Yamada Yumi, Shamoto Hiroshi, Maeda Keisuke, Wakabayashi Hidetaka
Rehabilitation Visiting Nursing Station TRY, Seto City, Aichi, Japan.
Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan.
Prog Rehabil Med. 2018 Nov 20;3:20180019. doi: 10.2490/prm.20180019. eCollection 2018.
Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published.
A 72-year-old man with Parkinson's disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient's body weight was 39.0 kg (-33.8%/4 months, body mass index: 15.3 kg/m), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient's swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia.
Sarcopenic dysphagia may be a complication of Parkinson's disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.
肌少症性吞咽困难是由肌少症导致的吞咽肌肉的肌肉量减少和肌肉无力引起的。治疗肌少症性吞咽困难的关键是康复治疗与积极的营养管理相结合的综合疗法。然而，据我们所知，尚未有基于家庭医疗护理环境的研究发表。
一名72岁的帕金森病男性患者在住院调整药物期间出现了肌少症和可能的肌少症性吞咽困难。出院时，患者体重为39.0 kg（4个月内下降33.8%，体重指数：15.3 kg/m），巴氏指数为45，功能性经口摄食量表为4级，吞咽困难严重程度量表为4级。通过小腿围23.8 cm、握力22 kg和步速0.5 m/s确诊为肌少症。根据肌少症性吞咽困难的共识诊断标准，该患者被诊断为肌少症性吞咽困难。患者出院后，接受了吞咽困难康复、日常活动训练和积极的营养管理相结合的治疗，营养管理从每天1200 kcal开始，最高达到每天2800 kcal。出院4个月后，患者的吞咽功能恢复正常（功能性经口摄食量表：7级，吞咽困难严重程度量表：6级），体重增加了31%（体重指数：20.1 kg/m）。肌肉量增加（小腿围：32 cm）、肌肉力量增加（握力：34 kg）、身体功能增加（步速：1 m/s）和日常生活活动能力增加（巴氏指数：90）表明肌少症已康复。
肌少症性吞咽困难可能是帕金森病的一种并发症，以家庭为基础的康复治疗与积极的营养管理相结合的综合疗法可能对治疗这种疾病有效。
