Evaluation of Swallowing Function according to the Stage of Alzheimer’s Disease

Abstract

<b><i>Background:</i></b> Alzheimer’s disease (AD) is a progressive neurodegenerative disease, and swallowing difficulties may occur as the disease progresses. Dysphagia has many consequences, such as aspiration and pneumonia. In particular, in the advanced stage, approximately 70% of the causes of death in AD involve aspiration pneumonia. Therefore, it is vital to assess the presence or absence of dysphagia in AD. <b><i>Objective:</i></b> This study aims to describe swallowing difficulty across the stages of AD. <b><i>Methods:</i></b> Thirty-five AD patients were evaluated. The Mini-Mental State Examination was conducted. A bedside water swallow test (BWST) and the Eating Assessment Tool (EAT-10) were administered. Finally, fiberoptic endoscopic evaluation of swallowing was used to evaluate residual, aspiration and penetration conditions. <b><i>Results:</i></b> EAT-10 scores, BWST results, and penetration-aspiration status were statistically significantly different according to AD stage (<i>p</i> < 0.05). Among all patients, 74.3% had residue, 25.7% had penetration, and 2.9% had aspiration. <b><i>Conclusions:</i></b> This study has demonstrated that swallowing dysfunction begins at a mild stage and progressively worsens toward the advanced stage in patients with AD. At all stages of AD, residue was observed, and this poses a risk for the development of penetration-aspiration. Therefore, it is necessary to evaluate the early dysphagia of individuals.

Investigation of cognition, nutrition, independence and swallowing difficulty, relationship with quality of life, and effect levels in elderly people with Alzheimer’s disease living with their families

“…In addition, many studies on patients with dementia have shown that the likelihood of dysphagia increases as the disease stage progresses. 7,8,17,30 In the results of our study, similar to the literature, the incidence of dysphagia increased towards the advanced stage. This shows that as the disease progresses, not only cognitive functions, but also the swallowing deteriorated.…”

“…21 In our previous study, we found BWST to be consistent with the instrumental evaluation in clinical practice in individuals with AD. 7 In BWST, six observations that may occur while drinking 10 milliliters (ml) of water and after drinking were evaluated. These observations were: (1) taking more than one swallow to finish the 10mL water (2) drooling of water from the mouth, (3) absence of laryngeal movement while drinking the water and after 10 minutes, (4) a 2% and above decrease in oxygen saturation while drinking, (5) coughing after drinking the water (5), and (6) a change in voice.…”

“…5 As AD progresses, dysphagia, which is defined as an obstruction in the passage of food from the mouth to the stomach, and difficulty in swallowing may be observed. 6,7 The prevalence of dysphagia was found to be 80% in patients with AD. 8 Feeding problems and swallowing difficulties can further affect the quality of life of patients.…”

Dysphagia and dementia: a ‘double dilemma’

“…Increasing dyscoordination, or apraxia, of swallow function accompanying cortical and subcortical deterioration will eventually produce an inability to eat safely and effectively on one's own. Aspiration pneumonia has in fact been described as the most frequent complication leading to death in this population [8].…”

Validity and reliability of the Turkish version of the Holden Communication Scale

“…Dementia is a syndrome characterized by a greater impairment of the cognitive function (i.e., the ability to process thought) than would be expected in normal old age (Parlak, Altan, et al., 2022; World Health Organization, 2017). Some of the cognitive processes, such as attention, memory, executive function, and language, are affected in individuals with dementia (Parlak, Tokgöz, et al., 2022; Parlak, Babademez, et al., 2022). Problems in these functions may affect verbal and nonverbal communication (Parlak & Köse, 2023; Parlak, Güç, et al, 2023).…”