Feature articleDementia and Dysphagia
Section snippets
Dysphagia
Dysphagia is the term used to describe disordered swallowing regardless of etiology. Logemann18 explained dysphagia as difficulty moving food from the mouth to the stomach and includes problems with “behavioral, sensory, and preliminary motor acts in preparation for the swallow, as well as cognitive awareness of the upcoming eating situation, visual recognition of food, and all of the physiologic responses to the smell and presence of food (pg 1).” For example, sensory damage can produce
Dysphagia and Dementia
When present, dysphagia predisposes individuals with dementia to dehydration, malnutrition, weight loss, and aspiration pneumonia.48, 49, 50 Aspiration of food and or secretions may predispose individuals to respiratory complications, aspiration pneumonia, and possibly death.51 With loss of vitality, dementia patients may become more dependent on others for care and more susceptible to depression. Because depression is frequently associated with loss of appetite, a vicious cycle may develop
Summary
See Table 1 for a summary of important points discussed in this article.
Swallowing is the safe and efficient movement of a bolus from the mouth to the stomach without aspiration. Like many physiologic functions, swallowing is subserved by a neural network that involved cortex, subcortical areas, brainstem, and cranial nerves. Age-related changes in sensation, dentition, and muscle strength make swallowing less efficient and problematic in many older neurologically adults. Dysphagia is the term
CARYN EASTERLING, PhD, CCC, BRS-S is an assistant professor with the Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.
References (95)
- et al.
Oropharyngeal swallowing in normal adults of different ages
Gastroenterology
(1992) - et al.
Lesion site in unilateral stroke patients with dysphagia
J Stroke Cerebrovas Dis
(1996) Effects of aging on the swallowing mechanism
Otolaryngol Clin North Am
(1990)- et al.
Laryngo-upper esophageal sphincter contractile reflex in humans deteriorates with age
Gastroenterology
(2004) - et al.
Effect of aging, position, and temperature on the threshold volume triggering pharyngeal swallows
Gastroenterology
(1994) - et al.
Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients
Arch Phys Med Rehabil
(1993) - et al.
Shape, volume and content of the deglutitive pharyngeal chamber imaged by ultrafast computerized tomography
Gastroenterology
(1993) - et al.
Swallowing disorders in the elderly
Clin Geriatr Med
(1991) The neuropsychology of olfaction in Alzheimer's disease
Neurobiol Aging
(1986)- et al.
Anorexia in the elderly
Neurobiol Aging
(1988)
Nutritional factors relevant to Alzheimer's disease
J Am Diet Assoc
Swallowing difficulty in Parkinson's disease
Clin Neurol Neurosurg
Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke
J Commun Disord
Assessing problem feeding behaviors in mid-stage Alzheimer's disease
Geriatr Nurs
Use of tube feeding to prevent aspiration pneumonia
Lancet
Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison
J Am Med Dir Assoc
Radiologic assessment of abnormal oral and pharyngeal phasese of swallowing
AJR Am J Roentgenol
Physiology and radiology of the normal oral and pharyngeal phases of swallowing
AJR Am J Roentgenol
Food transport and bolus formation during complete feeding sequences on foods of different initial consistency
Dysphagia
Coordination of mastication and swallowing
Dysphagia
Aspiration after stroke: lesion analysis by brain MRI
Dysphagia
Swallowing after unilateral stroke of the cerebral cortex: preliminary experience
Dysphagia
The role of the insular cortex in dysphagia
Dysphagia
Lesion localization in acute stroke patients with risk of aspiration
J Neuroimaging
Cerebral cortical representation of reflexive and volitional swallowing in humans
Am J Physiol Gastrointest Liver Physiol
Cerebral cortical representation of automatic and volitional swallowing in humans
J Neurophysiol
Parallel cortical networks for volitional control of swallowing in humans
Exp Brain Res
Cortical activation during human volitional swallowing: an event-related fMRI study
Am J Physiol Gastrointest Liver Physiol
Identification of the cerebral loci processing human swallowing with H2 15 O PET activation
J Neurophysiol
Swallow related cerebral cortical activity maps are not specific to deglutition
Am J Physiol Gastrointest Liver Physiol
Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study
J Neurophysiol
Evaluation and treatment of swallowing disorders
Swallowing in Alzheimer's disease
Alzheimer Dis Assoc Disord
Prevalence of subjective dysphagia in community residents aged over 87
BMJ
Prandial aspiration and pneumonia in an elderly population followed over 3 years
Dysphagia
The prevalence of swallowing disorders in two teaching hospitals
Dysphagia
Silent aspiration following stroke
Neurology
Prevalence of swallowing complaints and clinical findings among 50-70 year old men and women in an urban population
Dysphagia
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota
Gastroenterology
Oropharyngeal dysphagia in the elderly
Clin Geriat Med
Mealtime difficulties in a home for the aged: not just dysphagia
Dysphagia
The impact of swallowing disorders in the elderly
Ann Acad Med Singapore
Quantitative aspects of swallowing in an elderly nondysphagic population
Dysphagia
Age effects on lingual pressure generation as a risk factor for dysphagia
J Gerontol
Age-related changes in pharyngeal and supraglottic sensation
Ann Otol Rhinol Laryngol
Nutritional support of the dysphagic patient: methods, risks and complications of therapy
J Parenter Enteral Nutr
The effect of the loss of teeth on diet and nutrition
Int Dent J
Cited by (141)
Thirstiness, body hydration and thickened water: A study about their relationship
2023, Food Quality and PreferenceSarcopenic dysphagia in institutionalised older adults
2021, Endocrinologia, Diabetes y NutricionEating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding
2024, International Psychogeriatrics
CARYN EASTERLING, PhD, CCC, BRS-S is an assistant professor with the Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.
ELIZABETH ROBBINS, MA is a research assistant, Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI.