Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan; Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan.
Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Clin Neurol Neurosurg. 2020 Nov;198:106196. doi: 10.1016/j.clineuro.2020.106196. Epub 2020 Sep 13.
Patients with neurological and neuromuscular disorders (NNMD) frequently experience swallowing disorders that increase aspiration pneumonia risk and therefore require specialized diets or tube feeding. Diet type level usually is assessed by video fluoroscopic swallowing study (VFSS). To identify a simpler assessment method, we examined the association between diet type (based on the Functional Oral Intake Scale [FOIS]) diet type and maximum tongue pressure (MTP).
From 2011-2020, FOIS diet type level and MTP were assessed in a sample of 927 patients. Of these patients, 186 had Parkinson's disease (PD), 69 had Parkinson-related disease (PRD), 61 had multiple system atrophy (MSA), 42 had spinocerebellar degeneration (SCD), 147 had amyotrophic lateral sclerosis (ALS), 180 had myotonic dystrophy type 1 (DM1), and 242 had Duchenne muscular dystrophy (DMD). VFSS was conducted while patients swallowed water and foods containing barium. MTP measurements were collected the same day. Participants' diet type level was adjusted based on the VFSS, with some participants requiring multiple examinations. Relationships between diet type level and MTP were tested using univariate and Spearman rank correlation analyses.
Mean MTP for the entire NNMD group (25.5 ± 13.1 kPa) was lower than that of healthy elderly individuals, as determined in previous reports. The highest MTP was found in the MSA group (32.2 ± 15.7 kPa) and the lowest in the DM1 group (19.1 ± 9.0 kPa). Diet type level was highest in the MSA group (5.8 ± 1.4) and lowest in the DMD group (5.2 ± 1.7). A significant correlation was observed between diet type level and MTP (R = 0.384, p < 0.001). The optimum MTP cutoff values-detected using ROC curves to predict a requirement to change to a dysphagia diet-was highest in the DMD group (29.0 kPa) and lowest in the ALS group (12.3 kPa).
The decision to change NNMD patients to a dysphagia diet can be made based on MTP. Modifying a patient's oral diet (FOIS level ≤ 5) should be considered for those with a MTP of 10-25 kPa, with the cutoff value varying by disease.
患有神经和神经肌肉疾病（NNMD）的患者经常出现吞咽障碍，这会增加吸入性肺炎的风险，因此需要特殊的饮食或管饲。饮食类型通常通过视频荧光透视吞咽研究（VFSS）来评估。为了找到更简单的评估方法，我们研究了饮食类型（基于功能性口腔摄入量表[FOIS]）和最大舌压（MTP）之间的关联。
2011 年至 2020 年，对 927 名患者进行 FOIS 饮食类型水平和 MTP 评估。这些患者中，186 人患有帕金森病（PD），69 人患有帕金森相关疾病（PRD），61 人患有多系统萎缩症（MSA），42 人患有脊髓小脑变性症（SCD），147 人患有肌萎缩侧索硬化症（ALS），180 人患有肌强直性营养不良 1 型（DM1），242 人患有杜氏肌营养不良症（DMD）。在患者吞咽含钡水和食物时进行 VFSS。同一天收集 MTP 测量值。根据 VFSS 调整参与者的饮食类型水平，有些参与者需要多次检查。使用单变量和 Spearman 秩相关分析测试饮食类型水平和 MTP 之间的关系。
整个 NNMD 组的平均 MTP（25.5 ± 13.1 kPa）低于先前报告的健康老年人的 MTP。MSA 组的 MTP 最高（32.2 ± 15.7 kPa），DM1 组的 MTP 最低（19.1 ± 9.0 kPa）。MSA 组的饮食类型水平最高（5.8 ± 1.4），DMD 组的最低（5.2 ± 1.7）。饮食类型水平与 MTP 呈显著相关（R = 0.384，p < 0.001）。使用 ROC 曲线检测到的最佳 MTP 截断值-用于预测需要更改为吞咽困难饮食的要求-在 DMD 组中最高（29.0 kPa），在 ALS 组中最低（12.3 kPa）。
可以根据 MTP 来决定是否将 NNMD 患者更改为吞咽困难饮食。对于 MTP 为 10-25 kPa 的患者，应考虑将其口服饮食修改为（FOIS 水平≤5），并且根据疾病的不同，截断值也有所不同。
