Dysphagia Caused by Neurologic Deficits

Dray, Todd G.; Hıllel, Allen D.; Miller, Robert M.

doi:10.1016/s0030-6665(05)70067-0

Cited by 52 publications

(27 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 6,12 Although cortical brain centers can initiate a voluntary swallow, these activities appear to be primarily modulatory because observations in stroke patients have demonstrated that removal of all cortical and subcortical stimulation above the level of the brainstem still allows a functional swallow with appropriate pharyngeal stimuli. 13 …”

Section: Discussionmentioning

confidence: 99%

Swallowing Disorders in the Elderly

Schindler¹,

2002

View full text Add to dashboard Cite

Changes that occur as a natural part of senescence in the complex action of deglutition predispose us to dysphagia and aspiration. As the "baby-boomers" begin to age, the onset of swallowing difficulties will begin to manifest in a greater number of our population. Recent advances in the evaluation of normal and abnormal swallowing make possible more precise anatomical and physiological diagnoses. Coupled with an understanding of swallowing physiology, such detailed evaluation allows greater opportunity to safely manage dysphagia with directed therapy and appropriate surgical intervention. The current study is a discussion of the changes that occur in deglutition with normal aging, contemporary evaluation of swallowing function, and some of the common causes of dysphagia in elderly patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Swallowing Disorders in the Elderly

Schindler¹,

2002

View full text Add to dashboard Cite

show abstract

“…They probably had difficulties because of their PD symptoms such as resting tremors, akinesia and bradykinesia. [20][21][22]25,26 Even though most PD patients complained of food impaction, few PD patients had knowledge about the interdental brush. Therefore, it is very important for PD patients to get appropriate dental health advice from a dentist or dental hygienist, especially from their own family dentists.…”

Section: Oral Health Behavior Of Pd Patientsmentioning

confidence: 99%

Oral Health Conditions in Patients with Parkinson's Disease

Nakayama

Washio

Mori

2004

Journal of Epidemiology

View full text Add to dashboard Cite

AnalysesWe compared the case group with the control group using the unconditional logistic regression model 17 adjusted for sex and age. The adjusted odds ratio (OR) and its 95% confidence interval (CI) were estimated. We also conducted stratified analysis by sex and age group using this model. The 2 test and the Cochran-MantelHaenzel test were used for simple and stratified analyses of knowledge of oral health among PD patients, respectively. Tests of statistical significance were based on two-sided P values, and the -error was set at the 5% level. The SAS ® system (ver. 8) was employed for the analysis. 17Results from a case-control study Table 2 shows results using the unconditional logistic regression model, in men and women after adjusting for age, and in young elderly (from 60 to 69 years old) and old elderly (over 70 years old) after adjusting for age and sex.As shown in Table 2, more PD patients complained of chewing difficulties (OR = 6.0, 95% CI:2.8-12.8) after adjustment for sex and age. After adjusting for age, more PD patients complained of them than controls among both men (OR = 14.5, 95% CI:3.0-69.1) and women (OR = 4.2, 95% CI:1.7-10.5). In addition, more PD patients complained of chewing difficulties (young: OR = 4.5, 95% CI:1.6-12.3; old: OR = 8.9, 95% CI:2.5-32.0) than controls in both young and old elderly.Persons without their own teeth were more commonly seen among the PD patients than in the control group adjusted for sex and age (OR = 3.5, 95%CI:1.8-6.8). PD patients more commonly lacked their own teeth than controls in both sexes after adjusting for age (men: OR = 3.6, 95% CI:1.0-12.0; women: OR = 3.5, 95% CI:1.6-7.7). Among the old elderly, those without their own teeth were more commonly seen among PD patients than controls after adjusting for age and sex (OR = 4.1, 95% CI:1.8-9.3).Among the young elderly, more PD patients complained of swollen gums than controls after adjusting for age and sex.There were no differences between the two groups about having their own family dentists. Of the PD patients, 71 (68%) had their own family dentists.More PD patients complained of denture discomfort (OR = 3.9, 95% CI:1.9-8.0) than controls after adjustment for sex and age. Although the proportion of those who complained of denture discomfort did not differ between the two groups for men, more female PD patients complained of denture discomfort than female controls. More PD patients complained of denture discomfort (young: OR = 2.9, 95% CI:1.0-8.5; old: OR = 5.0, 95% CI:1.8-13.9) than controls in both the young and old elderly.

show abstract

“…5,6 It is unclear how to clinically identify patients at risk of aspiration. Data suggest that a variety of conditions including, but not limited to, decreased level of consciousness, 7,8 motor neuronal diseases, [9][10][11] inadequate cough, 12 structural abnormalities of the pharynx or larynx, and a history of chemotherapy 13 or radiotherapy 14 contribute to the risk of aspiration. Fiberoptic endoscopic evaluation of swallowing (FEES) can be performed at the bedside to predict a patient's ability to protect the airway, but the test is resource intensive and cannot be routinely applied for daily screening of longterm ventilated patients.…”

mentioning

confidence: 99%

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

et al. 2013

View full text Add to dashboard Cite

Background: Prolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. The authors hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis), as well as symptomatic aspiration occurring during a 3-month follow-up period. Methods: Thirty long-term ventilated patients admitted in two intensive care units at Massachusetts General Hospital were included. The authors conducted a fiberoptic endoscopic evaluation of swallowing and measured muscle strength using medical research council score within 24 h of each fiberoptic endoscopic evaluation of swallowing. A medical research council score less than 48 was considered clinically meaningful muscle weakness. A retrospective chart review was conducted to identify symptomatic aspiration events.Results: Muscle weakness predicted pharyngeal dysfunction, defined as either valleculae and pyriform sinus residue scale of more than 1, or penetration aspiration scale of more than 1. Area under the curve of the receiver-operating curves for muscle strength (medical research council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% CI, 0.63-0.97; P = 0.012), 0.79 (95% CI, 0.56-1; P = 0.02), and 0.74 (95% CI, 0.56-0.93; P = 0.02), respectively. Seventy percent of patients with muscle weakness showed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic aspiration risk (odds ratio = 9.8; 95% CI, 1.6-60; P = 0.009). Conclusion: In critically ill patients, muscle weakness is an independent predictor of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may help identify patients at risk of symptomatic aspiration.

show abstract

Dysphagia Caused by Neurologic Deficits

Cited by 52 publications

References 44 publications

Swallowing Disorders in the Elderly

Swallowing Disorders in the Elderly

Oral Health Conditions in Patients with Parkinson's Disease

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

Contact Info

Product

Resources

About