Eating & Swallowing Deficits in Individuals with Dementia - PDF document

2013/06/10 Eating & Swallowing Deficits in Individuals with Dementia Rebecca Affoo June 11, 2013 Acknowledgements Acknowledgements Co-Author Support Ontario Ministry of Health and Long-Term Care • Career Scientist Award • Dr. Ruth Martin, Western University • Western University Graduate Thesis Research Award • Alzheimer Foundation London and Middlesex Doctoral Award Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Today’s Agenda Today’s Agenda Systematic Review What is Dementia? Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 1

2013/06/10 Today’s Agenda Today’s Agenda What is the prevalence of What do we know about dementia in Canada? eating and swallowing deficits in individuals with dementia? Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Today’s Agenda Today’s Agenda What do we know about Conclusions eating and swallowing assessment, management, and treatment in this population? Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Today’s Agenda Systematic Review Purpose: Questions 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 Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 2

2013/06/10 Systematic Review What is Dementia? A syndrome caused by progressive • Methodology: disorders that affect: Systematic searches of the PubMed, • • Memory EBSCOhost, PsychINFO, Cochrane, Thinking • EMBASE, and Scopus databases • Behaviour were conducted Ability to perform activities of daily • living (ADL) Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia What is Dementia? What is the Prevalence of Dementia in Canada? Dementia Vascular Alzheimer’s disease dementia Lewy body Frontotemporal dementia lobe dementia Parkinson’s disease dementia Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in Alzheimer’s Disease (AD) What do we know about • Prevalence of dysphagia in moderate eating and swallowing and severe AD ~ 32% to 93% deficits in individuals with Chouinard et al., 1998 dementia? Volicer et al., 1989 Horner et al., 1994 Feinberg et al., 1992 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 3

2013/06/10 Dysphagia in AD Dysphagia in AD Dysphagia may occur early in AD Functional changes to the swallow • • may be associated with functional Humbert et al., 2010 changes in the cortical swallowing Priefer and Robbins, 1997 network Humbert et al., 2010 Humbert et al., 2011 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in AD Dysphagia in AD The oral and pharyngeal stages may Dysphagia may occur in all stages of • • be affected AD and may be a marker of disease severity Humbert et al., 2010 Garon et al., 2009 Wada et al., 2001 Suh et al., 2009 Horner et al., 1994 Wada et al., 2001 Priefer and Robbins, 1997 Horner et al., 1994 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in AD Behavioural Eating Deficits in AD Eating and swallowing deficits in AD • appear to be less severe compared • Behavioural eating difficulties may with other types of dementia occur in all stages of AD Shinagawa et al., 2009 Edahiro et al., 2012 Ikeda et al., 2002 Priefer and Robbins, 1997 Durnbaugh et al., 1996 Burge, 1994 Morris et al., 1989 Suski and Nelsen, 1989 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 4

2013/06/10 Dysphagia in Vascular Dysphagia in VaD Dementia (VaD) Aspiration rates and silent aspiration • rates appear to be higher than those The oral and pharyngeal stages may • of AD patients be affected Suh et al., 2009 Suh et al., 2009 Logemann, 1998 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in VaD Dysphagia in Lewy Body Dementia (LBD) • Aspiration rates in individuals with LBD have been found to be 35.6% Yamamoto et al., 2010 Suh et al., 2009 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in Parkinson’s Dysphagia in LBD Disease Dementia (PDD) • Caregivers report: • Significantly greater swallowing • Prevalence of dysphagia in PDD ~ 25% deficits with solids and liquids • Increased difficulty with sputum, loss Bine et al., 1995 of appetite, and constipation Shinagawa et al., 2009 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 5

2013/06/10 Dysphagia in PDD Behavioural Eating Deficits in PDD • Individuals may demonstrate an impaired ability to manipulate food in • Disabilities may occur in the areas of the oral cavity concentration, communication, manipulation of food on the plate, and Athlin et al., 1989 transporting food to the mouth Athlin et al., 1989 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Dysphagia in Behavioural Eating Deficits Frontotemporal Lobe in FTD Dementia (FTD) • Caregivers have reported swallowing problems, appetite changes, food • Pharyngeal stages may be primarily preference changes, and abnormal affected eating behaviours Langmore et al., 2007 Ikeda et al., 2002 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Assessment What do we know about Best assessment practices are • eating and swallowing currently unknown assessment, management, Feinberg et al. 1992 Leder et al., 2009 and treatment in this Hansen et al., 2011 population? Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 6

2013/06/10 Treatment/Management Treatment/Management A physiotherapist administered Thickening liquids to a honey- • • cervical spine mobilization protocol thickened consistency may eliminate may improve “dysphagia limit” in thin liquid aspiration in individuals with individuals with severe AD and altered dementia neck posture Logemann et al., 2008 Robbins et al., 2008 Bautmans et al., 2008 Hines et al., 2010 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Treatment/Management Treatment/Management High calorie supplements and other Treatment with dopamine agonists • • oral feeding options may help and angiotensin-converting enzyme individuals with dementia gain weight inhibitors (ACEIs) may result in positive outcomes in swallowing and Asplund et al., 1991 feeding Hanson et al., 2011 Yamaguchi et al., 2010 Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia Treatment/Management Conclusions Tube feeding vs. hand feeding Demographics • • VanOrt and Phillips, 1992 • Nature of Dysphagia VanOrt and Phillips, 1995 Finucane et al., 1999 Contribution to Eating Deficits • Garrow et al., 2007 Sampson et al., 2009 Assessment • • Treatment Eating & Swallowing Deficits in Eating & Swallowing Deficits in Individuals with Dementia Individuals with Dementia 7