Dysphagia最新文献

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.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

Dysphagia is a prevalent complication before, during and after treatment for head and neck cancer (HNC). Besides the medical and societal consequences, dysphagia has a negative impact on functioning, activity, participation and quality of life. These aspects are all affected by the environmental factors (EF). However, patient-reported outcome measures (PROMS) such as the Head-and-Neck Cancer Survivors' Assessment of Mealtimes (HNSAM), which thoroughly assess participation and EF in addition to function and activity, are rare. Therefore, this study aimed to translate and validate the HNSAM into Dutch (D-HNSAM). The HNSAM was translated according to the standardized procedure of translation & back-translation and according to the international cross-cultural adaptation process. A pilot study was then conducted with 10 HNC patients to assess the linguistic features and comprehensibility of the test items. Finally, the D-HNSAM was completed by 50 participants who were at least 6 months post-treatment for HNC. The Performance Status Scale for Head and Neck cancer patients (PSS-HN)- subscales normalcy of diet and eating in public, the Dysphagia Handicap Index (DHI), the Functional Oral Intake scale (FOIS) and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) were used to examine the psychometric properties of the D-HNSAM. High correlations with related assessment tools and low correlations with unrelated assessment tools were expected. Internal consistency was found to be weak to good. Test-retest reliability, convergent validity and divergent validity were demonstrated except for the EF subscale. The D-HNSAM can detect differences in impact of dysphagia on daily functioning and quality of life. The D-HNSAM is a reliable and clinically valuable PROM for assessing the impact of dysphagia on daily functioning and quality of life in patients with HNC. The unique aspect of this PROM, the subscale EF, has unfortunately weak psychometric properties and requires further refinement.

Swallowing is considered a three-phase mechanism involving the oral, pharyngeal, and esophageal phases. The pharyngeal phase relies on highly coordinated movements in the pharynx and larynx to move food through the aerodigestive crossing. While the brainstem has been identified as the primary control center for the pharyngeal phase of swallowing, existing evidence suggests that the higher brain regions can contribute to controlling the pharyngeal phase of swallowing to match the motor response to the current context and task at hand. This suggests that the pharyngeal phase of swallowing cannot be exclusively reflexive or voluntary but can be regulated by the two neural controlling systems, goal-directed and non-goal-directed. This capability allows the pharyngeal phase of swallowing to adjust appropriately based on cognitive input, learned knowledge, and predictions. This paper reviews existing evidence and accordingly develops a novel perspective to explain these capabilities of the pharyngeal phase of swallowing. This paper aims (1) to integrate and comprehend the neurophysiological mechanisms involved in the pharyngeal phase of swallowing, (2) to explore the reflexive (non-goal-directed) and voluntary (goal-directed) neural systems of controlling the pharyngeal phase of swallowing, (3) to provide a clinical translation regarding the pathologies of these two systems, and (4) to highlight the existing gaps in this area that require attention in future research. This paper, in particular, aims to explore the complex neurophysiology of the pharyngeal phase of swallowing, as its breakdown can lead to serious consequences such as aspiration pneumonia or death.

Identifying and addressing daily challenges and resources associated with chronic oropharyngeal dysphagia (OD) is a pivotal, though still neglected component of person-centred care, yet overlooked in research studies. To investigate these dimensions, 25 Italian adults with chronic OD due to cancer or neurodegenerative diseases participated in semi-structured interviews, designed following a modified framework analysis approach. Two researchers independently transcribed and coded interviews, elaborated a working analytical framework, indexed and charted the data, solving discrepancies through negotiated agreement and discussion with a third researcher. Proportion agreement on extracted quotations was calculated. Overall, 457 quotations were extracted from the interviews (88% agreement). Daily challenges pertained to physical, practical, and social domains; most participants reported OD-related problems; almost half mentioned care needs and obstacles in using healthcare services. Concerning resources in OD management, most participants referred to problem-focused and meaning-focused coping strategies, personal capabilities, and support from family and healthcare services. Finally, almost half of the participants reported OD-related changes in life view and meaning. Findings suggest that adjusting to OD implies challenges and resource mobilization in different life domains. Future studies should longitudinally elucidate the dynamics of positive adjustment, to promote patient-centred OD care based on individually perceived needs and challenges, and to inform healthcare policies.

Dysphagia affects up to 70% of older adults living in residential long-term care settings (RLTCS) and may lead to serious complications if not identified and adequately managed. However, there is a dearth of clinical guidelines tailored to older adults at risk of dysphagia in RLTCS. An online survey consisting of 40 questions was conducted to identify dysphagia screening practices, referral patterns and interventions implemented by nurses in cases of suspected dysphagia, to quantify the number of residents with dysphagia, episodes of aspiration pneumonia in the previous year, and use of modified texture diets and fluids and explore differences between groups of RLTCS. The survey was developed using Qualtrics XM Platform and circulated via email, with one response per RLTCS sought. Data were analysed using RStudio. Of the 429 RLTCS contacted, 45 completed and returned the survey, a 10.5% response rate. Dysphagia screening practices, referral patterns, and dysphagia management interventions varied across participating RLTCS. All participants reported that they observe for signs and symptoms of dysphagia at mealtimes to identify residents at-risk of dysphagia. Ninety six percent of RLTCS reported referring residents with suspected dysphagia to speech and language therapy dysphagia services. A diagnosis of dysphagia was reported in 35.3% of residents. All participating RLTCS reported providing modified texture diets and fluids if residents had suspected dysphagia. The implementation of standardised and validated dysphagia screening protocols in RLTCS in the Republic of Ireland may be useful in supporting the identification of at-risk residents.

Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.