Swallowing in behavioral variant frontotemporal dementia.

Sheilla De Medeiros Correia Marin,Paulo Henrique Ferreira Bertolucci,José Roberto Wajman,Valéria Santoro Bahia,Luis Fabiano Marin,Fabricio Ferreira De Oliveira,Letícia Lessa Mansur

doi:10.1590/0004-282x20200060

Sheilla De Medeiros Correia Marin, Paulo Henrique Ferreira Bertolucci + Show 5 more

Open Access

https://doi.org/10.1590/0004-282x20200060

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Abstract

Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: "Mini-Mental State Examination", "Severe Mini-Mental State Examination", "FTLD-modified Clinical Dementia Rating", "Neuropsychiatric Inventory", "Frontal Assessment Battery", "Index of Independence in Activities of Daily Living", "Swallowing Rating Scale" and "Assessment of Feeding and Swallowing Difficulties in Dementia". Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage. Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.

Highlights

Swallowing is a complex and synchronized neuromuscular process during feeding that includes sensory and motor aspects
It starts with voluntary mechanisms that are highly dependent upon cognition, language, behavior and funcionality; swallowing consists on the following five phases[1]: the first phase precedes the food in the oral cavity; the second phase is related to the preparation of the bolus with oral motor acts; the third phase is characterized by the backward movement of the tongue for oral ejection of food; the fourth and the fifth phases are involuntary
Behavioral variant frontotemporal dementia is a clinical syndrome characterized by progressive changes in behavior and personality, whereas at least three of the following clinical features must be present: early disinhibition, early apathy, loss of empathy for others, overeating, compulsions, and frontal executive loss; these features may occur in isolation or in addition to executive dysfunction[4,5,6,7]

Summary

Introduction

Swallowing is a complex and synchronized neuromuscular process during feeding that includes sensory and motor aspects. Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. Objective: To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. Swallowing problems in bvFTD correlated with impaired functionality (p

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