Quantifying Airway Invasion and Pharyngeal Residue in Patients with Dementia.

Ashwini Namasivayam-MacDonald,Luis Riquelme

doi:10.3390/geriatrics4010013

Abstract

Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration–Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid swallows with significant NRRSp that were unsafe on the subsequent swallow was significantly greater than the proportion of swallows with significant NRRSp that were safe on the subsequent swallow. As such, there was a 2.83 times greater relative risk of penetration–aspiration in the presence of thin liquid pyriform sinus residue. Future research should determine the impaired physiology causing aspiration and residue in this population.

Highlights

Dementia is one of the main causes of disability later in life, ahead of cancer, cardiovascular disease, and stroke [1]
When the results of the present study are compared to results of a similar study evaluating residue in a sample of patients with neurogenic dysphagia, we find that patients with dementia present with more vallecular residue on thin liquid boluses [26]
The current study provides additional data on the pathophysiology of the swallow in persons with dementia

Summary

Introduction

Dementia is one of the main causes of disability later in life, ahead of cancer, cardiovascular disease, and stroke [1]. There are an estimated 5.3 million Americans over the age of 65 currently living with dementia and by 2050, this number could rise as high as 16 million [2]. Total health care system costs and out of pocket costs of caring for people with dementia in the United States were US$259 billion in 2016, and are projected to quadruple by 2050 [2]. Dysphagia (i.e., swallowing difficulties) is a known comorbidity of dementia, with up to 93% of people with dementia presenting with some type of swallowing impairment [3]. While the literature provides several reports of dysphagia in people living with dementia, we still lack a comprehensive understanding of the nature of the impairment

Objectives

Methods

Results

Discussion

Conclusion