{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T10:16:39Z","timestamp":1790504199133,"version":"4.1.0"},"reference-count":63,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T00:00:00Z","timestamp":1606089600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T00:00:00Z","timestamp":1606089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Dysphagia is frequent in many neurological diseases and gives rise to severe complications such as malnutrition, dehydration and aspiration pneumonia. Therefore, early detection and management of dysphagia is essential and can reduce mortality. This study investigated the effect of cognitive and motor dual-task interference on swallowing in healthy participants, as dual-task effects are reported for other motor tasks such as gait and speech. 27 participants (17 females; 29.2\u2009\u00b1\u20094.1 years) were included in this prospective study and examined using flexible endoscopic evaluation of swallowing (FEES). Using a previously established FEES-based score, the paradigms \u201cbaseline swallowing\u201d, \u201ccognitive dual-task\u201d and \u201cmotor dual-task\u201d were assessed. Scores of the three paradigms were compared using a repetitive measures ANOVA and post-hoc analysis. Mean baseline swallowing score in single task was 5\u2009\u00b1\u20093. It worsened to 6\u2009\u00b1\u20095 in the cognitive (<jats:italic>p<\/jats:italic>\u2009=\u20090.118), and to 8\u2009\u00b1\u20095 in the motor dual-task condition (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). This change was driven by subclinical worsening of premature bolus spillage and pharyngeal residue. Oropharyngeal swallowing is not exclusively reflexive in nature but requires attention, which leads to motor dual-task interference. This has potential diagnostic and therapeutic implications, e.g. in the early screening for dysphagia or in avoiding dual-task situations while eating.<\/jats:p>","DOI":"10.1038\/s41598-020-77421-3","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T11:14:02Z","timestamp":1606130042000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Effects of cognitive and motor dual-tasks on oropharyngeal swallowing assessed with FEES in healthy individuals"],"prefix":"10.1038","volume":"10","author":[{"given":"Paul","family":"Muhle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Claus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bendix","family":"Labeit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mao","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Dziewas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Suntrup-Krueger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Warnecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,23]]},"reference":[{"key":"77421_CR1","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","volume":"36","author":"R Martino","year":"2005","unstructured":"Martino, R. et al. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 36, 2756\u20132763. https:\/\/doi.org\/10.1161\/01.STR.0000190056.76543.eb (2005).","journal-title":"Stroke"},{"key":"77421_CR2","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.parkreldis.2011.11.006","volume":"18","author":"JG Kalf","year":"2012","unstructured":"Kalf, J. G., de Swart, B. J. M., Bloem, B. R. & Munneke, M. Prevalence of oropharyngeal dysphagia in Parkinson\u2019s disease: A meta-analysis. Parkinson. Relat. Disord. 18, 311\u2013315 (2012).","journal-title":"Parkinson. Relat. Disord."},{"key":"77421_CR3","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1001\/archneur.64.1.58","volume":"64","author":"SE Langmore","year":"2007","unstructured":"Langmore, S. E., Olney, R. K., Lomen-Hoerth, C. & Miller, B. L. Dysphagia in patients with frontotemporal lobar dementia. Arch Neurol. 64, 58\u201362. https:\/\/doi.org\/10.1001\/archneur.64.1.58 (2007).","journal-title":"Arch Neurol."},{"key":"77421_CR4","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/WAD.0b013e318192a539","volume":"23","author":"MK Suh","year":"2009","unstructured":"Suh, M. K., Kim, H. & Na, D. L. Dysphagia in patients with dementia: Alzheimer versus vascular. Alzheimer Dis. Assoc. Disord. 23, 178\u2013184 (2009).","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"77421_CR5","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s10072-015-2067-7","volume":"36","author":"XL Guan","year":"2015","unstructured":"Guan, X. L., Wang, H., Huang, H. S. & Meng, L. Prevalence of dysphagia in multiple sclerosis: A systematic review and meta-analysis. Neurol. Sci. 36, 671\u2013681. https:\/\/doi.org\/10.1007\/s10072-015-2067-7 (2015).","journal-title":"Neurol. Sci."},{"key":"77421_CR6","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s00455-011-9384-7","volume":"27","author":"PC Langdon","year":"2012","unstructured":"Langdon, P. C., Mulcahy, K., Shepherd, K. L., Low, V. H. & Mastaglia, F. L. Pharyngeal dysphagia in inflammatory muscle diseases resulting from impaired suprahyoid musculature. Dysphagia 27, 408\u2013417 (2012).","journal-title":"Dysphagia"},{"key":"77421_CR7","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s00455-011-9338-0","volume":"27","author":"KP Mulcahy","year":"2012","unstructured":"Mulcahy, K. P., Langdon, P. C. & Mastaglia, F. Dysphagia in inflammatory myopathy: Self-report, incidence, and prevalence. Dysphagia 27, 64\u201369 (2012).","journal-title":"Dysphagia"},{"key":"77421_CR8","doi-asserted-by":"publisher","first-page":"441","DOI":"10.4065\/82.4.441","volume":"82","author":"TH Oh","year":"2007","unstructured":"Oh, T. H. et al. Dysphagia in inflammatory myopathy: Clinical characteristics, treatment strategies, and outcome in 62 patients. Mayo Clin. Proc. 82, 441\u2013447. https:\/\/doi.org\/10.4065\/82.4.441 (2007).","journal-title":"Mayo Clin. Proc."},{"key":"77421_CR9","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/s00405-017-4801-7","volume":"275","author":"EH de Lima Alvarenga","year":"2018","unstructured":"de Lima Alvarenga, E. H., Dall\u2019Oglio, G. P., Murano, E. Z. & Abrahao, M. Continuum theory: Presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur. Arch. Oto-rhino-laryngol. 275, 443\u2013449. https:\/\/doi.org\/10.1007\/s00405-017-4801-7 (2018).","journal-title":"Eur. Arch. Oto-rhino-laryngol."},{"key":"77421_CR10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s00455-017-9844-9","volume":"33","author":"E Jones","year":"2018","unstructured":"Jones, E. et al. Health-related quality of life and oropharyngeal dysphagia: A systematic review. Dysphagia 33, 141\u2013172. https:\/\/doi.org\/10.1007\/s00455-017-9844-9 (2018).","journal-title":"Dysphagia"},{"key":"77421_CR11","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1161\/STROKEAHA.116.015332","volume":"48","author":"RA Joundi","year":"2017","unstructured":"Joundi, R. A. et al. Predictors and outcomes of dysphagia screening after acute ischemic stroke. Stroke 48, 900\u2013906. https:\/\/doi.org\/10.1161\/STROKEAHA.116.015332 (2017).","journal-title":"Stroke"},{"key":"77421_CR12","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1093\/ageing\/afl149","volume":"36","author":"DG Smithard","year":"2007","unstructured":"Smithard, D. G., Smeeton, N. C. & Wolfe, C. D. Long-term outcome after stroke: Does dysphagia matter?. Age Ageing 36, 90\u201394. https:\/\/doi.org\/10.1093\/ageing\/afl149 (2007).","journal-title":"Age Ageing"},{"key":"77421_CR13","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s00455-001-0110-8","volume":"17","author":"R Teasell","year":"2002","unstructured":"Teasell, R., Foley, N., Fisher, J. & Finestone, H. The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Dysphagia 17, 115\u2013120. https:\/\/doi.org\/10.1007\/s00455-001-0110-8 (2002).","journal-title":"Dysphagia"},{"key":"77421_CR14","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000487811","volume":"45","author":"S Suntrup-Krueger","year":"2018","unstructured":"Suntrup-Krueger, S. et al. The effect of improved dysphagia care on outcome in patients with acute stroke: Trends from 8-year data of a large stroke register. Cerebrovasc. Dis. 45, 101\u2013108. https:\/\/doi.org\/10.1159\/000487811 (2018).","journal-title":"Cerebrovasc. Dis."},{"key":"77421_CR15","doi-asserted-by":"publisher","first-page":"e75719","DOI":"10.1371\/journal.pone.0075719","volume":"8","author":"MM Grube","year":"2013","unstructured":"Grube, M. M. et al. Influence of acute complications on outcome 3 months after ischemic stroke. PLoS\u00a0One 8, e75719. https:\/\/doi.org\/10.1371\/journal.pone.0075719 (2013).","journal-title":"PLoS\u00a0One"},{"key":"77421_CR16","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1136\/jnnp-2016-313356","volume":"88","author":"BD Bray","year":"2017","unstructured":"Bray, B. D. et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J. Neurol. Neurosurg. Psychiatry 88, 25\u201330. https:\/\/doi.org\/10.1136\/jnnp-2016-313356 (2017).","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"77421_CR17","first-page":"136","volume":"5","author":"RF Pfeiffer","year":"1998","unstructured":"Pfeiffer, R. F. Gastrointestinal dysfunction in Parkinson\u2019s disease. Clin. Neurosci. 5, 136\u2013146 (1998).","journal-title":"Clin. Neurosci."},{"key":"77421_CR18","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/j.1445-5994.2004.00764.x","volume":"35","author":"SJ Lynn","year":"2005","unstructured":"Lynn, S. J., Sawyers, S. M., Moller, P. W., O\u2019Donnell, J. L. & Chapman, P. T. Adult-onset inflammatory myopathy: North Canterbury experience 1989\u20132001. Intern. Med. J. 35, 170\u2013173. https:\/\/doi.org\/10.1111\/j.1445-5994.2004.00764.x (2005).","journal-title":"Intern. Med. J."},{"key":"77421_CR19","doi-asserted-by":"publisher","first-page":"R231","DOI":"10.1186\/cc10472","volume":"15","author":"M Macht","year":"2011","unstructured":"Macht, M. et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit. Care 15, R231. https:\/\/doi.org\/10.1186\/cc10472 (2011).","journal-title":"Crit. Care"},{"key":"77421_CR20","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/S1474-4422(15)00007-1","volume":"14","author":"A Fasano","year":"2015","unstructured":"Fasano, A., Visanji, N. P., Liu, L. W., Lang, A. E. & Pfeiffer, R. F. Gastrointestinal dysfunction in Parkinson\u2019s disease. Lancet Neurol. 14, 625\u2013639. https:\/\/doi.org\/10.1016\/S1474-4422(15)00007-1 (2015).","journal-title":"Lancet Neurol."},{"key":"77421_CR21","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.parkreldis.2010.07.004","volume":"16","author":"R Mehanna","year":"2010","unstructured":"Mehanna, R. & Jankovic, J. Respiratory problems in neurologic movement disorders. Parkinson. Relat. Disord. 16, 628\u2013638. https:\/\/doi.org\/10.1016\/j.parkreldis.2010.07.004 (2010).","journal-title":"Parkinson. Relat. Disord."},{"key":"77421_CR22","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1001\/archinte.164.16.1761","volume":"164","author":"PU Heuschmann","year":"2004","unstructured":"Heuschmann, P. U. et al. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: The German Stroke Registers Study Group. Arch. Intern. Med. 164, 1761\u20131768. https:\/\/doi.org\/10.1001\/archinte.164.16.1761 (2004).","journal-title":"Arch. Intern. Med."},{"key":"77421_CR23","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1378\/chest.124.1.328","volume":"124","author":"PE Marik","year":"2003","unstructured":"Marik, P. E. & Kaplan, D. Aspiration pneumonia and dysphagia in the elderly. Chest 124, 328\u2013336. https:\/\/doi.org\/10.1378\/chest.124.1.328 (2003).","journal-title":"Chest"},{"key":"77421_CR24","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1161\/01.STR.0000177529.86868.8d","volume":"36","author":"JA Hinchey","year":"2005","unstructured":"Hinchey, J. A. et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 36, 1972\u20131976. https:\/\/doi.org\/10.1161\/01.STR.0000177529.86868.8d (2005).","journal-title":"Stroke"},{"key":"77421_CR25","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s00455-005-0018-9","volume":"20","author":"D Ramsey","year":"2005","unstructured":"Ramsey, D., Smithard, D. & Kalra, L. Silent aspiration: What do we know?. Dysphagia 20, 218\u2013225. https:\/\/doi.org\/10.1007\/s00455-005-0018-9 (2005).","journal-title":"Dysphagia"},{"key":"77421_CR26","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s42466-019-0021-5","volume":"1","author":"R Dziewas","year":"2019","unstructured":"Dziewas, R. et al. Safety and clinical impact of FEES\u2014results of the FEES-registry. Neurol. Res. Pract. 1, 16. https:\/\/doi.org\/10.1186\/s42466-019-0021-5 (2019).","journal-title":"Neurol. Res. Pract."},{"key":"77421_CR27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.appet.2014.09.016","volume":"86","author":"CP Herman","year":"2015","unstructured":"Herman, C. P. The social facilitation of eating. A review. Appetite 86, 61\u201373. https:\/\/doi.org\/10.1016\/j.appet.2014.09.016 (2015).","journal-title":"Appetite"},{"key":"77421_CR28","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.dsx.2017.09.008","volume":"12","author":"S Ghobadi","year":"2018","unstructured":"Ghobadi, S. & Faghih, S. Eating breakfast and snacks while television viewing are associated with some cardio metabolic risk factors among Iranian children. Diabetes Metab. Syndr. 12, 235\u2013243. https:\/\/doi.org\/10.1016\/j.dsx.2017.09.008 (2018).","journal-title":"Diabetes Metab. Syndr."},{"key":"77421_CR29","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1016\/j.jand.2019.02.013","volume":"119","author":"AC Trofholz","year":"2019","unstructured":"Trofholz, A. C., Tate, A., Loth, K., Neumark-Sztainer, D. & Berge, J. M. Watching television while eating: Associations with dietary intake and weight status among a diverse sample of young children. J. Acad. Nutr. Diet 119, 1462\u20131469. https:\/\/doi.org\/10.1016\/j.jand.2019.02.013 (2019).","journal-title":"J. Acad. Nutr. Diet"},{"key":"77421_CR30","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1002\/mds.23060","volume":"25","author":"T Warnecke","year":"2010","unstructured":"Warnecke, T. et al. Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov. Disord. 25, 1239\u20131245. https:\/\/doi.org\/10.1002\/mds.23060 (2010).","journal-title":"Mov. Disord."},{"key":"77421_CR31","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1159\/000135652","volume":"26","author":"R Dziewas","year":"2008","unstructured":"Dziewas, R. et al. Towards a basic endoscopic assessment of swallowing in acute stroke\u2014development and evaluation of a simple dysphagia score. Cerebrovasc. Dis. 26, 41\u201347. https:\/\/doi.org\/10.1159\/000135652 (2008).","journal-title":"Cerebrovasc. Dis."},{"key":"77421_CR32","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1007\/s00415-008-0664-6","volume":"255","author":"T Warnecke","year":"2008","unstructured":"Warnecke, T. et al. Fiberoptic endoscopic evaluation of swallowing with simultaneous Tensilon application in diagnosis and therapy of myasthenia gravis. J. Neurol. 255, 224\u2013230. https:\/\/doi.org\/10.1007\/s00415-008-0664-6 (2008).","journal-title":"J. Neurol."},{"key":"77421_CR33","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00455-014-9549-2","volume":"29","author":"LW Baijens","year":"2014","unstructured":"Baijens, L. W., Speyer, R., Pilz, W. & Roodenburg, N. FEES protocol derived estimates of sensitivity: Aspiration in dysphagic patients. Dysphagia 29, 583\u2013590. https:\/\/doi.org\/10.1007\/s00455-014-9549-2 (2014).","journal-title":"Dysphagia"},{"key":"77421_CR34","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/bf02414429","volume":"2","author":"SE Langmore","year":"1988","unstructured":"Langmore, S. E., Schatz, K. & Olsen, N. Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia 2, 216\u2013219. https:\/\/doi.org\/10.1007\/bf02414429 (1988).","journal-title":"Dysphagia"},{"key":"77421_CR35","doi-asserted-by":"publisher","first-page":"918719","DOI":"10.1155\/2012\/918719","volume":"2012","author":"VE Kelly","year":"2012","unstructured":"Kelly, V. E., Eusterbrock, A. J. & Shumway-Cook, A. A review of dual-task walking deficits in people with Parkinson\u2019s disease: Motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons. Dis. 2012, 918719. https:\/\/doi.org\/10.1155\/2012\/918719 (2012).","journal-title":"Parkinsons. Dis."},{"key":"77421_CR36","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.neubiorev.2010.08.008","volume":"35","author":"E Al-Yahya","year":"2011","unstructured":"Al-Yahya, E. et al. Cognitive motor interference while walking: A systematic review and meta-analysis. Neurosci. Biobehav. Rev. 35, 715\u2013728. https:\/\/doi.org\/10.1016\/j.neubiorev.2010.08.008 (2011).","journal-title":"Neurosci. Biobehav. Rev."},{"key":"77421_CR37","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1044\/2018_JSLHR-S-MSC18-18-0146","volume":"62","author":"C Dromey","year":"2019","unstructured":"Dromey, C. & Simmons, K. Bidirectional interference between simulated driving and speaking. J. Speech Lang. Hear. Res. 62, 2053\u20132064. https:\/\/doi.org\/10.1044\/2018_JSLHR-S-MSC18-18-0146 (2019).","journal-title":"J. Speech Lang. Hear. Res."},{"key":"77421_CR38","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1515\/jbcpp-2013-0123","volume":"25","author":"E Kodesh","year":"2014","unstructured":"Kodesh, E. & Kizony, R. Measuring cardiopulmonary parameters during dual-task while walking. J. Basic Clin. Physiol. Pharmacol. 25, 155\u2013160 (2014).","journal-title":"J. Basic Clin. Physiol. Pharmacol."},{"key":"77421_CR39","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/mds.21720","volume":"23","author":"G Yogev-Seligmann","year":"2008","unstructured":"Yogev-Seligmann, G., Hausdorff, J. M. & Giladi, N. The role of executive function and attention in gait. Mov. Disord. 23, 329\u2013342. https:\/\/doi.org\/10.1002\/mds.21720 (2008) ((quiz 472)).","journal-title":"Mov. Disord."},{"key":"77421_CR40","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1007\/s00455-018-9961-0","volume":"34","author":"F Mozzanica","year":"2019","unstructured":"Mozzanica, F. et al. Effect of age, sex, bolus volume, and bolus consistency on whiteout duration in healthy subjects during FEES. Dysphagia 34, 192\u2013200. https:\/\/doi.org\/10.1007\/s00455-018-9961-0 (2019).","journal-title":"Dysphagia"},{"key":"77421_CR41","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1037\/\/0096-1523.29.1.3","volume":"29","author":"M Tombu","year":"2003","unstructured":"Tombu, M. & Jolicoeur, P. A central capacity sharing model of dual-task performance. J. Exp. Psychol. Hum. Percept Perform. 29, 3\u201318. https:\/\/doi.org\/10.1037\/\/0096-1523.29.1.3 (2003).","journal-title":"J. Exp. Psychol. Hum. Percept Perform."},{"key":"77421_CR42","first-page":"345","volume-title":"Functional Cerebral Space: A Model for Overflow Transfer and Interference Effects in Human Performance: A Tutorial Review. In Attention and Performance VII","author":"M Kingsbourne","year":"1978","unstructured":"Kingsbourne, M. Functional Cerebral Space: A Model for Overflow Transfer and Interference Effects in Human Performance: A Tutorial Review. In Attention and Performance VII 345\u2013362 (Lawrence Erlbaum, New Jersey, 1978)."},{"key":"77421_CR43","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1037\/0033-2909.116.2.220","volume":"116","author":"H Pashler","year":"1994","unstructured":"Pashler, H. Dual-task interference in simple tasks: Data and theory. Psychol. Bull. 116, 220\u2013244. https:\/\/doi.org\/10.1037\/0033-2909.116.2.220 (1994).","journal-title":"Psychol. Bull."},{"key":"77421_CR44","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1152\/physrev.2001.81.2.929","volume":"81","author":"A Jean","year":"2001","unstructured":"Jean, A. Brain stem control of swallowing: Neuronal network and cellular mechanisms. Physiol. Rev. 81, 929\u2013969 (2001).","journal-title":"Physiol. Rev."},{"key":"77421_CR45","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.bjorl.2015.08.006","volume":"81","author":"MS Lima","year":"2015","unstructured":"Lima, M. S., Mangilli, L. D., Sassi, F. C. & Andrade, C. R. Functional magnetic resonance and swallowing: Critical literature review. Braz. J. Otorhinolaryngol. 81, 671\u2013680. https:\/\/doi.org\/10.1016\/j.bjorl.2015.08.006 (2015).","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"77421_CR46","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/1471-2202-8-62","volume":"8","author":"IK Teismann","year":"2007","unstructured":"Teismann, I. K. et al. Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing. BMC Neurosci. 8, 62. https:\/\/doi.org\/10.1186\/1471-2202-8-62 (2007).","journal-title":"BMC Neurosci."},{"key":"77421_CR47","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s00455-002-0088-x","volume":"18","author":"M Suzuki","year":"2003","unstructured":"Suzuki, M. et al. Activation of cerebellum and basal ganglia on volitional swallowing detected by functional magnetic resonance imaging. Dysphagia 18, 71\u201377. https:\/\/doi.org\/10.1007\/s00455-002-0088-x (2003).","journal-title":"Dysphagia"},{"key":"77421_CR48","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1007\/s00455-009-9249-5","volume":"25","author":"NA Leopold","year":"2010","unstructured":"Leopold, N. A. & Daniels, S. K. Supranuclear control of swallowing. Dysphagia 25, 250\u2013257. https:\/\/doi.org\/10.1007\/s00455-009-9249-5 (2010).","journal-title":"Dysphagia"},{"key":"77421_CR49","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/0031512517742283","volume":"125","author":"T Dodderi","year":"2018","unstructured":"Dodderi, T., Philip, N. E. & Mutum, K. Effects of a dual swallow-attention task on swallow and cognitive performance measures. Percept. Mot. Skills 125, 109\u2013125. https:\/\/doi.org\/10.1177\/0031512517742283 (2018).","journal-title":"Percept. Mot. Skills"},{"key":"77421_CR50","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s00455-005-9007-2","volume":"21","author":"SK Daniels","year":"2006","unstructured":"Daniels, S. K., Corey, D. M., Fraychinaud, A., DePolo, A. & Foundas, A. L. Swallowing lateralization: The effects of modified dual-task interference. Dysphagia 21, 21\u201327. https:\/\/doi.org\/10.1007\/s00455-005-9007-2 (2006).","journal-title":"Dysphagia"},{"key":"77421_CR51","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s00455-011-9367-8","volume":"27","author":"MB Brodsky","year":"2012","unstructured":"Brodsky, M. B. et al. Effects of divided attention on swallowing in healthy participants. Dysphagia 27, 307\u2013317. https:\/\/doi.org\/10.1007\/s00455-011-9367-8 (2012).","journal-title":"Dysphagia"},{"key":"77421_CR52","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.parkreldis.2013.12.011","volume":"20","author":"MS Troche","year":"2014","unstructured":"Troche, M. S., Okun, M. S., Rosenbek, J. C., Altmann, L. J. & Sapienza, C. M. Attentional resource allocation and swallowing safety in Parkinson\u2019s disease: A dual task study. Parkinson. Relat. Disord. 20, 439\u2013443 (2014).","journal-title":"Parkinson. Relat. Disord."},{"key":"77421_CR53","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1007\/s00455-011-9381-x","volume":"27","author":"MB Brodsky","year":"2012","unstructured":"Brodsky, M. B. et al. Effects of divided attention on swallowing in persons with idiopathic Parkinson\u2019s disease. Dysphagia 27, 390\u2013400. https:\/\/doi.org\/10.1007\/s00455-011-9381-x (2012).","journal-title":"Dysphagia"},{"key":"77421_CR54","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s00455-018-9906-7","volume":"33","author":"H Reynolds","year":"2018","unstructured":"Reynolds, H., Miller, N. & Walker, R. Drooling in Parkinson\u2019s disease: Evidence of a role for divided attention. Dysphagia 33, 809\u2013817. https:\/\/doi.org\/10.1007\/s00455-018-9906-7 (2018).","journal-title":"Dysphagia"},{"key":"77421_CR55","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/s0966-6362(01)00141-2","volume":"14","author":"BR Bloem","year":"2001","unstructured":"Bloem, B. R., Valkenburg, V. V., Slabbekoorn, M. & Willemsen, M. D. The Multiple Tasks Test: Development and normal strategies. Gait Posture 14, 191\u2013202. https:\/\/doi.org\/10.1016\/s0966-6362(01)00141-2 (2001).","journal-title":"Gait Posture"},{"key":"77421_CR56","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.parkreldis.2016.03.007","volume":"26","author":"S Heinzel","year":"2016","unstructured":"Heinzel, S. et al. Motor dual-tasking deficits predict falls in Parkinson\u2019s disease: A prospective study. Parkinson. Relat. Disord. 26, 73\u201377 (2016).","journal-title":"Parkinson. Relat. Disord."},{"key":"77421_CR57","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1177\/000348940911800204","volume":"118","author":"SG Butler","year":"2009","unstructured":"Butler, S. G., Stuart, A. & Kemp, S. Flexible endoscopic evaluation of swallowing in healthy young and older adults. Ann. Otol. Rhinol. Laryngol. 118, 99\u2013106. https:\/\/doi.org\/10.1177\/000348940911800204 (2009).","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"77421_CR58","doi-asserted-by":"publisher","first-page":"564","DOI":"10.5535\/arm.2017.41.4.564","volume":"41","author":"SY Jo","year":"2017","unstructured":"Jo, S. Y., Hwang, J. W. & Pyun, S. B. Relationship between cognitive function and dysphagia after stroke. Ann. Rehabil. Med. 41, 564\u2013572. https:\/\/doi.org\/10.5535\/arm.2017.41.4.564 (2017).","journal-title":"Ann. Rehabil. Med."},{"key":"77421_CR59","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1017\/cjn.2015.304","volume":"42","author":"JS Kim","year":"2015","unstructured":"Kim, J. S. et al. Cognitive and motor aspects of Parkinson\u2019s disease associated with dysphagia. Can. J. Neurol. Sci. 42, 395\u2013400. https:\/\/doi.org\/10.1017\/cjn.2015.304 (2015).","journal-title":"Can. J. Neurol. Sci."},{"key":"77421_CR60","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1016\/0140-6736(90)92758-a","volume":"335","author":"K Sekizawa","year":"1990","unstructured":"Sekizawa, K., Ujiie, Y., Itabashi, S., Sasaki, H. & Takishima, T. Lack of cough reflex in aspiration pneumonia. Lancet 335, 1228\u20131229. https:\/\/doi.org\/10.1016\/0140-6736(90)92758-a (1990).","journal-title":"Lancet"},{"key":"77421_CR61","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13690","author":"B Labeit","year":"2019","unstructured":"Labeit, B. et al. FEES-based assessment of pharyngeal hypesthesia\u2014proposal and validation of a new test procedure. Neurogastroenterol. Motil. https:\/\/doi.org\/10.1111\/nmo.13690 (2019).","journal-title":"Neurogastroenterol. Motil."},{"key":"77421_CR62","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2016.04.034","author":"T Warnecke","year":"2016","unstructured":"Warnecke, T. et al. Levodopa responsiveness of dysphagia in advanced Parkinson\u2019s disease and reliability testing of the FEES-Levodopa-test. Parkinson. Relat. Disord. https:\/\/doi.org\/10.1016\/j.parkreldis.2016.04.034 (2016).","journal-title":"Parkinson. Relat. Disord."},{"key":"77421_CR63","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1177\/00131640021970961","volume":"60","author":"I Berkovits","year":"2000","unstructured":"Berkovits, I., Hancock, G. R. & Nevitt, J. Bootstrap resampling approaches for repeated measure designs: Relative robustness to sphericity and normality violations. Educ. Psychol. Meas. 60, 877\u2013892. https:\/\/doi.org\/10.1177\/00131640021970961 (2000).","journal-title":"Educ. Psychol. Meas."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-77421-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-77421-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-77421-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T00:03:35Z","timestamp":1670371415000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-77421-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,23]]},"references-count":63,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["77421"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-77421-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,23]]},"assertion":[{"value":"7 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20403"}}