Effects of Cued and Uncued Swallowing in Patients With Dementia

Abstract

Purpose: Parameters such as bolus location at swallow onset (BLSO), stage transition duration (STD), pharyngeal transition duration (PTD), pharyngeal response duration (PRD), and pharyngeal phase duration (PPD) often vary between cued and uncued swallowing conditions. Research has demonstrated that cued swallows may offer functional benefits that mitigate pathophysiological processes. However, there are limited data assessing differences between cued and uncued swallows in disordered populations, such as dementia. The purpose of this study was to evaluate if cued swallowing alters swallowing biomechanics in patients living with dementia. Method: Through a retrospective analysis of videofluoroscopic swallow studies (VFSS), 105 swallows from 26 participants living with dementia ( M age = 81 years; 14 women) were analyzed in duplicate by blinded raters using the Analysis of Swallowing Physiology, Events, Kinematics, and Timing method. Only VFSS with at least one cued and one uncued swallow were included in the analysis. Chi-square tests were used to explore differences in BLSO. Repeated-measures analyses of variance (ANOVAs) were used to explore differences in STD, PTD, PRD, and PPD. Results: Results revealed no significant differences in BLSO between cued and uncued swallows for patients living with dementia ( p = .934). Repeated-measures ANOVAs revealed no significant differences between the two types of swallows for STD ( p = .995), PTD ( p = .864), PRD ( p = .807), or PPD ( p = .660). Conclusions: This study suggests that there may be limited benefit to providing cued swallows to individuals living with dementia. Further research should investigate if this is due to impaired cognition and/or changes in motor control to volitionally complete the cued swallow.

Differentiation of Bolus Texture During Deglutition via High‐Density Surface Electromyography: A Pilot Study

“…Future studies will require a larger sampling of the normal population, inter-subject comparison, and cued versus noncued swallow comparison since previous findings have demonstrated differences between the two. [70][71][72] Stroke and iatrogenic injury, which have focal neurologic deficits, would be an interesting focus of the study to see if the concepts of laterality, cranial/caudal patterns, and consistency identification differs. An additional limitation stemmed from variability in neck size and shape.…”

Tube feeding in advanced dementia: Insights from South African speech-language therapists

“…Eating and swallowing difficulties, including compromised mastication and an increased risk of aspiration, are common in people with advanced dementia (Espinosa-Val et al, 2020;Schwartz, 2018). Oropharyngeal dysphagia (OPD) is prevalent in 53% -60% of people with advanced dementia with increased transition duration oral transit times being a contributing factor (Alagiakrishnan et al, 2013;Espinosa-Val et al, 2020;Guastella et al, 2022;Ijaopo & Ijaopo, 2019). Speech-language therapists (SLTs), experts in OPD treatment, use direct and indirect treatment methods to manage patients with OPD and may recommend tube feeding (Beckley, 2017;Cloete et al, 2022;Ellison, 2016).…”