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Pages and Files
Introduction to Clients with Dementia
The Environment of the Nursing Home
Swallowing and Dysphagia
The Normal Swallow
Age-Related Changes to the Swallow
Dysphagia Coupled with Dementia
Oro-motor or Cranial Nerve Assessment
Considerations for planning
Possible Interventions for Moderate Dysphagia
Decreasing the Risk of Aspiration
Working within the Residential Setting
Tube feeding and the Ethics Involved
Links and Resources
Useful Information for Speech-Language Therapists
Information for Carers
Dysphagia Coupled with Dementia
Dementia and dysphagia:
Chouinard, Lavigne and Villeneuve (1998) found that over 45% of patients with advanced dementia showed signs of dysphagia. Others report that the prevalence of dysphagia in patients residing in long-term care facilities is as high as 55% (where 86% of residents were moderate-severely cognitively impaired) (Easterling & Robbins, 2008; Kayser-Jones & Pengilly, 1999). However, the actual incidence and prevalence of dysphagia in dementia patients living in nursing homes is unknown.
Often the first indicator of dysphagia in an individual with dementia is noticable weight loss (Crary & Groher, 2003). During the later stages of dementia this persistent weight loss results in what has been termed the "failure to thrive syndrome of advanced dementia" (Chouinard et al., p. 153).
The severity of the patient’s dysphagia has been shown to correlate with the severity of the patient’s dementia (Easterling & Robbins).
Volitional movements, such as those required in the pre-oral and oral phases, are impaired in patients with moderate-severe dementia because of their decline in cognitive capacity (Crary & Groher). Easterling and Robbins found that the most common swallowing abnormality experienced by patients with moderate-severe dementia is prolonged oral phase. This can be characterised by the following:
including delayed initiation - or holding food in their mouth
atypical bite sizes
decreased chewing (Easterling & Robbins), absence of chewing (Chouinard, Lavigne and Villeneuve, 1998) or suck-swallow mastication pattern (Curfman, 2005)
poor tongue control – including reduced control of liquid in the mouth (Crary & Groher, 2003) and failing to properly manage the bolus (Finucane, Christmas & Travis, 1999))
Other common swallowing abnormalities experienced by patients with moderate-severe dementia tend to include the following:
poor sensory awareness/integration (Curfman)
negative reaction to food – including textures and consistencies
difficulty taking liquids (Easterling & Robbins)
presence of coughing/choking with feeding or drinking
forgetting to swallow
inconsistent airway protection
delayed pharyngeal response/reflex
insufficient pharyngeal clearance
For a good resource on the physiological changes associated with dementia affecting deglutition see
Dining with Dementia
(Griffin et al., 2009
For a discussion about the differences in dysphagia found between patients with AD and VaD see Mee Kyung (2009).
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