Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF
  • Original article
  • Open access
  • Published:

Oropharyngeal dysphagia profile in early versus late stage dementia

The Egyptian Journal of Otolaryngology volume 35, pages 103–109 (2019)Cite this article

Abstract

Objective

The aim of this study was to evaluate swallowing in early and late stage dementia cases referred to the swallowing clinic with oropharyngeal dysphagia in order to have a comprehensive view about their characteristic oropharyngeal dysphagia profile toward different food textures to address them in their rehabilitation program.

Patients and Methods

Fiber-optic endoscopic examination of swallowing (FEES) was conducted to evaluate formally the oropharyngeal stage of swallowing in 26 individuals diagnosed with early mild Alzheimer dementia and late severe Alzheimer dementia. The FEES protocol included symptoms of presentation, route of feeding, bedside evaluation using different textures followed by evaluation of the oral preparatory stage, and the pharyngeal stage through FEES. In addition to observing the ability of the patient to imitate various oromotor actions and ability to follow commands related to the oral phase of swallowing.

Results

For early stage dementia, all food consistencies were considered safe except for mixed consistencies, large volumes of thin liquids and jelly, while the safest consistencies to use with the late stage dementia cases for quality of life and pleasurable feeds were thickened liquids and jelly consistency.

Conclusion

Oropharyngeal dysphagia profiles in early stage Alzheimer dementia is different from late stage Alzheimer dementia indicating that the mechanism behind dysphagia is different in the two groups.

References

  1. Humbert IA, McLaren DG, Kosmatka K, Fitzgerald M, Johnson S, Porcaro E, et al. Early deficits in cortical control of swallowing in Alzheimer’s disease. J Alzheimers Dis 2010; 19:1185–1197.

    Article  Google Scholar 

  2. Affoo RH, Foley N, Rosenbek J, Shoemaker JK, Martin RE. Swallowing dysfunction and autonomic nervous system dysfunction in Alzheimer’s disease: a scoping review of the evidence. J Am Geriatr Soc 2013; 61:2203–2213.

    Article  Google Scholar 

  3. Morley IE. Nutrition in the elderly. Curr Opin Gastroenterol 2002; 18:240–245.

    Article  CAS  Google Scholar 

  4. Serby M, Larson P, Kalkstein D. The nature and course of olfactory deficits in Alzheimer’s disease. Am J Psychiatry 1991; 148:357–360.

    Article  CAS  Google Scholar 

  5. Groher ME, Crary MA. Dysphagia: clinical management in adults and children. Maryland Heights, MO: Mosby Elsevier 2010.

    Google Scholar 

  6. American Geriatrics Society Ethics C P. Clinical and C. Models of Care. American geriatrics society feeding tubes in advanced dementia position statement’. J Am Geriatr Soc 2014; 62:1590–1593.

    Google Scholar 

  7. Langmore SE, Olney RK, Lomen-Hoerth C, Miller BL. Dysphagia in patients with frontotemporal lobar dementia. Arch Neurol 2007; 64:58–62.

    Article  Google Scholar 

  8. Suiter DM, Leder SB. Clinical utility of the 3 ounce water swallow test. Dysphagia 2008; 23:244–250.

    Article  Google Scholar 

  9. Priefer BA, Robbins J. Eating changes in mild-stage Alzheimer’s disease: a pilot study. Dysphagia 1997; 12:212–221.

    Article  CAS  Google Scholar 

  10. Sitzmann JV, Mueller R. Enteral and parenteral feeding in the dysphagic patient. Dysphagia 1988; 3:38–45.

    Article  CAS  Google Scholar 

  11. Singh S, Mulley GP, Losowsky MS. Why are Alzheimer patients thin? Ageing 1988; 17:21–28.

    CAS  Google Scholar 

  12. Troche MS, Okun MS, Rosenbek JC, Altmann LJ, Sapienza CM. Attentional resource allocation and swallowing safety in Parkinson’s disease: a dual task study. Parkinsonism Relat Disord 2014; 20:439–443.

    Article  Google Scholar 

  13. Harwood RH. Feeding decisions in advanced dementia. JR Coll Physicians Edinb 2014; 44:232–237.

    Article  CAS  Google Scholar 

  14. Troche MS, Sapienza CM, Rosenbek JC. Effects of bolus consistency on timing and safety of swallow in patients with Parkinson’s disease. Dysphagia 2008; 23:26–32.

    Article  Google Scholar 

  15. Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res 1994; 37:1041–1059.

    Article  Google Scholar 

  16. O’Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167.

    Article  Google Scholar 

  17. .Edahiro A, Hirano H, Yamada R, Chiba Y, Watanabe Y, Tonogi M. Factors affecting independence in eating among elderly with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12:481–490.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Phoniatric Unit, ENT Department, Faculty of Medicine, Cairo University, Al Haram Street, Cairo, 11562, Egypt

    Ayatallah Raouf Sheikhany, Aisha Fawzy Abdel Hady MD (Lecturer of Phoniarics) & Sheikhany Farag

Authors
  1. Ayatallah Raouf Sheikhany
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aisha Fawzy Abdel Hady MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheikhany Farag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aisha Fawzy Abdel Hady MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sheikhany, A.R., Hady, A.F.A. & Farag, S. Oropharyngeal dysphagia profile in early versus late stage dementia. Egypt J Otolaryngol 35, 103–109 (2019). https://doi.org/10.4103/ejo.ejo_98_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejo.ejo_98_18

Keywords