Abordaje de la disfagia en enfermos de alzhéimer

Abstract

Palabras clave:Alzheimer. Disfagia. Multidisciplinar. Revisión sistemática. Key words:Alzheimer. Dysphagia. Multidisciplinary. Systematic review. AbstractIntroduction: Dysphagia is a symptom that refers to the inability to move the bolus from the mouth to the stomach. Despite its importance and the severity of possible complications it is relatively little known and studied. The prevalence of oropharyngeal dysphagia in Alzheimer patients is up to 84% and it may cause complications with great clinical signifi cance due to alterations in swallowing effi ciency and security. Aim: To know the current state of knowledge regarding the integrated approach of dysphagia in Alzheimer patients, fi nding the factors that enable an early diagnosis to facilitate the prevention of complications and to choose the pattern most appropriate action. Methodology: Systematic review of papers published English and Spanish between 2005 and 2014. Databases consulted: PubMed, Cochrane, Scopus, Elsevier, Scielo and Dialnet. Mesh terms used: disfagia, dysphagia, alzheimer, and texture modifi ed food. Results: The diagnosis of dysphagia in Alzheimer patients is performed using clinical methods and complementary examinations such as videofl uoroscopy, considered to be the gold standard for the study of oropharyngeal dysphagia, detecting from 1/3 to 1/4 of the cases, who could present no diagnosable clinically silent aspiration. There are therapeutic strategies that include changes in bolus volume and viscosity, postural changes, deglutition maneuvers, rehabilitation procedures and increase sensory techniques that have proved effective, but it is a complex task that requires a multidisciplinary approach for a correct diagnosis and treatment to improve the quality of life of these patients. Conclusions: There is a lack of scientifi c evidence in addressing dysphagia and of knowledge about the feeding and nutrition of these patients. This condition requires a multidisciplinary intervention where dietary measures play a major role.

Atendimento fonoaudiológico para pacientes em cuidados paliativos com disfagia orofaríngea

“…According to the authors, the prevalence of fluid aspiration decreased significantly when thickened, being a highly effective strategy, as it does not require cognitive integrity. It is also noted that the diet modification technique is indicated to avoid asphyxia due to inefficient oral food preparation, which can be used at a time when the disease progresses, but must be performed together with a team of nutritionists, as it can decrease the individual's caloric and proteic intake (19) .…”

“…In most cases in which maneuvers and tactile-thermal stimulation were used, there was a decrease in changes in the oral phase and in the clinical signs of laryngeal penetration and/or laryngo-tracheal aspiration. In a literature review with dysphagic patients with Alzheimer's disease (19) , it was found that, besides the change in bolus consistency and volume, effective therapeutic measures in the treatment of this population included postural maneuvers, which tend to decrease the incidence of aspiration. In addition, tactile and thermal sensory stimuli assist the triggering of swallowing and can reduce aspirations.…”

“…Specific swallowing maneuvers, which aim to compensate for biomechanical changes, besides adjunctive therapy with transcutaneous electrostimulation, were also mentioned in the referred literature review. Despite the strategies described above, there is little scientific evidence and important gaps still remain regarding the clinical management of swallowing in Alzheimer's disease, which will require further investigation (19) .…”

A Disfagia No Envelhecimento Associada a Desnutrição E Desencadeamento De Transtornos Mentais

“…Contudo a se faz necessário um olhar de prevenção e intervenção precoce para assegurar um suporte nutricional adequado em consistência ou via alimentar segura para o idoso de modo a retardar o avanço da doença e promover maior qualidade de vida, para tanto é importante a abordagem multidisciplinar o que permitirá incluir as contribuições de diferentes domínios profissionais (44).…”

Estudo da deglutição em idosos portadores de demência devido á doença de Alzheimer e validação de protocolo de avaliação

“…A DA acarreta muitas alterações, inclusive na sua alimentação.Os distúrbios de alimentação podem manifestar-se por meio de uma série de sintomas, tais como: não aceitação do alimento, diminuição do apetite, alterações no paladar e no olfato, desordem na mastigação, dificuldade de iniciar a deglutição, regurgitação nasal, controle da saliva diminuído, tosse e engasgos durante as refeições, dor no peito, sensação de alimento parado na garganta. Podem apresentar também desidratação, tempo prolongado para realizar as refeições, perda de peso e pneumonia aspirativa ou quaisquer outros problemas pulmonares(SANTINI, 2001;GONZÁLEZ; RECIO, 2016).A prevalência da disfagia em idosos e que apresentam doenças neurológicas é alta.Nas doenças neurodegenerativas, até 84% dos pacientes com doença de Alzheimer podem ter disfagia e mais de 60% de indivíduos institucionalizados ou idosos podem apresentar alterações da deglutição(CLAVÉ et al, 2004). Muitos processos fisiológicos associados ao processo de envelhecimento alteram vários parâmetros da deglutição, porém ainda há divergências no que se refere envelhecimento saudável, se essas mudanças ocasionadas pela idade causam modificações que acarretam disfagias.…”