Enteral Nutrition in Idiopathic Parkinson's Disease and Atypical Parkinsonism: A Systematic Review

BACKGROUND: Dysphagia and malnutrition are common in advanced Parkinson's disease and atypical parkinsonism. There is a lack of evidence to guide the use of enteral nutrition in these situations, including whether it improves survival or reduces aspiration pneumonia. OBJECTIVES: To systematically review the impact of enteral nutrition in Parkinson's disease and atypical parkinsonism on survival and morbidity (including aspiration pneumonia). METHODS: We followed PRISMA guidelines and conducted searches using PubMed and Scopus databases. ROBINS-I V2 (n = 2) and JBI Cohort Study (n = 14) checklists were used to assess risk of bias. RESULTS: We identified 16 eligible studies. Risk of bias was moderate or high in all studies. Reported enteral feeding rates in parkinsonian disorders varied widely. The rate of aspiration pneumonia following enteral feeding was around 40% in those with parkinsonism. The weighted median survival following gastrostomy insertion in Parkinson's disease was 1.35 years (n = 83; 3 studies) and in atypical parkinsonism 1.49 years (n = 46; 2 studies). One study in atypical parkinsonism found improved survival with enteral feeding compared to at-risk feeding (24 vs. 12 months), whilst another in Parkinson's disease found no difference in mortality rates. CONCLUSIONS: There is a lack of high-quality evidence on the impact of enteral feeding on prognosis and morbidity. It is unclear whether enteral feeding improves survival compared to at-risk feeding. There is a need for more robust evidence such as through enteral feeding registries with standardized data collection.