Dysphagia最新文献

Dysphagia is frequent and detrimental in advanced Parkinson's disease (PD) and does not respond to standard treatments. Experimental models suggested that pathological overactivity of the substantia nigra pars reticulata (SNr) may hinder oral contributions to swallowing. Here, we hypothesized that the combined stimulation of subthalamic nucleus (STN) and SNr improves measures of dysphagia after eight weeks of active treatment. We enrolled 20 PD patients with dysphagia and deep brain stimulation (DBS). Patients were assessed in 'medication on' and 'STN' stimulation at baseline (V1) and then were randomized 1:1 to 'STN' or 'STN + SNr' stimulation. In addition, patients of both groups received swallowing therapy as a standard of care. The primary endpoint was the change in Penetration-Aspiration Scale (PAS) at eight-week follow-up (V2) with respect to the baseline (V1) under the hypothesis, that 'STN + SNr' was superior to 'STN'. We obtained further secondary endpoints on oral preparation, transport, pharyngeal phase, penetration, and aspiration. PAS change from V1 to V2 was not significantly different between groups (p = 0.221). When considering all patients for secondary analyses, we found that the entire study cohort showed better PAS scores at V2 compared to V1 irrespective from DBS treatment allocation (p = 0.0156). Both STN and STN + SNr treatments were safe. 'STN + SNr' stimulation was not superior compared to standard 'STN' stimulation both on PAS and the secondary endpoints. We found that the entire study cohort improved dysphagia after eight weeks, which presumably mirrors the effect of continued swallowing therapy and the increased patient attention on swallowing.

Background: Dermatomyositis is a rare autoimmune-mediated disease characterised by distinctive rash and progressive muscle weakness. Patients with dermatomyositis may develop swallowing disorders (dysphagia) due to the inflammation of muscles involved in swallowing which may lead to serious health consequences. However, to date, the clinical characteristics of and risk factors for dysphagia in dermatomyositis remain poorly understood. This retrospective study aimed to identify the characteristics and risk factors for dysphagia in dermatomyositis.

Methods: All patients with clinical diagnosis of dermatomyositis (ICD-9-CM 701.3) were identified and retrieved retrospectively via hospital electronic record over a 10-year period for review.

Results: A total of 231 patients were identified with 149 fulfilled the inclusion criteria (median age [range] = 54.5 [3-92] years; 51 males) were recruited. The incidence of dysphagia was 18.8%, with predominantly pharyngeal phase impairments. Six patients had silent aspiration. Dysphagia was positively correlated with the age of diagnosis (r[148] = 0.187, p = 0.023), mortality (r[149] = 0.186, p = 0.023), presence of underlying malignancy (r[149] = 0.222, p = 0.007), methylprednisolone use (r[149] = 0.166, p = 0.042) and intravenous immunoglobulin (IVIg; r[149] = 0.217, p = 0.008), and negatively correlated with disease duration (r[147]=-0.273, p < 0.001). Moreover, it was more likely to have symptomatic dysphagia in patients prescribing systemic corticosteroid (OR[95%CI] = 4.43[1.02, 19.27], p = 0.047) and IVIg (OR[95%CI] = 6.39[1.14, 35.68], p = 0.035).

Discussion: Dysphagia was associated with advanced age, increased mortality and malignancy in patients with dermatomyositis. Routine screening of dysphagia is recommended at initial diagnosis and severe disease activity requiring high dose systemic steroid and IVIg use.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

Breastfeeding is widely regarded as the optimal form of feeding infants, as it provides both nutritional and physiological benefits. For example, breastfed infants generate greater intraoral suction and have higher amplitude muscle activities compared to bottle-fed infants, with downstream implications for motor function, development, and health. One mechanism that might explain these physiological differences is the structure of the nipple an infant is feeding on. Breasts in most mammals are ducted soft-tissue structures that require suction to be generated for milk to be released, whereas bottle nipples are hollow and allow milk to be acquired by compression of the nipple. We used a validated animal model (pigs) to test how being raised on a novel ducted nipple impacted feeding physiology and performance compared to infants raised on a standard (cisternic) nipple. At the end of infancy, we fed both groups with both nipple types and used high-speed videofluoroscopy synchronized with intraoral pressure measurements to evaluate feeding function. Nipple type did not have a profound impact on sucking or swallowing rates. However, when feeding on a ducted nipple, infant pigs raised on a ducted nipple generated more suction, consumed milk at a faster rate, swallowed larger boluses of milk, and had decreased likelihood of penetration and aspiration than those raised on a cisternic nipple. These data replicate those found when comparing breast- and bottle-fed infants, suggesting that a ducted, biomimetic nipple may provide bottle-fed infants with the physiologic benefits of breastfeeding.

Dysphagia is defined as difficulty in swallowing, while presbyphagia is described as a change in swallowing process in healthy older adults, which is a compensable physiological impairment and synonymous with dysphagia. Aging is a well-known risk factor for Alzheimer's disease (AD), and oropharyngeal dysphagia (OD) is a common condition in AD. Our study aims to compare OD in AD patients and older adults with presbyphagia (OAwP). 65 older adults (AD = 32, mean age:76.5 ± 6; OAwP = 33, mean age:71.1 ± 4) were included. Swallowing disorders were evaluated by Flexible Endoscopic Evaluation Study, which scored by Penetration Aspiration Scale (PAS) that scores other than 1 indicate dysphagia, Murray Secretion Severity Scale (MSSS), and Eating Assessment Tool-10 (EAT-10). Neurologist determined Clinical Dementia Rating (CDR) scores of AD patients. AD and OAwP groups had OD, respectively, 96.87% vs. 81.81% by PAS, 87.5% vs. 60.60% by MSSS, and 56.25% vs. 18.18% by EAT-10. No statistical differences were observed between AD and OAwP in terms of gender, age, PAS, and MSSS values (p > 0.05). There was a significant difference in EAT-10 total scores (p = 0.000), and had OD by EAT-10 (p = 0.024). No differences were found in age, time elapsed since diagnosis, PAS, and EAT-10 scores based on CDR, but there was a difference in MSSS scores (p = 0.013). CDR in AD were associated with gender, time elapsed since diagnosis, and MSSS scores (p < 0.05). OAwP experience swallowing problems at least as much as those with AD. Evaluation of swallowing disorders after diagnosis is essential for both AD and OAwP. Early-stage management of disease with preventive treatment approaches can delay onset of symptoms.

Sarcopenia, dysphagia, and frailty are geriatric syndromes that commonly occur with age and are associated with various adverse health consequences. Nevertheless, the complex associations among them require further study to be clarified. The objectives of this study were to investigate (1) the potential role of dysphagia as a mediator in the association between sarcopenia and frailty and (2) the potential role of taste and smell dysfunction as a moderator of this mediator effect in community-dwelling older adults. A total of 352 older adults (mean age = 70.48 ± 5.31 years; 57.67% female) enrolled in this cross-sectional study. The SARC-F, Eating Assessment Tool-10 (EAT-10), and Edmonton Frailty Scale (EFS) were used to assess sarcopenia, dysphagia, and frailty, respectively. The Taste and Smell Dysfunction Questionnaire (TSDQ) was employed to assess taste and smell dysfunction. Frailty was present in 21.86%, sarcopenia risk in 39.77%, and dysphagia in 26.99% of the participants. The mediation analysis showed that the SARC-F had a significant effect on the EAT-10 (B = 1.001; p < 0.001), which in turn had a significant effect on the EFS (B = 0.129; p < 0.001). The direct (B = 0.659; p < 0.001), indirect (B = 0.129), and total (B = 0.778; p < 0.001) effects of SARC-F on EFS were significant. Of the association between sarcopenia and frailty, 16.6% was explained by dysphagia. The moderated mediation analysis showed that the TSDQ (B = 0.127; p < 0.001) moderated the association between SARC-F and EAT-10 and that the EAT-10 mediated the association between SARC-F and EFS only in older adults who scored moderate and high on the TSDQ (B = 0.049 and B = 0.114, respectively). The EAT-10 partially mediates the association between the SARC-F and the EFS, implying that sarcopenia affects frailty indirectly via dysphagia. Furthermore, taste and smell dysfunction moderates this mediator effect, with sarcopenia functioning as a mediator in older adults who scored moderate and high on the TSDQ. Therefore, it is plausible to anticipate that if someone has taste and smell dysfunction in addition to sarcopenia, they are more likely to have dysphagia and, ultimately, frailty. These findings emphasize the importance of addressing sarcopenia, taste and smell dysfunction, and dysphagia concurrently in frailty management in older adults.

The co-occurrence of depression and dysphagia is obvious to clinicians and has been the focus of several research investigations. Dysphagia not only leads to physical complications but also exerts a negative emotional impact, resulting in a decline in quality of life. The purpose of the study was to investigate the association between dysphagia and depressive symptoms at the population level while accounting for various demographics and health conditions. This study was a cross-sectional design using the 2022 National Health Interview Survey. The study subjects were American adults who completed the survey questionnaires about depressive symptoms, swallowing problems, and health conditions. Regression models and three different propensity score matching approaches were utilized to estimate associations between dysphagia and depressive symptom. Data analyzed in the study showed that among 25,651 U.S. adults, 1,664 (6.48%) reported dysphagia. Among patients with dysphagia, 976 (58.65%) were women, and the average age was 55.48 years. The differences in demographics and health conditions between individuals with and without dysphagia were balanced by three propensity score matching approaches (p >.05). After adjustments using population-weighted multivariable logistic regression, the inverse probability of treatment weighting (IPTW) with both normalized weights, IPTW with stabilized weights, and Greedy algorithms with 1:1 matching method, the risks of having depressive symptom in those with dysphagia were significantly higher than those without dysphagia (odds ratios ranged from 1.763 to 2.402, p <.0001). The study supports that dysphagia and depressive symptoms frequently co-occur in U.S. adults, highlighting the need for comprehensive care that addresses both physical and mental health aspects of swallowing impairments.

This study aimed to identify the independent predictors of postacute stroke dysphagia at discharge using sarcopenia-related parameters. This single-center prospective observational study assessed consecutive inpatients diagnosed with cerebral infarction or cerebral hemorrhage upon admission to the stroke unit. Tongue pressure, grip strength, and body composition were evaluated within 48 h. Dysphagia was defined by a functional oral intake scale of ≤ 5. Patient characteristics were compared between non-dysphagia and dysphagia groups using Mann-Whitney or chi-squared tests. Logistic regression analysis was performed using age, sex, tongue pressure, grip strength, skeletal muscle mass index (SMI), and National Institutes of Health Stroke Scale (NIHSS) scores as explanatory variables, with dysphagia at discharge as the objective variable. A total of 302 patients (mean age: 69.4 ± 13.8 years, 67.5% male) were analyzed, with 64 having dysphagia at discharge (21.2%). The dysphagia group was significantly older (p<0.001), had higher NIHSS scores on admission (p<0.001), lower SMI (p = 0.002), lower grip strength (p<0.001), and lower tongue pressure (p<0.001) than the non-dysphagia group. Logistic regression revealed that age (OR: 1.042, p = 0.018), tongue pressure (OR: 0.954, p = 0.010), and grip strength (OR: 0.943, p = 0.048) on admission were independent predictors of dysphagia at discharge, while NIHSS scores (OR: 1.403, p = 0.106), sex, and SMI (OR: 1.403, p = 0.150) were not. Older age, reduced tongue pressure, and reduced grip strength are strong predictors of persistent poststroke dysphagia at discharge. Thus, muscle strength is a more valuable parameter than muscle mass in predicting persistent poststroke dysphagia.

This study aimed to examine the compatibility between individuals with Alzheimer's disease (IwAD) and Eating Assessment Tool (EAT-10) results obtained from their caregivers and to compare EAT-10 results obtained from IwAD and caregivers with fiberoptic endoscopic swallow evaluation (FEES) results. EAT-10 questions were read aloud to the IwAD; simultaneously, the caregiver was asked to complete the EAT-10 by thinking of the IwAD in a different room. Aspiration, penetration, and residual status were first assessed as "present" or "absent" using FEES, then the Penetration Aspiration Scale (PAS) was used. EAT-10 items were analyzed with agreement between IwAD and caregiver.The sensitivity and specificity of IwAD and caregiver EAT-10 results for aspiration, penetration, and residue were assessed. EAT-10 cut-off scores were determined for IwAD according to different sources of information.Agreement of the EAT-10 total measurements of IwAD and caregiver was determined to be poor. There was no statistically significant correlation between PAS scores and EAT-10 total IwAD (p = 0.072) and caregiver (p = 0.195) scores. In the aspiration, penetration, and residue measurements of the participants, the area under the ROC curve was not statistically significant (p > 0.05) according to both IwAD and caregiver responses. It was observed that IwAD's statement for aspiration, penetration, and residue in mild stage AD; IwAD for aspiration, caregiver for penetration, both for residue in moderate stage; caregivers for advanced stage gave more accurate results in differentiating individuals with aspiration, penetration, and residue.In conclusion, in this study, according to the information obtained from IwAD or caregivers, it was determined that the agreement between EAT-10 and FEES results was low, especially in recognizing IwAD with aspiration. Therefore, the use of the EAT-10 in IwAD does not provide adequate diagnosis; there is a need to develop other swallowing assessment tools that also provide information about the effectiveness and safety of swallowing specific to IwAD.

Ultrasound (US) is a non-invasive method used to study the kinematics of the swallowing function. Kinematic measurements are reported in studies evaluating swallowing using US, but there is no standardization. The aim of this scoping review was to identify and characterize the kinematic measurements of swallowing obtained by ultrasound. We followed the methodological recommendations of the Joanna Briggs Institute (JBI) and the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-extension for scoping reviews (PRISMA-ScR). The research question followed the acronym PCC (population, concept, and context). Seven databases and gray literature were searched. Studies were selected using a blind, paired, and independent method. Data were extracted using a standardized tool. There were 2591 studies and 42 were eligible. Most studies had samples of less than 30 participants and mostly included healthy young adults and older people. The swallowing tasks during the assessments were not standardized. The most commonly studied measures were hyoid displacement and tongue movement during swallowing. However, there is no consensus between studies on the definition of the measures and the procedures for ultrasound assessment, including image acquisition and analysis.