may need a more in-depth evaluation of their swallowing function.
The EAT-10 consists of 10 statements that the patient rates on a severity scale from 0 ('no problem') to 4 ('severe problem'). The total score, ranging from 0 to 40, provides a measure of the patient's perceived dysphagia severity.
The 10 Items of the EAT-10
The questionnaire assesses the emotional, physical, and functional impacts of swallowing issues. The 10 items are typically worded as follows:
- My swallowing problem has caused me to lose weight.
- My swallowing problem interferes with my ability to go out for meals.
- Swallowing liquids takes extra effort.
- Swallowing solids takes extra effort.
- Swallowing pills takes extra effort.
- Swallowing is painful.
- The pleasure of eating is affected by my swallowing.
- When I swallow, food sticks in my throat.
- I cough when I eat.
- Swallowing is stressful.
Why EAT-10 is Used in Parkinson's
For patients with PD, the EAT-10 is a valuable screening tool because it can detect problems that patients may not consciously perceive or report. PD often affects the nerve signals that control swallowing, and some patients may experience 'silent aspiration,' where food or liquid enters the airway without causing a cough or choke. Regular use of the EAT-10 can help clinicians monitor changes in swallowing ability over time and intervene early to prevent serious complications.
Benefits of EAT-10 in PD Management
- Early Detection: Can help identify swallowing problems in early and intermediate stages of PD, before they become severe.
- Simple and Fast: The questionnaire is easy for patients to complete and takes only a few minutes.
- Tracks Progress: Provides a repeatable measure to monitor changes in dysphagia severity over time and evaluate the effectiveness of treatment.
- Identifies Risk: Helps identify patients who may be at an increased risk of aspiration or pneumonia, flagging them for further, more objective testing.
- Non-invasive: Unlike instrumental swallowing evaluations like videofluoroscopy (VFSS), the EAT-10 is a non-invasive, self-report tool.
Limitations of EAT-10
While highly useful, the EAT-10 is a screening tool, not a diagnostic test. Studies have shown discrepancies between subjective reporting via the EAT-10 and objective findings from instrumental exams. Its accuracy can be affected by poor self-awareness of swallowing difficulties, which is common in PD. Therefore, a poor EAT-10 score is not a definitive diagnosis but a flag for further action. A study from 2021 even concluded that the EAT-10 alone is not suited for detecting penetration and aspiration in PD patients and should not be used as a primary screening method for aspiration risk in this specific population.
Comparison of Dysphagia Screening Tools for PD
| Feature | EAT-10 | Swallowing Clinical Assessment Score in PD (SCAS-PD) | Videofluoroscopic Swallowing Study (VFSS) |
|---|---|---|---|
| Type of Assessment | Patient-reported self-assessment questionnaire | Clinical assessment by a speech-language pathologist (SLP) | Instrumental, moving X-ray study |
| Invasiveness | Non-invasive | Non-invasive, but involves consuming different food consistencies | Invasive (exposure to radiation and barium) |
| Speed | Very quick (2-5 minutes) | Quick (approx. 5 minutes) | Longer (requires a hospital radiology setting) |
| Cost | Low cost | Low cost | High cost |
| Reliability in PD | Can have lower specificity in early-intermediate PD; patient awareness can be low | Has demonstrated good concordance with VFSS | Considered the gold standard for objective evaluation |
| Best Use Case | Initial screening and monitoring perceived changes over time | Clinical screening with specific signs, complements subjective report | Definitive diagnosis and detailed analysis of the swallow mechanism |
Managing Swallowing Problems in Parkinson's
When the EAT-10 or a clinical evaluation raises concerns about dysphagia, a speech-language pathologist (SLP) should conduct a comprehensive swallowing assessment, which may include instrumental exams like VFSS or Flexible Endoscopic Evaluation of Swallowing (FEES). Based on these findings, an individualized treatment plan is developed.
Treatment and Management Strategies
- Dietary Modifications: Adjusting the texture and consistency of food and liquids to make them easier and safer to swallow. Thickening liquids or using soft, moist foods are common strategies.
- Compensatory Techniques: Using specific postures or maneuvers during eating and drinking. Examples include chin tucks or turning the head to one side.
- Rehabilitative Exercises: Working with an SLP on exercises to strengthen muscles involved in swallowing.
- Medication Timing: For patients on levodopa, adjusting the timing of medication relative to meals can be critical, as protein can interfere with its absorption.
- Hydration and Nutrition: Ensuring adequate hydration and nutrition is maintained, especially if food intake is reduced.
Conclusion: The Importance of Proactive Screening
The EAT-10 is a simple yet effective screening tool that plays a crucial role in the proactive management of swallowing difficulties in Parkinson's disease. While not a definitive diagnostic test, its ability to quickly identify a patient's perception of their symptoms is invaluable for early intervention. A positive EAT-10 score is a call to action for further professional evaluation, which can lead to tailored treatment strategies that prevent serious complications like aspiration pneumonia. For those living with PD, being vigilant about swallowing changes and utilizing tools like the EAT-10 as part of routine care can significantly improve safety, quality of life, and overall health outcomes. Regular communication with a healthcare team, including an SLP, is the best approach to managing this complex and progressive symptom.
Visit the Michael J. Fox Foundation for additional resources on managing swallowing issues in PD
