Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Feinberg, Michael J.; Ekberg, Olle; Segall, Linda; Tully, Joann

doi:10.1148/radiology.183.3.1584939

Cited by 90 publications

(42 citation statements)

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“…Pneumonia can be precipitated by an episode of aspiration associated with dysphagia [32,33], a common sequela of dementia [34,35,36]. While dysphagia is most commonly reported in patients with advanced dementia [32,33], it has also been observed in patients in the earlier, milder stages of disease progression [37]. Gastro-oesophageal reflux may also contribute to the development of pneumonia, particularly when enteral feeding tubes are used in the management of dysphagia [38].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis Examining Pneumonia-Associated Mortality in Dementia

Foley

Affoo

Martin³

2014

Dement Geriatr Cogn Disord

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Background: Although it is generally accepted that deaths associated with pneumonia are more common in patients with dementia, no comprehensive reviews on the subject have previously been published. Summary: Relevant studies were identified through a literature search of the PubMed, EMBASE, Scopus, and ISI Web of Science databases for publications up to August 2013. Studies were included if (1) a group of adult subjects with dementia and a (comparison) group composed of subjects without dementia were included, (2) the cause(s) of death was/were reported, and (3) pneumonia was identified as one of the possible causes of death. The occurrence of death due to pneumonia associated with dementia was expressed as an odds ratio (OR) with 95% confidence interval (CI). Thirteen studies were included. The odds of death resulting from pneumonia were significantly increased for persons with any form of dementia compared with those without dementia (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). In a subgroup analysis, using the results from 8 studies that restricted inclusion to persons with Alzheimer's disease, the odds of death resulting from pneumonia were also significantly higher (OR = 1.70, 95% CI 1.12-2.58, p = 0.013). Key Messages: The odds of pneumonia-associated mortality were increased more than 2-fold for patients with dementia. © 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis Examining Pneumonia-Associated Mortality in Dementia

Foley

Affoo

Martin³

2014

Dement Geriatr Cogn Disord

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“…Signs of laryngeal dysfunction, such as an overall rating of the presence or absence of dysphonia, have been identified in several studies (Daniels et al, 1998;Horner et al, 1993;Horner et al, 1990;Horner et al, 1988;Linden et al, 1993). Additional signs linked to aspiration in adults with neurologic etiologies are the presence of dysarthria (Daniels et al, 1998;Hartelius & Svensson, 1994), depressed mental status (Chokshi, Asper, & Khandheria, 1986;Feinberg, Ekberg, Segall, & Tully, 1992), cough after the swallow (Daniels et al, 1998;Logemann et al, 1999), voice change after the swallow (Daniels et al, 1998;Logemann et al, 1999), reduced laryngeal elevation (Logemann et al, 1999), multiple swallows per bolus (Logemann et al, 1999), difficulty managing secretions (Linden et al, 1993), and choking during the ''3-oz swallow test'' (DePippo, Holas, & Reding, 1992). A history of pneumonia may also predict aspiration on VFSE (Cogen & Weinryb, 1989;Logemann et al, 1999).…”

Section: Utility Of Clinical Swallowing Examination Measures For Detementioning

confidence: 99%

Utility of Clinical Swallowing Examination Measures for Detecting Aspiration Post-Stroke

McCullough

Rosenbek

Wertz

et al. 2005

J Speech Lang Hear Res

147

112

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The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that investigation as well as with other research on CSEs. The results suggest that clinicians can make an accurate judgment of the occurrence of aspiration in most poststroke patients. However, ruling out aspiration when it is absent appears more problematic. More work needs to be done if data collected from noninstrumented examinations are to be strongly predictive of the presence and absence of aspiration on VFSE. At present, there are no data to suggest that CSEs can be used to quantify aspiration or make adequate recommendations regarding patient care.

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“…Oropharyngeal dysphagia impacts 1 in 25 adults in the United States [9] and is a consequence of many disease processes, such as Parkinson disease [10], amyotrophic lateral sclerosis [11], stroke [12], dementia [13], head and neck cancer [14], and age-related muscle degeneration [15]. Dysphagia is a risk factor for malnutrition, dehydration, aspiration pneumonia, and death [16,17].…”

Section: Introductionmentioning

confidence: 99%

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Jones

Meisner

Broadfoot

et al. 2018

Front. Appl. Math. Stat.

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Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter (UES) reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3-10 consecutive swallows had no overall difference in variability, but sets of two swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

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Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Cited by 90 publications

References 0 publications

A Systematic Review and Meta-Analysis Examining Pneumonia-Associated Mortality in Dementia

A Systematic Review and Meta-Analysis Examining Pneumonia-Associated Mortality in Dementia

Utility of Clinical Swallowing Examination Measures for Detecting Aspiration Post-Stroke

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

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