Abstract
Objectives
The objective of this study was to assess the pathophysiology of oropharyngeal dysphagia
(OD) in patients with dementia, specifically in those taking antipsychotics (APs).
Design
A cross-sectional study was performed from January 2011 to May 2017 in a general hospital.
Setting and Participants
We included 114 patients with dementia, of which 39 (34.2%) were taking APs (82.5 ± 7.8 years,
Barthel Index 52.28 ± 30.42) and 29 patients without dementia (82.4 ± 6.7 years, Barthel
Index 77.71 ± 24.7) and OD confirmed by a videofluoroscopy.
Measures
Demographical and clinical factors as well as swallowing function of patients with
dementia with OD were compared with older patients without dementia with OD. We also
compared patients with dementia taking and not taking APs. Impaired efficacy during
videofluoroscopy was defined as the presence of oral and/or pharyngeal residue, and
impaired safety (unsafe swallow) was defined as aspiration or penetration. Receiver
operating characteristic curves were drawn for laryngeal vestibule closure (LVC) time
to predict unsafe swallow.
Results
87.7% of patients with dementia presented impaired efficacy of swallow and 74.6% impaired
safety [penetration-aspiration scale (PAS) 3.94 ± 1.94]. 86.2% of patients without
dementia presented impaired efficacy and 44.8% impaired safety (PAS 2.21 ± 1.92).
Time to LVC was significantly delayed in patients with dementia taking APs in comparison
with patients without dementia (LVC 0.377 ± 0.093 vs 0.305 ± 0.026, P = .003). In contrast, there were no differences in the PAS and LVC time in patients
with dementia taking and not taking APs (PAS 3.96 ± 0.26 vs 3.88 ± 0.22, LVC 0.398 ± 0.117
vs 0.376 ± 0.115, NS). LVC time ≥0.340 seconds predicted unsafe swallow in patients
with dementia with an accuracy of 0.71.
Conclusions/Implications
Patients with dementia presented high prevalence and severity of videofluoroscopy
signs of impaired efficacy and safety of swallow and a more severe impairment in airway
protection mechanisms (higher PAS and LVC delay). Clinical practice should implement
specific protocols to prevent OD and its complications in these patients. AP treatment
did not significantly worsen swallowing impairments.
Keywords
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Article info
Footnotes
The authors declare no conflicts of interest.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Dysphagia in Frail Older Persons: Making the Most of Current KnowledgeJournal of the American Medical Directors AssociationVol. 19Issue 9
- PreviewDysphagia and related problems with oral intake must certainly be numbered among the important geriatric syndromes.1 They, like other geriatric syndromes, become increasingly common as people age, are especially prevalent in aging-related conditions such as stroke and Alzheimer's disease, and are usually multifactorial.2 In developing evidence-based approaches to such common aging problems, the scientific community goes through a sequence of investigative steps. We begin by identifying and defining the problem.
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