Transtornos de deglutição em pessoas idosas com demência por doença de Alzheimer: achados videofluoroscópicos
Swallowing disorders in older people with dementia due to Alzheimer’s disease: videofluoroscopic findings
Patrícia Marques de Oliveira; Laélia Cristina Caseiro Vicente; Grazielle Duarte de Oliveira; Maria Aparecida Camargos Bicalho; Amélia Augusta de Lima Friche
Resumo
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Abstract
Purpose: To analyze the biomechanics of swallowing in older people with Alzheimer’s disease who are fed orally, regarding the presence and severity of dysphagia and laryngotracheal aspiration, and to verify if there is an association with demographic characteristics and disease severity.
Methods: This cross-sectional observational study analyzed videofluoroscopic swallowing studies of 55 older adults with Alzheimer’s disease, without other associated neurological diseases, of both sexes, on exclusive oral feeding. The presence of dysphagia and laryngeal penetration and tracheal aspiration was assessed using the O’Neil and Rosenbek scales. Descriptive and association analyses were performed with a 5% significance level.
Results: Most participants had functional swallowing (87.3%). When dysphagia was present, mild severity prevailed (9.1%). The frequency of laryngotracheal penetration/ aspiration was 10.9%, with a higher occurrence of penetration of liquid consistency. There were alterations in all phases of swallowing, with the most frequent impairments related to chewing (100%), presence of oral residue (96%), pharyngeal residue (80%), and esophageal transit (82%). An association was found between dysphagia and the severity of dementia and age.
Conclusion: Functional swallowing was frequent among the analyzed population. The presence of dysphagia in Alzheimer’s disease was associated with more advanced dementia and older age. All phases of swallowing showed some impairment, indicating the importance of investigating swallowing, even in older adults on exclusive oral feeding.
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References
1 Morley JE, Farr SA, Nguyen AD. Alzheimer disease. Clin Geriatr Med. 2018;34(4):591-601.
2 Ferreira-Filho SF, Borelli WV, Sguario RM, Biscaia GF, Müller VS, Vicentini G, et al. Prevalence of dementia and cognitive impairment with no dementia in a primary care setting in southern Brazil. Arq Neuropsiquiatr. 2021;79(7):565-70.
3 Paschalidis M, Konstantyner TCRO, Simon SS, Martins CB. Trends in mortality from Alzheimer’s disease in Brazil, 2000-2019. Epidemiol Serv Saude. 2023;32(2):e2022886.
4 Wu J, Burdick R, Deckelman C, Gustafson S, Yee J, Rogus-Pulia N. Management of dysphagia in neurodegenerative disease. Curr Otorhinolaryngol Rep. 2023;11(3):352-64.
5 Carvalho BAS, Nunes EL. Phonoaudiological role in neurogenic dysphagia due to Alzheimer’s disease. Res Soc Dev. 2024;13(1):e13113144860.
6 Correia SM, Morillo LS, Jacob Filho W, Mansur LL. Swallowing in moderate and severe phases of Alzheimer’s disease. Arq Neuropsiquiatr. 2010;68(6):855-61.
7 Mira A, Gonçalves R, Rodrigues IT. Dysphagia in Alzheimer’s disease: a systematic review. Dement Neuropsychol. 2022;16(3):261-9.
8 Affoo RH, Foley N, Rosenbek J, Shoemaker JK, Martin RE. Swallowing dysfunction and autonomic nervous system dysfunction in Alzheimer’s disease: a scoping review of the evidence. J Am Geriatr Soc. 2013;61(12):2203-13.
9 Espinosa-Val MC, Martín-Martínez A, Graupera M, Arias O, Elvira A, Cabré M, et al. Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients. 2020;12(3):863.
10 Costa EG, Silva MCC, Costa MLG, Barros ALS, Soares RF. Analysis of swallowing in subject bearers of disease Alzheimer. Rev Bras Otorrinolaringologia. 2008;74(1).
11 Seçil Y, Arici Ş, Íncesu TK, Gürgör N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer’s disease. Clin Neurophysiol. 2016;46(3):171-8.
12 Simões ALS, Oliva Filho A, Hebling E. Signs for early detection of dysphagia in older adults with severe Alzheimer’s disease. J Nutr Health Aging. 2020;24(6):659-64.
13 Dantas RO. Videofluoroscopy in swallowing evaluation. Salud(i) Ciencia. 2022;24(7-8):369-75.
14 Dias MC, Vicente LCC, Friche AAL, Ribeiro EG, Motta AR. Oral transit time in Alzheimer’s disease. Audiol Commun Res. 2018;23:e1900.
15 Namasivayam-MacDonald AM, Alomari N, Attner L, Benjamin RD, Chill A, Doka S, et al. A retrospective analysis of swallowing function and physiology in patients living with dementia. Dysphagia. 2022;37(4):900-8.
16 Schilling LP, Balthazar MLF, Radanovic M, Forlenza OV, Silagi ML, Smid J, et al. Diagnosis of Alzheimer’s disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol. 2022;16(3, Suppl. 1):25-39.
17 Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas R, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293-314.
18 van der Kruis JGJ, Baijens LWJ, Speyer R, Zwijnenberg I. Biomechanical analysis of hyoid bone displacement in videofluoroscopy: A systematic review of intervention effects. Dysphagia. 2011;26(2):171-82.
19 Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769-85, viii.
20 Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residue severity rating scale: an anatomically defined and image-based tool. Dysphagia. 2015;30(5):521-8.
21 Scheeren B, Maciel AC, Barros SGS. Videofluoroscopic swallowing study: esophageal alterations in patients with dysphagia. Arq Gastroenterol. 2014;51(3):221-5.
22 O’Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia. 1999;14(3):139-45.
23 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8.
24 Tavares TE, Carvalho CMRG. Characteristics of mastication and swallowing in Alzheimer’s disease. Rev CEFAC. 2012;14(1):122-37.
25 Lages DRP, Fonseca LC, Tedrus GMAS, Oliveira IB. The relationship between dysphagia and clinical and cognitive aspects in elderly patients presented with dementia. Rev CEFAC. 2020;22(2):e5719.
26 Feng HY, Zhang PP, Wang XW. Presbyphagia: dysphagia in the elderly. World J Clin Cases. 2023;11(11):2363-73.
27 Parlak MM, Babademez MA, Tokgöz S, Bizpınar Ö, Saylam G. Evaluation of swallowing function according to the stage of Alzheimer’s disease. Folia Phoniatr Logop. 2022;74(3):186-94.
28 Tanrıverdi M, Osmanoğlu E, Gelişin Ö, Çalım ÖF, Soysal P. The comparison of oropharyngeal dysphagia in Alzheimer’s disease versus older adults with presbyphagia. Dysphagia. 2025;40(4):792-800.
29 Gray LT, Shune S, Perry S, Kosty D, Namasivayam-MacDonald A. Dysphagia symptoms contribute to greater care partner burden in neurodegenerative disease. Am J Speech Lang Pathol. 2025;34(4):2053-61.
Submitted date:
01/30/2025
Accepted date:
11/25/2025
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