Eating & Swallowing Deficits in Individuals with Dementia - - PDF document

2013/06/10 1

Eating & Swallowing Deficits in Individuals with Dementia

Rebecca Affoo

June 11, 2013

Acknowledgements

Co-Author

• Dr. Ruth Martin, Western University

Eating & Swallowing Deficits in Individuals with Dementia

Acknowledgements

Support

• Ontario Ministry of Health and Long-Term Care

Career Scientist Award

• Western University Graduate Thesis Research

Award

• Alzheimer Foundation London and Middlesex

Doctoral Award

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

Systematic Review

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

What is Dementia?

Eating & Swallowing Deficits in Individuals with Dementia

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Today’s Agenda

What is the prevalence of dementia in Canada?

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

What do we know about eating and swallowing deficits in individuals with dementia?

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

What do we know about eating and swallowing assessment, management, and treatment in this population?

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

Conclusions

Eating & Swallowing Deficits in Individuals with Dementia

Today’s Agenda

Questions

Eating & Swallowing Deficits in Individuals with Dementia

Systematic Review

Purpose:

• Describe, synthesize, and interpret

literature on dysphagia and/or autonomic nervous system dysfunction in dementia

• Identify gaps in the existing literature

Eating & Swallowing Deficits in Individuals with Dementia

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Systematic Review

Methodology:

• Systematic searches of the PubMed,

EBSCOhost, PsychINFO, Cochrane, EMBASE, and Scopus databases were conducted

Eating & Swallowing Deficits in Individuals with Dementia

What is Dementia?

• A syndrome caused by progressive

disorders that affect:

• Memory
• Thinking
• Behaviour
• Ability to perform activities of daily

living (ADL)

Eating & Swallowing Deficits in Individuals with Dementia

What is Dementia?

Eating & Swallowing Deficits in Individuals with Dementia

Dementia

Alzheimer’s disease Vascular dementia Frontotemporal lobe dementia Lewy body dementia Parkinson’s disease dementia

What is the Prevalence of Dementia in Canada?

Eating & Swallowing Deficits in Individuals with Dementia

What do we know about eating and swallowing deficits in individuals with dementia?

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in Alzheimer’s Disease (AD)

• Prevalence of dysphagia in moderate

and severe AD ~ 32% to 93%

Chouinard et al., 1998 Volicer et al., 1989 Horner et al., 1994 Feinberg et al., 1992

Eating & Swallowing Deficits in Individuals with Dementia

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Dysphagia in AD

• Dysphagia may occur early in AD

Humbert et al., 2010 Priefer and Robbins, 1997

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in AD

• Functional changes to the swallow

may be associated with functional changes in the cortical swallowing network

Humbert et al., 2010 Humbert et al., 2011

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in AD

• The oral and pharyngeal stages may

be affected

Humbert et al., 2010 Garon et al., 2009 Suh et al., 2009 Wada et al., 2001 Priefer and Robbins, 1997 Horner et al., 1994

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in AD

• Dysphagia may occur in all stages of

AD and may be a marker of disease severity

Wada et al., 2001 Horner et al., 1994

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in AD

• Eating and swallowing deficits in AD

appear to be less severe compared with other types of dementia

Shinagawa et al., 2009 Ikeda et al., 2002

Eating & Swallowing Deficits in Individuals with Dementia

Behavioural Eating Deficits in AD

• Behavioural eating difficulties may
• ccur in all stages of AD

Edahiro et al., 2012 Priefer and Robbins, 1997 Durnbaugh et al., 1996 Burge, 1994 Morris et al., 1989 Suski and Nelsen, 1989

Eating & Swallowing Deficits in Individuals with Dementia

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Dysphagia in Vascular Dementia (VaD)

• The oral and pharyngeal stages may

be affected

Suh et al., 2009 Logemann, 1998

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in VaD

• Aspiration rates and silent aspiration

rates appear to be higher than those

• f AD patients

Suh et al., 2009

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in VaD

Eating & Swallowing Deficits in Individuals with Dementia

Suh et al., 2009

Dysphagia in Lewy Body Dementia (LBD)

• Aspiration rates in individuals with

LBD have been found to be 35.6%

Yamamoto et al., 2010

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in LBD

• Caregivers report:
• Significantly greater swallowing

deficits with solids and liquids

• Increased difficulty with sputum, loss
• f appetite, and constipation

Shinagawa et al., 2009

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in Parkinson’s Disease Dementia (PDD)

• Prevalence of dysphagia in PDD ~ 25%

Bine et al., 1995

Eating & Swallowing Deficits in Individuals with Dementia

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Dysphagia in PDD

• Individuals may demonstrate an

impaired ability to manipulate food in the oral cavity

Athlin et al., 1989

Eating & Swallowing Deficits in Individuals with Dementia

Behavioural Eating Deficits in PDD

• Disabilities may occur in the areas of

concentration, communication, manipulation of food on the plate, and transporting food to the mouth

Athlin et al., 1989

Eating & Swallowing Deficits in Individuals with Dementia

Dysphagia in Frontotemporal Lobe Dementia (FTD)

• Pharyngeal stages may be primarily

affected

Langmore et al., 2007

Eating & Swallowing Deficits in Individuals with Dementia

Behavioural Eating Deficits in FTD

• Caregivers have reported swallowing

problems, appetite changes, food preference changes, and abnormal eating behaviours

Ikeda et al., 2002

Eating & Swallowing Deficits in Individuals with Dementia

What do we know about eating and swallowing assessment, management, and treatment in this population?

Eating & Swallowing Deficits in Individuals with Dementia

Assessment

• Best assessment practices are

currently unknown

Feinberg et al. 1992 Leder et al., 2009 Hansen et al., 2011

Eating & Swallowing Deficits in Individuals with Dementia

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Treatment/Management

• A physiotherapist administered

cervical spine mobilization protocol may improve “dysphagia limit” in individuals with severe AD and altered neck posture

Bautmans et al., 2008

Eating & Swallowing Deficits in Individuals with Dementia

Treatment/Management

• Thickening liquids to a honey-

thickened consistency may eliminate thin liquid aspiration in individuals with dementia

Logemann et al., 2008 Robbins et al., 2008 Hines et al., 2010

Eating & Swallowing Deficits in Individuals with Dementia

Treatment/Management

• High calorie supplements and other
• ral feeding options may help

individuals with dementia gain weight

Asplund et al., 1991 Hanson et al., 2011

Eating & Swallowing Deficits in Individuals with Dementia

Treatment/Management

• Treatment with dopamine agonists

and angiotensin-converting enzyme inhibitors (ACEIs) may result in positive outcomes in swallowing and feeding

Yamaguchi et al., 2010

Eating & Swallowing Deficits in Individuals with Dementia

Treatment/Management

• Tube feeding vs. hand feeding

VanOrt and Phillips, 1992 VanOrt and Phillips, 1995 Finucane et al., 1999 Garrow et al., 2007 Sampson et al., 2009

Eating & Swallowing Deficits in Individuals with Dementia

Conclusions

• Demographics
• Nature of Dysphagia
• Contribution to Eating Deficits
• Assessment
• Treatment

Eating & Swallowing Deficits in Individuals with Dementia

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Conclusions

• Correlations
• Neural Mechanisms

Eating & Swallowing Deficits in Individuals with Dementia

Questions

Eating & Swallowing Deficits in Individuals with Dementia

References

Alzheimer Society of Canada. (2010). Rising tide: The impact of dementia on Canadian society. (Executive summary.) Retrieved from http://www.alzheimer.ca/docs/RisingTide/AS%20Rising%20TideExecutive%20Sum mary_Eng_FINAL_SecuredVersion.pdf Athlin E, Norberg A, Axelsson K, et al. Aberrant eating behavior in elderly parkinsonian patients with and without dementia: analysis of video-recorded meals. Research In Nursing and Health 1989; 12(1), 41-51. Asplund K, Norberg A, & Adolfsson R. The sucking behaviour of two patients in the final stage of dementia of the alzheimer type. Scandinavian Journal of Caring Sciences 1991; 5(3), 141-147. Bautmans I, Demarteau J, Cruts B, et al. Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine

• mobilization. Journal of Rehabilitation Medicine 2008; 40(9), 755-760.

Eating & Swallowing Deficits in Individuals with Dementia

References

Bine JE, Frank EM, McDade HL. Dysphagia and dementia in subjects with Parkinson’s disease. Dysphagia 1995; 10(3), 160-164. Burge P. Textured soft diets and feeding techniques among the elderly mentally ill. Journal of Human Nutrition and Dietetics 1994; 7, 191-198. Chouinard J, Lavigne E, & Vileneuve C. Weight loss, dysphagia, and outcome in advanced dementia. Dysphagia 1998; 13(3), 151-155 Durnbaugh T, Haley B, & Roberts S. Assessing problem feeding behaviors in mid- stage alzheimer's disease. Geriatric Nursing 1996; 17(2), 63-67. Edahiro A, Hirano H, Yamada R, et al. Factors affecting independence in eating among elderly with Alzheimer’s disease. Geriatrics and Gerontology Int 2012; 12, 481-490.

Eating & Swallowing Deficits in Individuals with Dementia

References

Feinberg MJ, Ekberg O, Segall L, et al. Deglutition in elderly patients with dementia: Findings of videofluorographic evaluation and impact on staging and

• management. Radiology 1992; 183(3), 811-814.

Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 1999; 282, 1365-1370. Garon BR, Sierzant T, & Ormiston C. Silent aspiration: Results of 2,000 video fluoroscopic evaluations. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses 2009; 41(4), 178-85. Garrow D, Pride P, Moran W, et al. Feeding alternative in patients with dementia: examining the evidence. Clinical Gastroenterology and Hepatology 2007; 5, 1372- 1378.

Eating & Swallowing Deficits in Individuals with Dementia

References

Global, T. World Alzheimer Report 2010. Alzheimerʼs Disease International (ADI) (online). Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:World+Alzheimer+ Report+2010#0 Hansen T, Kjaersgaard A, Faber J. Measuring elderly dysphagic patients' performance in eating--a review. Disability and Rehabilitation 2011; 33(21-22), 1931-1940. Hanson LC, Ersek M, Gilliam R, et al. Oral feeding options for people with dementia: a systematic review. Journal of the American Geriatrics Society 2011; 59(3), 463-472. Hines S, McCrow J, Abbey J, et al. Thickened fluids for people with dementia in residential aged care facilities. International Journal of Evidence Based Healthcare 2010; 8(4), 252-255.

Eating & Swallowing Deficits in Individuals with Dementia

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References

Horner J, Alberts MJ, Dawson DV et al. Swallowing in alzheimer's

• disease. Alzheimer Disease and Associated Disorders 1994; 8(3), 177-189.

Humbert IA, McLaren DG, Kosmatka K et al. Early deficits in cortical control of swallowing in alzheimer's disease. Journal of Alzheimer's Disease 2010; 19(4), 1185-1197. Humbert IA, McLaren DG, Malandraki G, et al. Swallowing intentional off-state in aging and Alzheimer’s disease: Preliminary study. Journal of Alzheimer’s disease 2011; 26(2), 347-354. Ikeda M, Brown J, Holland AJ et al. Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry 2002; 73(4), 371-376. Langmore SE, Olney RK, Lomen-Hoerth C, et al. Dysphagia in patients with frontotemporal lobar dementia. Archives of Neurology 2007; 64(1), 58-62.

Eating & Swallowing Deficits in Individuals with Dementia

References

Leder SB, Suiter DM, & Lisitano Warner H. Answering orientation questions and following single-step verbal commands: Effect on aspiration status. Dysphagia 2009; 24(3), 290-295. Logemann JA, Gensler G, Robbins J, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or parkinson's

• disease. Journal of Speech, Language, and Hearing Research 2008; 51(1), 173-

183. Morris CH, Hope RA, & Fairburn CG. Eating habits in dementia a descriptive study. British Journal of Psychiatry 1989; 154, 801-806. Priefer BA, & Robbins J. Eating changes in mild-stage alzheimer's disease: A pilot

• study. Dysphagia 1997; 12(4), 212-221.

Robbins J, Gensler G, Hind J, et al. Comparison of 2 interventions for liquid aspiration on pneumonia incidence: A randomized trial. Annals of Internal Medicine 2008; 148(7), 509-518.

Eating & Swallowing Deficits in Individuals with Dementia

References

Sampson EL, Candy B, & Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews, 2009. Shinagawa S, Adachi H, Toyota Y et al. Characteristics of eating and swallowing problems in patients who have dementia with lewy bodies. International Psychogeriatrics/IPA 2009; 21(3), 520-525. Suh MK, Kim H, & Na DL. Dysphagia in patients with dementia: Alzheimer versus

• vascular. Alzheimer Disease and Associated Disorders 2009; 23(2), 178-184.

Suski NS, & Nielsen CC. Factors affecting food intake of women with alzheimer's type dementia in long-term care. Journal of the American Dietetic Association 1989; 89(12), 1770-1773. Thies W, Bleiler L, & Alzheimer's Association. 2013 alzheimer's disease facts and

• figures. Alzheimer's & Dementia: The Journal of the Alzheimer's Association 2013;

9(2), 208-245.

Eating & Swallowing Deficits in Individuals with Dementia

References

Volicer L, Seltzer B, Rheaume Y et al. Eating difficulties in patients with probable dementia of the alzheimer type. Journal of Geriatric Psychiatry and Neurology 1989; 2(4), 188-195 Wada H, Nakajoh K, Satoh-Nakagawa T et al. Risk factors of aspiration pneumonia in Alzheimer's disease patients. Gerontology 2001; 47(5), 271-276. Yamaguchi H, Maki Y , & Maki Y . Tube feeding can be discontinued by taking dopamine agonists and angiotensin-converting enzyme inhibitors in the advanced stages of dementia. Journal of the American Geriatrics Society 2010; 58(10), 2035- 2036. Yamamoto T, Kobayashi Y , & Murata M. Risk of pneumonia onset and discontinuation of oral intake following videofluorography in patients with lewy body

• disease. Parkinsonism & Related Disorders 2010; 16(8), 503-506.

VanOrt S, & Phillips L. Feeding nursing home residents with Alzheimer’s disease. Geriatric nursing 1992; 13, 249-253.

Eating & Swallowing Deficits in Individuals with Dementia

References

VanOrt S, & Phillips L. Nursing intervention to promote functional feeding. Journal

• f Gerontological Nursing 1995; 21, 6-14.

Eating & Swallowing Deficits in Individuals with Dementia