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Oropharyngeal dysphagia profile in early versus late stage dementia



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.


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.


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.


  1. 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. 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. 3

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

    CAS  Article  Google Scholar 

  4. 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.

    CAS  Article  Google Scholar 

  5. 5

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

    Google Scholar 

  6. 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. 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. 8

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

    Article  Google Scholar 

  9. 9

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

    CAS  Article  Google Scholar 

  10. 10

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

    CAS  Article  Google Scholar 

  11. 11

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

    CAS  Google Scholar 

  12. 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. 13

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

    CAS  Article  Google Scholar 

  14. 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. 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. 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. 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 

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Corresponding author

Correspondence to Aisha Fawzy Abdel Hady MD.

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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).

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  • Alzheimer dementia
  • fiber-optic endoscopic examination of swallowing
  • food consistencies
  • oropharyngeal dysphagia