Timing of Dysphagia Screening in Alzheimer's Dementia

Cemile Özsürekci; Selen Serel Arslan; Numan Demir; Hatice Çalışkan; Gözde Şengül Ayçiçek; Hasan Erkan Kılınç; Ömer Faruk Yaşaroğlu; Cemal Kızılarslanoğlu; Rana Tuna Doğrul; Cafer Balcı; Fatih Sümer; Ayşe Karaduman; Burcu Balam Yavuz; Mustafa Cankurtaran; Meltem Gülhan Halil

doi:10.1002/jpen.1664

Timing of Dysphagia Screening in Alzheimer's Dementia

JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):516-524. doi: 10.1002/jpen.1664. Epub 2019 Jun 6.

Authors

Cemile Özsürekci¹, Selen Serel Arslan², Numan Demir², Hatice Çalışkan¹, Gözde Şengül Ayçiçek¹, Hasan Erkan Kılınç², Ömer Faruk Yaşaroğlu², Cemal Kızılarslanoğlu³, Rana Tuna Doğrul¹, Cafer Balcı¹, Fatih Sümer¹, Ayşe Karaduman², Burcu Balam Yavuz¹, Mustafa Cankurtaran¹, Meltem Gülhan Halil¹

Affiliations

¹ Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey.
² Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey.
³ Internal Medicine Department, Division of Geriatrics, Gazi University Medical Faculty, Ankara, Turkey.

PMID: 31172554
DOI: 10.1002/jpen.1664

Abstract

Background: Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD.

Methods: This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups.

Results: Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively).

Conclusion: Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.

Keywords: Alzheimer's disease; EWGSOP2; aspiration; dysphagia; sarcopenia.

MeSH terms

Aged
Aged, 80 and over
Alzheimer Disease* / complications
Alzheimer Disease* / diagnosis
Deglutition
Deglutition Disorders* / diagnosis
Deglutition Disorders* / etiology
Dementia*
Female
Humans
Male
Severity of Illness Index