Recent advances in the diagnosis and treatment of dysphagia in neurological diseases

Abstract

Swallowing disorders are common in many neurological diseases, especially in stroke, Parkinson’s disease, amyotrophic lateral sclerosis, dementia, and multiple sclerosis. Neurogenic dysphagia is associated with an increased risk of death and serious complications, including aspiration pneumonia, dehydration, and malnutrition, which points to the importance of implementing recent advances in the diagnosis and treatment of swallowing disorders into neurological practice. If the initial screening for swallowing disorders is positive, further workup includes a combination of bedside tests and ancillary investigations, such as comprehensive clinical, videofluoroscopic and endoscopic swallowing evaluation. These measures allow to determine the type and degree of dysphagia severity, which is necessary for choosing the optimal therapeutic strategy. Treatment of patients with neurogenic dysphagia requires multidisciplinary approaches involving a team of specialists, including neurologists, speech and language therapists, gastroenterologists, and dietitians. Therapeutic strategy should include providing adequate nutritional support by diet modification and/or enteral nutrition through a nasogastric tube or gastrostomy, appropriate management of underlying and concomitant diseases, prevention and treatment of complications as well as rehabilitation interventions. Future directions to reduce swallowing disorders in neurological diseases will probably comprise a combination of rehabilitation measures with pharmacotherapy and non-invasive stimulation/neuromodulation. Early detection and effective treatment of dysphagia is crucial for achieving better outcomes and improving the quality of life in patients with neurological diseases.