Abstract
Objectives
To define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older
persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference
clinical screening test for swallowing disorders, to assess the feasibility of the
V-VST in an ambulatory care setting, to search for associations between geriatric
parameters and OD, and to identify a relationship between severities of cognitive
impairment and OD.
Design
Prospective, monocentric study.
Setting
Population from a geriatric outpatients clinic.
Participants
Patients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective
cough, and ability of voluntary swallowing for testing.
Measurements
OD screening was realized using V-VST during consultation. Severity of cognitive impairment
was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale
(DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities,
cognition, nutrition, mood disorders, frailty).
Results
117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence
of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment,
52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary
to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was
independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI)
1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1;
95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity
of cognitive impairment.
Conclusion
OD is very frequent in community-dwelling older persons with dementia and is associated
with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening
test in this population and therefore should be systematically included in the geriatric
assessment of older persons with dementia. The role of V-VST in therapeutic strategies
of OD remains to be evaluated.
Keywords
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Article info
Publication history
Published online: May 31, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
