Although it has often been considered a feature of late stage PD (Lieberman et al.,

1980), dysphagia has also been reported in early stages ofPD (Ali et al., 1996; Coates &

Bakheit, 1997; Stroudley & Walsh, 1991) and as a presenting symptom of the disease

(Croxson & Pye, 1988). These changes are of marked concern due to its association with

considerable morbidity from nutritional and pulmonary compromise (Ali et al., 1996;

Bassotti et al., 1998; Coates & Bakheit, 1997), as well as the possibility of death

(Kirshner, 1997; Stroudley & Walsh, 1991). In fact, aspiration pneumonia is the leading

cause of death in PD (Fernandez & Lapane, 2002; Gorell, Johnson, & Rybicki, 1994;

Hoehn & Yahr, 1967; Schiermier, Schafer, Schafer, Greulich, & Schlafke, 2001; Shill &

Stacy, 1998; Singer, 1992).

 The incidence of dysphagia in persons with PD is hard to define, with evidence of

swallow dysfunction reported between 18.5% to 100% of the patients studied (Ali et al.,

1996; Bassotti et al., 1998; Coates & Bakheit, 1997; Hunter et al., 1997; Logemann,

Blonsky, & Boshes, 1975; Stroudley & Walsh, 1991), depending on the criteria and

instrumentation used to diagnose dysphagia and the participant population selected. In

comparison, studies assessing patients' awareness of dysphagia have found only 15-50%

of these patients demonstrating signs of swallow dysfunction complain of dysphagia,

compared to 6-12% in age matched adults (Born et al., 1996; Logemann et al., 1975).

Therefore, many patients with PD are unaware of their swallowing dysfunction. In

addition, studies have found that as many as 15% of patients with PD who do not

complain of dysphagia do not recognize they are aspirating, termed silent aspiration (Ali

et al., 1996). It is this aspiration, in conjunction with a decreased cough strength and