Abstract
Dysphagia is frequent in many neurological diseases and gives rise to severe complications such as malnutrition, dehydration and aspiration pneumonia. Therefore, early detection and management of dysphagia is essential and can reduce mortality. This study investigated the effect of cognitive and motor dual-task interference on swallowing in healthy participants, as dual-task effects are reported for other motor tasks such as gait and speech. 27 participants (17 females; 29.2 ± 4.1 years) were included in this prospective study and examined using flexible endoscopic evaluation of swallowing (FEES). Using a previously established FEES-based score, the paradigms “baseline swallowing”, “cognitive dual-task” and “motor dual-task” were assessed. Scores of the three paradigms were compared using a repetitive measures ANOVA and post-hoc analysis. Mean baseline swallowing score in single task was 5 ± 3. It worsened to 6 ± 5 in the cognitive (p = 0.118), and to 8 ± 5 in the motor dual-task condition (p < 0.001). This change was driven by subclinical worsening of premature bolus spillage and pharyngeal residue. Oropharyngeal swallowing is not exclusively reflexive in nature but requires attention, which leads to motor dual-task interference. This has potential diagnostic and therapeutic implications, e.g. in the early screening for dysphagia or in avoiding dual-task situations while eating.
Highlights
Oropharyngeal dysphagia frequently occurs in several neurological disorders such as stroke[1], Parkinson’s disease2, dementia[3,4], multiple sclerosis[5] or neuromuscular disorders such as inflammatory myopathies or myasthenia gravis[6,7,8], and as age-related dysphagia in elderly otherwise healthy people[9]
We investigated the effect of concurrent motor and cognitive dual-tasks on oropharyngeal swallowing using flexible endoscopic evaluation of swallowing (FEES) in healthy individuals
Mean value ± standard deviation (SD) of the swallowing score and its subdomains during single task condition and during motor dual-task condition as well as the p value of the post-hoc comparison are shown in Table 2. 11 participants (41%) presented with a worsening of swallowing function during the cognitive dual-task compared to baseline
Summary
Oropharyngeal dysphagia frequently occurs in several neurological disorders such as stroke[1], Parkinson’s disease2, dementia[3,4], multiple sclerosis[5] or neuromuscular disorders such as inflammatory myopathies or myasthenia gravis[6,7,8], and as age-related dysphagia in elderly otherwise healthy people[9]. Several previous studies have shown that the simultaneous execution of two tasks (dual-task) often results in delayed reaction time or deteriorated performance in one or both of the t asks[35,36,37] This phenomenon is referred to as dual-task c ost[35] and was shown in various motor tasks such as gait[36] or s peech[37] and in more autonomous functions like breathing[38]. Hypothesized that dual-task interference might impair the complex neuromuscular processing of swallowing which requires the precise central coordination of multiple muscle pairs via cranial nerves To evaluate this hypothesis, we investigated the effect of concurrent motor and cognitive dual-tasks on oropharyngeal swallowing using FEES in healthy individuals
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