Dysphagia and swallowing disorders in patients with dementia

Dysphagia and swallowing disorders are a major health problem, especially in people with neurodegenerative diseases, in relation to malnutrition, risk of dehydration, weight loss, functional impairment and fear of eating or drinking for the patient and the primary caregiver.

This systematic review (1) analyses the current situation regarding the different diagnostic and therapeutic procedures, depending on the aetiology of the dementias. Nineteen studies that meet the inclusion criteria are collected, analysing a sample size of 12,904 people.

The prevalence of dysphagia in patients with dementia ranges from 13-57%, affecting the early stages of Alzheimer's disease and the final stages of frontotemporal dementia.

There are different techniques for clinical assessment of swallowing, or through videofluoroscopy, fibre optics. Once the swallowing disorder has been detected, therapeutic alternatives include modifying the consistency of food and liquids, oral rehabilitation techniques, pharmacological interventions or the placement of enteral tubes (nasogastric gastrostomy tube).

The evidence from the different screening and assessment tests, as well as from intervention are scarce, possibly due to the methodological design of the studies that present a great heterogeneity in the control groups, with possible biases and scarce randomization.

What is known is that the placement of enteral tubes (NHS, STP) in patients with advanced dementia does not improve the primary objectives of improving survival, quality of life or decrease the incidence of aspiration pneumonia.

A simple screening test such as the water test should be carried out in all care resources serving people with dementia, and early identification of episodes of choking on solids or fluids should be made in interviews with caregivers. Once the swallowing disorder has been identified, a multidisciplinary and comprehensive intervention should be carried out, with decision-making agreed with the family.

(1) Archives of Gerontology and Geriatrics 56 (2013) 1-9. Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review

"If I am rich in anything, it is in perplexities and not in certainties." José Luis Borges