Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Gebäude A1, 48149, Münster, Germany.
Institute of Biomagnetism and Biosignalanalysis, University Hospital Muenster, University of Muenster, Malmedyweg 15, 48149, Münster, Germany.
Sci Rep. 2020 Nov 23;10(1):20403. doi: 10.1038/s41598-020-77421-3.
Dysphagia is frequent in many neurological diseases and gives rise to severe complications such as malnutrition, dehydration and aspiration pneumonia. Therefore, early detection and management of dysphagia is essential and can reduce mortality. This study investigated the effect of cognitive and motor dual-task interference on swallowing in healthy participants, as dual-task effects are reported for other motor tasks such as gait and speech. 27 participants (17 females; 29.2 ± 4.1 years) were included in this prospective study and examined using flexible endoscopic evaluation of swallowing (FEES). Using a previously established FEES-based score, the paradigms "baseline swallowing", "cognitive dual-task" and "motor dual-task" were assessed. Scores of the three paradigms were compared using a repetitive measures ANOVA and post-hoc analysis. Mean baseline swallowing score in single task was 5 ± 3. It worsened to 6 ± 5 in the cognitive (p = 0.118), and to 8 ± 5 in the motor dual-task condition (p < 0.001). This change was driven by subclinical worsening of premature bolus spillage and pharyngeal residue. Oropharyngeal swallowing is not exclusively reflexive in nature but requires attention, which leads to motor dual-task interference. This has potential diagnostic and therapeutic implications, e.g. in the early screening for dysphagia or in avoiding dual-task situations while eating.
吞咽困难在许多神经疾病中很常见，并会导致严重的并发症，如营养不良、脱水和吸入性肺炎。因此，早期发现和管理吞咽困难至关重要，可以降低死亡率。本研究调查了认知和运动双重任务干扰对健康参与者吞咽的影响，因为双重任务效应已在其他运动任务（如步态和言语）中得到报道。这项前瞻性研究纳入了 27 名参与者（17 名女性；29.2±4.1 岁），并使用灵活的内镜吞咽评估（FEES）进行了检查。使用先前建立的基于 FEES 的评分，评估了“基础吞咽”、“认知双重任务”和“运动双重任务”这三种模式。使用重复测量方差分析和事后分析比较了这三种模式的评分。在单一任务中的平均基础吞咽评分是 5±3。在认知双重任务中恶化到 6±5（p=0.118），在运动双重任务中恶化到 8±5（p<0.001）。这种变化是由亚临床的过早吞咽液溢出和咽部残留恶化引起的。口咽吞咽不仅仅是反射性的，它需要注意力，这导致了运动双重任务的干扰。这具有潜在的诊断和治疗意义，例如在早期筛查吞咽困难或在进食时避免双重任务情况。
