Eating & Swallowing Deficits in Individuals with Dementia · 2013-06-18 · 2013/06/10 1 Eating &...

2013/06/10

1

Eating & Swallowing

Deficits in

Individuals with

Dementia

Rebecca Affoo June 11, 2013

Acknowledgements

Co-Author

• Dr. Ruth Martin, Western University

Eating & Swallowing Deficits in

Individuals with Dementia

Acknowledgements

Support • Ontario Ministry of Health and Long-Term Care

Career Scientist Award

• Western University Graduate Thesis Research

Award

• Alzheimer Foundation London and Middlesex

Doctoral Award



Today’s Agenda

Systematic Review



Today’s Agenda

What is Dementia?



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Today’s Agenda

What is the prevalence of

dementia in Canada?



Today’s Agenda

What do we know about

eating and swallowing

deficits in individuals with

dementia?



Today’s Agenda



assessment, management,

and treatment in this

population?



Today’s Agenda

Conclusions



Today’s Agenda

Questions



Systematic Review

Purpose:

• Describe, synthesize, and interpret

literature on dysphagia and/or

autonomic nervous system

dysfunction in dementia

• Identify gaps in the existing literature



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Systematic Review

Methodology:

• Systematic searches of the PubMed,

EBSCOhost, PsychINFO, Cochrane,

EMBASE, and Scopus databases

were conducted



What is Dementia? • A syndrome caused by progressive

disorders that affect:

• Memory

• Thinking

• Behaviour

• Ability to perform activities of daily

living (ADL)



What is Dementia?



Dementia

Alzheimer’s disease

Vascular dementia

Frontotemporal lobe dementia

Lewy body dementia

Parkinson’s disease dementia

What is the Prevalence of

Dementia in Canada?





deficits in individuals with

dementia?



Dysphagia in Alzheimer’s

Disease (AD) • Prevalence of dysphagia in moderate

and severe AD ~ 32% to 93%

Chouinard et al., 1998

Volicer et al., 1989

Horner et al., 1994 Feinberg et al., 1992



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Dysphagia in AD • Dysphagia may occur early in AD

Humbert et al., 2010 Priefer and Robbins, 1997



Dysphagia in AD • Functional changes to the swallow

may be associated with functional

changes in the cortical swallowing

network

Humbert et al., 2010




Dysphagia in AD • The oral and pharyngeal stages may

be affected


Garon et al., 2009

Suh et al., 2009

Wada et al., 2001

Priefer and Robbins, 1997 Horner et al., 1994



Dysphagia in AD • Dysphagia may occur in all stages of

AD and may be a marker of disease

severity

Wada et al., 2001 Horner et al., 1994



Dysphagia in AD • Eating and swallowing deficits in AD

appear to be less severe compared

with other types of dementia

Shinagawa et al., 2009 Ikeda et al., 2002



Behavioural Eating Deficits

in AD • Behavioural eating difficulties may

occur in all stages of AD

Edahiro et al., 2012

Priefer and Robbins, 1997

Durnbaugh et al., 1996

Burge, 1994

Morris et al., 1989

Suski and Nelsen, 1989



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Dysphagia in Vascular

Dementia (VaD) • The oral and pharyngeal stages may

be affected

Suh et al., 2009

Logemann, 1998



Dysphagia in VaD • Aspiration rates and silent aspiration

rates appear to be higher than those

of AD patients

Suh et al., 2009



Dysphagia in VaD



Suh et al., 2009

Dysphagia in Lewy Body

Dementia (LBD) • Aspiration rates in individuals with

LBD have been found to be 35.6%

Yamamoto et al., 2010



Dysphagia in LBD • Caregivers report:

• Significantly greater swallowing

deficits with solids and liquids

• Increased difficulty with sputum, loss

of appetite, and constipation

Shinagawa et al., 2009



Dysphagia in Parkinson’s

Disease Dementia (PDD) • Prevalence of dysphagia in PDD ~ 25%

Bine et al., 1995



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Dysphagia in PDD • Individuals may demonstrate an

impaired ability to manipulate food in

the oral cavity

Athlin et al., 1989




in PDD • Disabilities may occur in the areas of

concentration, communication,

manipulation of food on the plate, and

transporting food to the mouth

Athlin et al., 1989



Dysphagia in

Frontotemporal Lobe

Dementia (FTD) • Pharyngeal stages may be primarily

affected

Langmore et al., 2007




in FTD • Caregivers have reported swallowing

problems, appetite changes, food

preference changes, and abnormal

eating behaviours

Ikeda et al., 2002





assessment, management,

and treatment in this

population?



Assessment • Best assessment practices are

currently unknown

Feinberg et al. 1992

Leder et al., 2009

Hansen et al., 2011



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Treatment/Management • A physiotherapist administered

cervical spine mobilization protocol

may improve “dysphagia limit” in

individuals with severe AD and altered

neck posture

Bautmans et al., 2008



Treatment/Management • Thickening liquids to a honey-

thickened consistency may eliminate

thin liquid aspiration in individuals with

dementia

Logemann et al., 2008

Robbins et al., 2008

Hines et al., 2010



Treatment/Management • High calorie supplements and other

oral feeding options may help

individuals with dementia gain weight

Asplund et al., 1991

Hanson et al., 2011



Treatment/Management • Treatment with dopamine agonists

and angiotensin-converting enzyme

inhibitors (ACEIs) may result in

positive outcomes in swallowing and

feeding

Yamaguchi et al., 2010



Treatment/Management • Tube feeding vs. hand feeding

VanOrt and Phillips, 1992

VanOrt and Phillips, 1995

Finucane et al., 1999

Garrow et al., 2007

Sampson et al., 2009



Conclusions • Demographics

• Nature of Dysphagia

• Contribution to Eating Deficits

• Assessment

• Treatment



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Conclusions • Correlations

• Neural Mechanisms



Questions



References Alzheimer Society of Canada. (2010). Rising tide: The impact of dementia on

Canadian society. (Executive summary.) Retrieved from

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Athlin E, Norberg A, Axelsson K, et al. Aberrant eating behavior in elderly

parkinsonian patients with and without dementia: analysis of video-recorded meals.

Research In Nursing and Health 1989; 12(1), 41-51.

Asplund K, Norberg A, & Adolfsson R. The sucking behaviour of two patients in the

final stage of dementia of the alzheimer type. Scandinavian Journal of Caring

Sciences 1991; 5(3), 141-147.

Bautmans I, Demarteau J, Cruts B, et al. Dysphagia in elderly nursing home

residents with severe cognitive impairment can be attenuated by cervical spine

mobilization. Journal of Rehabilitation Medicine 2008; 40(9), 755-760.



References Bine JE, Frank EM, McDade HL. Dysphagia and dementia in subjects with

Parkinson’s disease. Dysphagia 1995; 10(3), 160-164.

Burge P. Textured soft diets and feeding techniques among the elderly mentally ill.

Journal of Human Nutrition and Dietetics 1994; 7, 191-198.

Chouinard J, Lavigne E, & Vileneuve C. Weight loss, dysphagia, and outcome in

advanced dementia. Dysphagia 1998; 13(3), 151-155

Durnbaugh T, Haley B, & Roberts S. Assessing problem feeding behaviors in mid-

stage alzheimer's disease. Geriatric Nursing 1996; 17(2), 63-67.

Edahiro A, Hirano H, Yamada R, et al. Factors affecting independence in eating

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481-490.



References Feinberg MJ, Ekberg O, Segall L, et al. Deglutition in elderly patients with dementia:

Findings of videofluorographic evaluation and impact on staging and

management. Radiology 1992; 183(3), 811-814.

Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced

dementia: a review of the evidence. JAMA 1999; 282, 1365-1370.

Garon BR, Sierzant T, & Ormiston C. Silent aspiration: Results of 2,000 video

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Garrow D, Pride P, Moran W, et al. Feeding alternative in patients with dementia:

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References Global, T. World Alzheimer Report 2010. Alzheimerʼs Disease International (ADI)

(online). Available at:

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Report+2010#0

Hansen T, Kjaersgaard A, Faber J. Measuring elderly dysphagic patients'

performance in eating--a review. Disability and Rehabilitation 2011; 33(21-22),

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Hanson LC, Ersek M, Gilliam R, et al. Oral feeding options for people with

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Hines S, McCrow J, Abbey J, et al. Thickened fluids for people with dementia in

residential aged care facilities. International Journal of Evidence Based Healthcare

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http://www.alzheimer.ca/docs/RisingTide/AS Rising TideExecutive Summary_Eng_FINAL_SecuredVersion.pdf

http://www.alzheimer.ca/docs/RisingTide/AS Rising TideExecutive Summary_Eng_FINAL_SecuredVersion.pdf

http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:World+Alzheimer+Report+2010

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2013/06/10

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References Horner J, Alberts MJ, Dawson DV et al. Swallowing in alzheimer's

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Humbert IA, McLaren DG, Kosmatka K et al. Early deficits in cortical control of

swallowing in alzheimer's disease. Journal of Alzheimer's Disease 2010; 19(4),

1185-1197.

Humbert IA, McLaren DG, Malandraki G, et al. Swallowing intentional off-state in

aging and Alzheimer’s disease: Preliminary study. Journal of Alzheimer’s disease

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Ikeda M, Brown J, Holland AJ et al. Changes in appetite, food preference, and

eating habits in frontotemporal dementia and Alzheimer’s disease. Journal of

Neurology, Neurosurgery, and Psychiatry 2002; 73(4), 371-376.

Langmore SE, Olney RK, Lomen-Hoerth C, et al. Dysphagia in patients with

frontotemporal lobar dementia. Archives of Neurology 2007; 64(1), 58-62.



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Morris CH, Hope RA, & Fairburn CG. Eating habits in dementia a descriptive study.

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Priefer BA, & Robbins J. Eating changes in mild-stage alzheimer's disease: A pilot

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