U.O. Foniatria, Dipartimento di Riabilitazione, ASL Lecce, Italy.
SSD Igiene ed Epidemiologia, Dipartimento di Farmacia, Università "G.d'Annunzio" Chieti - Pescara, Italy.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102501. doi: 10.1016/j.amjoto.2020.102501. Epub 2020 May 4.
To evaluate the prevalence of oropharyngeal dysphagia in elderly patients suffering from minimal or mild cognitive decline.
We retrospectively collected the data of patients suffering from mild cognitive impairment or mild dementia and were undergoing management for suspected oropharyngeal dysphagia, in our department. All our patients were subjected to Mini Mental State Examination test, MD Anderson dysphagia inventory and caregiver mealtime and dysphagia questionnaire. We performed a mealtime observation study and endoscopic evaluation of swallowing in all our patients. Following evaluation, we then analysed the data statistically.
Out of 708 patients who visited us for cognitive decline and suspected oropharyngeal dysphagia in the last two years, 52 patients were confirming to the inclusion criteria of this study. Classification of oropharyngeal dysphagia patients according to ASHA-NOMS scale showed that 32.7% of patients presented with grade 4 of dysphagia followed by another 32.7% with grade 5 and 30.8% presented with grade 6. Only 3.8% of our patients were considered normal (grade 7 of ASHA-NOMS scale). MD Anderson dysphagia inventory could collected swallowing alterations in only 23.1% of the cases. The caregiver mealtime and dysphagia questionnaire showed acceptable caregivers patient management in 53.8% of patients.
Our study underscores the fact that oropharyngeal dysphagia is present in many cases of mild cognitive decline. While patients understate their swallowing problems, the caregivers are not competent enough to manage this situation in a great percentage of cases. Only a mealtime observation by a speech-language pathologist along with FEES is able to identify the true prevalence of the condition.
评估轻度认知障碍或轻度痴呆老年患者中口咽吞咽困难的患病率。
我们回顾性收集了在我科接受疑似口咽吞咽困难治疗的轻度认知障碍或轻度痴呆患者的数据。所有患者均接受了简易精神状态检查、MD 安德森吞咽障碍量表和照料者进餐和吞咽问卷评估。所有患者均进行了进餐观察研究和内镜吞咽评估。评估后，我们对数据进行了统计学分析。
在过去两年中，708 名因认知障碍和疑似口咽吞咽困难就诊的患者中，有 52 名符合本研究的纳入标准。根据 ASHA-NOMS 量表对口咽吞咽困难患者进行分类，32.7%的患者吞咽困难程度为 4 级，其次为 32.7%的患者为 5 级，30.8%的患者为 6 级。仅有 3.8%的患者被认为正常（ASHA-NOMS 量表 7 级）。MD 安德森吞咽障碍量表仅能收集到 23.1%的吞咽改变。照料者进餐和吞咽问卷显示，53.8%的患者照料者能够对患者进行良好的管理。
本研究强调了轻度认知障碍患者中存在口咽吞咽困难的事实。虽然患者低估了自己的吞咽问题，但在很大比例的情况下，照料者无法胜任管理这种情况。只有言语治疗师进行的进餐观察和纤维内镜检查才能准确识别出该疾病的真实患病率。
