Dysphagia最新文献

A clinical swallow evaluation (CSE) is a noninvasive and indirect assessment of the anatomical and physiological integrity of the swallowing mechanism in a natural setting. A CSE goes beyond a screening, a dichotomized indicator of dysphagia risk, by comprehensively examining the patient's swallowing through gaining sensory and motor information of oral and pharyngeal function. Information obtained from CSEs in combination with medical, social, and environmental patient related factors allow clinicians to make critical decisions about patients' health and quality of life. It is essential that we have assessment tools with rigorous methodological quality to optimize the accuracy of our clinical judgement. The purpose of this study is to investigate the diagnostic validity of clinical observations obtained through the Mann Assessment of Swallowing Ability (MASA) to better inform clinicians regarding the confidence that the items are testing what they are intended to test and reflect indication of true physiologic swallowing impairment and airway invasion. Area Under the ROC Curve (AUC) analyses revealed that the MASA's diagnostic validity showed acceptable accuracy levels for detecting oral impairment and aspiration, and poor accuracy for detecting pharyngeal impairment and penetration. In the cross-validation analysis, the AUC accuracy level for aspiration changed from acceptable to poor, but remained the same for oral impairment, pharyngeal impairment and penetration. In our sample, acceptable levels for detecting aspiration but poor levels for detecting pharyngeal impairment indicate that the MASA does an adequate job of identifying risk but not explaining the nature of impairment. These results support the need for videofluoroscopic imaging to identify the nature and severity of swallowing impairment, guide intervention and provide recommendations for safe and efficient oral intake.

Eating and drinking are fundamental to life. However, older patients are often restricted with oral intake due to feared risk of aspiration. Eating and Drinking with Acknowledged Risks (EDAR) is an alternative process which enables comfort, dignity, and autonomy for these patients. While national guidance has been developed for EDAR in the UK, other ageing societies such as Japan do not have such guidance. To understand the perspectives and experiences of healthcare professionals regarding the complex decision-making process around EDAR we planned a mixed methods study comparing the two countries. This was the qualitative phase of the study. Twelve healthcare professionals (two doctors, nurses and speech and language therapists each in Japan and the UK) participated in semi-structured interviews on their roles and experiences related to EDAR in older adults. We analysed the data thematically, and three themes emerged: (1) healthcare professionals and healthcare systems, (2) priorities in decision-making and (3) relationship with family and patient. There were many similarities but also differences across the countries, in the setting, training and individual experience. Decision-making was shaped by a complex combination of individual, structural and cultural factors, which indicated in the Japanese culture a greater likeliness to defer clinical decision-making and to side with families' wishes. Healthcare professionals' experiences and attitudes towards EDAR differed depending on various factors related with the individual and environment. The next quantitative phase of our research aims to establish the mechanism to increase confidence around EDAR in professionals and training options.

This study aimed to identify functional challenges faced by individuals with non-esophageal dysphagia and to offer a tool for quantitatively evaluating the person abilities within the framework of the International Classification of Functioning, Disability and Health (ICF). Additionally, this study attempted to differentiate the personal abilities of individuals with dysphagia and hierarchize item difficulties using the ICF-based Item Response Theory (IRT) modeling approach. This cross-sectional study enrolled a cohort of 150 patients with dysphagia (105 male and 45 female) from a tertiary hospital in China. Participants were assigned to evaluate the 114-item ICF dysphagia questionnaire. To further assess their swallowing capabilities, eating patterns, quality of life, and nutritional status, participants underwent a battery of five additional scales. The ICF qualifiers underwent data shaping including dichotomization and missing value imputation, Mokken scale analysis (MSA) for checking unidimensionality, local independence, monotonicity, and invariant item ordering (IIO), and parametric IRT modeling for identifying an optimal model from the 1-parametric logistic model (1PLM), 2PLM, 3PLM, and 4PLM. Finally, we tested the robustness of the optimal model via Monte Carlo simulation and illustrated the usefulness of the model by its person-item map. The 1PLM emerged as the optimal model with a total of 50 ICF items (12 'd-Activities and Participation', 33 'b-Body Functions', and 5 'e-environmental' items). The final scale presented strong reliability with Cronbach's Alpha = 0.967. Furthermore, the scale showed good validity with a significant positive correlation (p < 0.001, ${\hat{r}}_{\mathrm{Winsorized}}$ = 0.60) between model-estimated person abilities and swallowing-quality of life (SWAL-QoL) scores. The findings also demonstrated measurement equivalence of the final model for individuals with different genders or across various age groups. The utilization of the person-item map can effectively compare the difficulty levels of items with the abilities of patients, thereby facilitating the delivery of tailored care and precise rehabilitation strategies that match the individual competency of those suffering from dysphagia. This study developed a parsimonious dysphagia-specific ICF outcomes tool derived from the IRT, named iSWAL-Performance Scale. The findings complement quantitative information on the psychometric characteristics of this 50-item scale.

We aimed to fine-tuning the Timed Water Swallow Test (TWST) screening procedure to provide the most reliable prediction of the Flexible Endoscopic Evaluation of Swallowing (FEES) assessment outcomes, with age, sex, and the presence of clinical signs of dysphagia being considered in the assessment. Participants were healthy people and patients with suspected dysphagia. TWST performance and participants' reported dysphagia symptoms were assessed in terms of their utility in predicting the outcome of a FEES assessment the same day. The FEES assessors were blinded to the nature of the TWST performance. The water swallowing capacity levels and clinical observations during a screening performance that were indicative of dysphagia/no symptoms in FEES were determined. Convergent validity was assessed as the agreement with the Functional Oral Intake Scale (FOIS) in the FEES assessment. TWST predicted FEES findings (aspiration and dysphagia) with a sensitivity of 72 and 45% and a specificity of 75% and 80%, respectively. Extended analysis of the TWST procedure (eTWST) identified aspiration (sensitivity = 92%, specificity = 62%) and dysphagia (sensitivity = 70%, and specificity = 72%) more accurately and showed a high correlation with FOIS (ɸ = 0.37). Excellent inter-rater reliability was further observed (Kw = 0.83). The extended evaluation of TWST performance has superior criterion validity to that of TWST. eTWST displayed high convergent validity and excellent interrater reliability. We therefore believe that eTWST can be highly relevant for clinical dysphagia screening.

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.