Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review

Abstract Introduction Dysphagia, or swallowing impairment, is a growing concern in dementia and can lead to malnutrition, dehydration, weight loss, functional decline, and fear of eating and drinking as well as a decrease in quality of life (QOL). Objective The aim of this article is to do a systema...

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Bibliographic Details
Published in:Archives of gerontology and geriatrics 2013-01, Vol.56 (1), p.1-9
Main Authors: Alagiakrishnan, Kannayiram, Bhanji, Rahima A, Kurian, Mini
Format: Article
Language:English
Subjects:
Aged
Alzheimer Disease - complications
Alzheimer's disease
Deglutition Disorders - complications
Deglutition Disorders - diagnosis
Deglutition Disorders - therapy
Dementia
Dementia - complications
Diet
Dysphagia
Enteral Nutrition
Frontotemporal Dementia - complications
Humans
Internal Medicine
Quality of life
Swallowing disorders
Thickened fluids
Tube feeding
Usefulness
Weight loss
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Summary:Abstract Introduction Dysphagia, or swallowing impairment, is a growing concern in dementia and can lead to malnutrition, dehydration, weight loss, functional decline, and fear of eating and drinking as well as a decrease in quality of life (QOL). Objective The aim of this article is to do a systematic review of the literature to determine the patterns of swallowing deficits in different types of dementia and to look at the usefulness of different diagnostic and management strategies. Methods An electronic literature search was done using five electronic databases from 1990 to 2011. One thousand and ten records were identified and 19 research articles met the inclusion criteria. These studies were heterogeneous in design and methodology, type of assessment and outcomes, so only descriptive analysis (narrative reporting) was possible. Results Prevalence of swallowing difficulties in patients with dementia ranged from 13 to 57%. Dysphagia developed during the late stages of frontotemporal dementia (FTD), but it was seen during the early stage of Alzheimer's dementia (AD). Limited evidence was available on the usefulness of diagnostic tests, effect of postural changes, modification of fluid and diet consistency, behavioral management and the possible use of medications. Use of Percutaneous Endoscopic Gastrostomy (PEG) tubes in advanced dementia, did not show benefit with regards to survival, improvement in QOL, or reduction in aspiration pneumonia. Significant gaps exist regarding the evidence for the evaluation and management of dysphagia in dementia.
ISSN:0167-4943
1872-6976
DOI:10.1016/j.archger.2012.04.011