Background The prevalence of dysphagia in patients with dementia ranges from 13% to 84%. The high prevalence is likely the result of the presence of age-related lesions in the diffuse area of the brain in addition to those produced by the neuropathology. Moreover, antipsychotics (APs), which are extensively used to treat dementia patients, have also been associated with impaired swallow.
Purpose The objective of this study is to characterise the patophysiology of oropharyngeal dysphagia (OD) using videofluoroscopy (VFS) in patients with dementia and those with dementia and taking APs.
Material and methods An observational cross-sectional study was performed on dementia patients (DP) discharged from the hospital with a diagnosis of dementia and a VFS study. Demographical, clinical factors and swallowing parameters measured by VFS were compared between no dementia patients (NDP). NDP were elderly patients with dysphagia but without a diagnosis of dementia or other neurological or cerebrovascular diseases. Moreover, DP taking APs (DPA) were also compared with DP not taking APs (DPWA). Receiver operating characteristic (ROC) curves were drawn for laryngeal vestibule closure (LVC) time for DPA, DPWA and NDP, which predicts unsafe swallow.
Results We included 129 consecutive DP (82.2±7.8 years, 56.3% females) studied by VFS. 85.2% presented impaired efficacy and 66.4% impaired safety of swallow, penetration aspiration scale (PAS)=3.81±1.94. Time to glossopalatal junction opening (GPJO) and upper esophagal sphincter opening (UESO) was significally delayed in DP in comparison with NDP (p<0.05). LVC time ≥340 ms predicts unsafe swallow in DP with a diagnostic accuracy of 0.71 and ≥320 ms in DPA with a diagnostic accuracy of 0.82.
The PAS, LVC and UESO averages were higher with increasing antipsychotic exposure, and more with typical antipsychotics and with the potency of the APs to induce EPs, but did not reach statistical significance after the multivariate analysis (p=0.2 for PAS and p=0.944 for oral and/or pharyngeal residue).
Conclusion Our study shows that DP present severe VFS signs of impaired safety and efficacy of swallow and they are more severe in DPA, although not reaching statistical significance in our study. This study highlights the importance of considering swallowing impairment as an adverse effect of APs use.
No conflict of interest
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