Dysphagia in Older Adults

Carnaby G.D., LaGorio L., Silliman S., Crary M.

Background Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post-stroke dysphagia; but application data remain conflicted. Objective This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. Methods Stroke patients (n = 53, x age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications. Results Post-treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2 = 5, P ≤ .022) and improved functional outcome by 3 months post-stroke (RR = 1.72, 1.04-2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to to pre-stroke diet of 4.317 [95% CI: 1.08- 17.2, P Conclusion Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.

Krajczy E., Krajczy M., Luniewski J., Bogacz K., Szczegielniak J.

Tagliaferri S., Lauretani F., Pelá G., Meschi T., Maggio M.

Oropharyngeal dysphagia (OD) is a widespread clinical condition among older adults. Although it represents a risk factor for malnutrition, dehydration and aspiration pneumonia, its assessment and contribution to functional decline is often ignored. The aim of the present study was to estimate the prevalence of OD in a large population of non-institutionalized older people and to evaluate its relationship with malnutrition and physical function. 10-item Eating Assessment Tool (EAT-10) and Mini Nutritional Assessment Short Form (MNA-SF) were used to identify the risk of dysphagia and malnutrition. Short Physical Performance Battery (SPPB) and hand-grip strength were used as functional endpoints. The relationship between risk of dysphagia and functional outcomes was tested in a multivariate regression analysis adjusted for age and sex (Model 1) and for other confounders including Mini Mental State Examination (MMSE) and polypharmacy (Model 2). Mean age of 773 subjects (61.3% female) was 81.97 years. The percentage of participants at risk of dysphagia (EAT ≥ 3) was 30.1%, 37.8% of subjects was malnourished (MNA-SF < 8), 46.2% was at risk of malnutrition (MNA-SF:8-11). EAT-10 was significantly and negatively associated to MNA-SF (β = -0.47 ± 0.06, p < 0.0001) and the strength of the relationship was attenuated but still statistically significant in the multivariate model (β = -0.28 ± 0.07, p < 0.0001). A significant and negative relationship was found between EAT-10 and SPPB and hand-grip strength in Model 1 (β = -0.25 ± 0.05, p < 0.0001) and Model 2 (β = -0.07 ± 0.03, p < 0.0001). After categorization of risk of dysphagia in two groups (at risk and not at risk), MNA-SF, SPPB and hand-grip strength were independently associated with higher risk of dysphagia (OR = 0.91, 95%CI = 0.83-0.99, p = 0.03; OR = 0.83, 95%CI = 0.77-0.89, p < 0.0001; OR = 0.96, 95%CI = 0.92-0.99, p = 0.02, respectively). In a large group of outpatient older individuals, we observed a significant negative association between risk of dysphagia and nutritional and physical performance, suggesting that the screening of OD, possibly supported by its assessment, should be implemented in the geriatric setting to potentially prevent the functional decline.

Christmas C., Rogus‐Pulia N.

Swallowing problems, or dysphagia, are common as people age, and are associated with significant negative outcomes, including weight loss, pneumonia, dehydration, shortened life expectancy, reduced quality of life, and increased caregiver burden. In this article, we will discuss the complex process of swallowing in normal circumstances and with healthy aging, then review etiologies that contribute to dysphagia. We will discuss approaches to evaluating and treating dysphagia, providing relevant data where they are available. We highlight the desperate need for high-quality research to guide best practices in treating dysphagia in older adults. J Am Geriatr Soc 67:2643-2649, 2019.

Barrera M.A., O'Connor Wells B.

Benfield J.K., Everton L.F., Bath P.M., England T.J.

To describe and systematically review the current evidence on the effects of swallow therapy augmented by biofeedback in adults with dysphagia (PROSPERO 2016:CRD42016052942).Two independent reviewers conducted searches that included MEDLINE, EMBASE, trial registries, and gray literature up to December 2016.Randomized controlled trials (RCTs) and non-RCTs were assessed, including for risk of bias and quality.Data were extracted by 1 reviewer and verified by another on biofeedback type, measures of swallow function, physiology and clinical outcome, and analysed using Cochrane Review Manager (random effects models). Results are expressed as weighted mean difference (WMD) and odds ratio (OR).Of 675 articles, we included 23 studies (N=448 participants). Three main types of biofeedback were used: accelerometry, surface electromyography (sEMG), and tongue manometry. Exercises included saliva swallows, maneuvers, and strength exercises. Dose varied between 6 and 72 sessions for 20-60 minutes. Five controlled studies (stroke n=95; head and neck cancer n=33; mixed etiology n=10) were included in meta-analyses. Compared to control, biofeedback augmented dysphagia therapy significantly enhanced hyoid displacement (3 studies, WMD=0.22cm; 95% confidence interval [CI] [0.04, 0.40], P=.02) but there was no significant difference in functional oral intake (WMD=1.10; 95% CI [-1.69, 3.89], P=.44) or dependency on tube feeding (OR =3.19; 95% CI [0.16, 62.72], P=.45). Risk of bias was high and there was significant statistical heterogeneity between trials in measures of swallow function and number tube fed (I2 70%-94%). Several nonvalidated outcome measures were used. Subgroup analyses were not possible due to a paucity of studies.Dysphagia therapy augmented by biofeedback using sEMG and accelerometry enhances hyoid displacement but functional improvements in swallowing are not evident. However, data are extremely limited and further larger well-designed RCTs are warranted.

Wirth R., Pourhassan M., Streicher M., Hiesmayr M., Schindler K., Sieber C.C., Volkert D.

Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia.One-day, annually repeated cross-sectional study, evaluating the nutritional situation of nursing home residents with 6-month mortality as outcome.191 nursing homes from 14 countries in Europe and the United States participating in the nutritionDay study between 2007 and 2012.Data of all nursing home residents in the nutritionDay study aged 65 years or older with available information about dysphagia and outcome were analyzed.Residents' characteristics and mortality rate were calculated by group comparison, and mortality risk was calculated by multivariate regression analysis with adjustment for potential confounding factors.10,185 residents (78% female) with a mean age of 85 ± 8.1 years were included in the analysis. Dysphagia was reported in 15.4% of residents. The 6-month mortality of residents with dysphagia was significantly higher than of those without dysphagia (24.7% vs 11.9%; P < .001). The multivariate regression analysis revealed dysphagia [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.24-1.68, P < .001] along with body mass index 5 kg (OR 1.61, 95% CI 1.37-1.88, P < .001) as independent and significant risk factors for mortality. Because of significant interaction, a disproportionately high mortality of 38.9% was found in residents with dysphagia accompanied by previous weight loss >5 kg (OR for interaction 1.44; 95% CI 1.03-2.01; P = .032). Tube feeding was reported in 14.6% of residents with dysphagia. The mortality rate of dysphagic residents receiving tube feeding vs those who were not was not significantly different (21.4% vs 25.3%; P = .244).In this nutritionDay study, dysphagia was identified as an independent risk factor for mortality in nursing home residents. Residents with dysphagia accompanied by weight loss are at a particularly high risk of mortality and should therefore receive special attention.

Michel A., Vérin E., Gbaguidi X., Druesne L., Roca F., Chassagne P.

To define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference clinical screening test for swallowing disorders, to assess the feasibility of the V-VST in an ambulatory care setting, to search for associations between geriatric parameters and OD, and to identify a relationship between severities of cognitive impairment and OD.Prospective, monocentric study.Population from a geriatric outpatients clinic.Patients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective cough, and ability of voluntary swallowing for testing.OD screening was realized using V-VST during consultation. Severity of cognitive impairment was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale (DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities, cognition, nutrition, mood disorders, frailty).117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment, 52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1; 95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity of cognitive impairment.OD is very frequent in community-dwelling older persons with dementia and is associated with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening test in this population and therefore should be systematically included in the geriatric assessment of older persons with dementia. The role of V-VST in therapeutic strategies of OD remains to be evaluated.

Rogus-Pulia N., Wirth R., Sloane P.D.

Namasivayam-MacDonald A., Shune S.

McCoy Y.M., Varindani Desai R.

Patel D.A., Krishnaswami S., Steger E., Conover E., Vaezi M.F., Ciucci M.R., Francis D.O.

The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and in-hospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009-2013). Patients aged 45 years or older with ≤180 days of stay in hospital with and without dysphagia were included. Multivariable survey regression methods with propensity weighting were used to assess associations between dysphagia and different outcomes. Overall, 2.7 of 88 million (3.0%) adult US inpatients had a dysphagia diagnosis (50.2% male, 72.4% white, 74.6% age 65-90 years) and prevalence increased from 408,035 (2.5% of admissions) in 2009 to 656,655 (3.3%) in 2013. After inverse probability of treatment weighting adjustment, mean hospital LOS in patients with dysphagia was 8.8 days (95% CI 8.66-8.90) compared to 5.0 days (95% CI 4.97-5.05) in the non-dysphagia group (P < 0.001). Total inpatient costs were a mean $6,243 higher among those with dysphagia diagnoses ($19,244 vs. 13,001, P < 0.001). Patients with dysphagia were 33.2% more likely to be transferred to post-acute care facility (71.9% vs. 38.7%, P < 0.001) with an adjusted OR of 2.8 (95% CI 2.73-2.81, P < 0.001). Compared to non-cases, adult patients with dysphagia were 1.7 times more likely to die in the hospital (95% CI 1.67-1.74). Dysphagia affects 3.0% of all adult US inpatients (aged 45-90 years) and is associated with a significantly longer hospital length of stay, higher inpatient costs, a higher likelihood of discharge to post-acute care facility, and inpatient mortality when compared to those with similar patient, hospital size, and clinical characteristics without dysphagia. Dysphagia has a substantial health and cost burden on the US healthcare system.

Doeltgen S.H., Ong E., Scholten I., Cock C., Omari T.

Objective To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation—the Mendelsohn maneuver and effortful swallowing—on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design Evaluation of intervention effects in a healthy control cohort. Setting A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry–based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction ( P = .001) and pharyngeal pressure ( P < .0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows ( P = .01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows ( P = .001). Conclusion Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.

Jansson-Knodell C.L., Codipilly D.C., Leggett C.L.

Evaluating a patient with dysphagia can be a complex and daunting task. In this article, we present a practical approach to the evaluation, physical examination, and subsequent work-up of dysphagia that is applicable to practicing physicians.

Gillman A., Winkler R., Taylor N.F.

The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain ‘nil by mouth’, as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients’ perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

Sawa Y.

Ye C., Zhao L., He X., Huang Q., Li J., Wang W., Yang K., Su J., Chen Y., Lin Y., Qiu Y., Wang B., Tang M., Zhang H.

Zhang Y., Gong Z., Cai J., Yu W., Dai Y., Wang H.

Muglia L., Beccacece A., Soraci L., Caloiero R., Arturi F., Fabbietti P., Di Rosa M., Sabbatinelli J., Greco G.I., Filicetti E., Volpentesta M., Montesanto A., Paparazzo E., Cherubini A., Fedecostante M., et. al.

Chou Y., Sung C., Chu Y., Chiang K., Chen R., Banda K.J., Lee C., Fajarini M., Chou K.

Abstract Background Decreased tongue strength, pressure, and endurance are key indicators in determining oropharyngeal dysphagia (OD). This study aimed to examine the accuracy of the Iowa Oral Performance Instrument (IOPI) in assessing tongue strength, endurance, and pressure, and to identify predictors of OD. Methods In this study, we analyzed data of community-dwelling older adults (age ≥ 65 years) collected between March to December 2022. The accuracy for IOPI was examined with Receiver operating characteristic curve using area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) and optimal cutoff with Youden index (J). Bivariate and multivariate logistic regression analysis for predictors of OD were performed presenting odds ratio (OR) with 95% confidence interval (CI). Results The cohort consisted of 85 older adults with mean age of 83.25 years (SD 6.76), of which 64 (75.3%) were female. The prevalence of OD using EAT-10 was 8.3%. Tongue strength demonstrated better diagnostic accuracy using anterior tongue strength (ATS): cut-off: 37.5 kPa (AUC: 0.79, Se: 0.86, and Sp: 0.65) and posterior tongue strength: cut-off: 31.5 kPa (AUC: 0.73, Se: 0.71, and Sp: 0.79). Tongue endurance demonstrated better diagnostic accuracy using anterior endurance target second (ATE-Target Sec): cut-off: 2.4 (AUC: 0.96, Se: 0.86, and Sp: 0.90), PTE-Target Sec: cut-off: 1.7 (AUC: 0.93, Se: 0.86, and Sp: 0.83), ATE-Target Max with cut-off: 34.4 kPa (AUC 0.81, Se = 0.86, and Sp = 0.64), and PTE-Target Max with cut-off: 29.5 kPa (AUC: 0.77, Se = 0.86, and Sp = 0.69). Tongue pressure revealed limited diagnostic accuracy using saliva swallowing pressure with cut-off: 23.3 kPa (AUC: 0.60) and effortful swallowing pressure with cut-off: 28.5 kPa (AUC: 0.62). Significant predictors for OD were frailty (3.02, 95%CI: 1.56–5.88), age (1.17, 95%CI: 1.01–1.35), nutritional status (0.72, 95%CI: 0.57–0.92), ATS (0.86, 95%CI: 0.77–0.97), ATE-Target Max (0.90, 95%CI: 0.84–0.97), PTE-Target Max (0.92, 95%CI: 0.86–0.99), ADL (0.91), IADL (0.67), and depression (1.32). Conclusions The findings suggest that tongue strength and endurance, measured by IOPI, are more effective parameters than tongue pressure, with frailty, age, nutritional status, ATS, ATE-Target Max, PTE-Target Max, ADL, IADL, and depression being essential for early screening of OD in community-dwelling older adults. Clinical trial number Not applicable.

Nakao-Kato M., Takahashi A., Magara J.

Background/Objective: The International Dysphagia Diet Standardisation Initiative (IDDSI) and the Japanese Dysphagia Diet 2021 (JDD2021) are prominent systems that classify thickened beverages for dysphagia management. We herein aim to establish a correspondence between these systems through systematic viscosity measurements. Methods: We analyzed 49 thickened beverage samples using an E-type viscometer, IDDSI flow test, and JDD syringe test. Results: Receiver operating characteristic analysis revealed the following viscosity cutoffs for IDDSI levels: 0–1 at 72.0 mPa·s (area under the curve [AUC] 0.94), 1–2 at 112.0 mPa·s (AUC 0.95), and 2–3 at 303.0 mPa·s (AUC 0.97). Multiple regression analysis revealed that beverage characteristics, including fat, sodium content, and settling time, significantly influenced viscosity (R2 = 0.803). The findings established that IDDSI Level 0 corresponds to a thinner viscosity than JDD Stage 1 and Stage 1 (0–72 mPa·s), Level 1 to Stage 1 (72–112 mPa·s), Level 2 to Stages 1–2 (112–303 mPa·s), and Level 3 to Stage 3 (>303 mPa·s). Moreover, the measurement methods had high correlations (r = 0.83–0.93, p < 0.001). Conclusions: The comprehensive map between IDDSI and JDD2021 classifications developed from the results of this study enables healthcare providers to translate between the classification systems, improving dysphagia management internationally while supporting evidence-based care and global research.

Dini F., Mancini S., Girelli A., Ercolini D.P., Reggiani A., Alonso Y.S., Inzitari M., Bellelli G., Marengoni A., Gentile S., Morandi A.

Abstract Background Dysphagia is a geriatric syndrome often unrecognized or underestimated, and there is a lack of studies in a heterogeneous population in intermediate care (IC) services. This study aims to describe the prevalence of dysphagia and its association with geriatric syndromes in older patients in IC. Methods Prospective cohort study of patients 70 years and older admitted to an IC unit. At admission, the severity of the clinical conditions, comorbidity, delirium, frailty, sarcopenia, nutritional status, and medications were assessed. Each patient was evaluated with the 3-OZ test, and dysphagia was confirmed by a speech therapy consultation. Two multivariable logistic regression models were used to evaluate the association of dysphagia at admission with geriatric syndromes (model 1), along with the severity of illness and admission diagnosis (model 2). Results A total of 455 patients were included. The prevalence of dysphagia was 10% and there was a high prevalence of mild-moderate dysphagia in patients with cognitive impairment and moderate risk of malnutrition. In the univariate analysis, an association was found between dysphagia and sarcopenia, malnutrition, and use of antipsychotics. In Model 1, higher odds of dysphagia were associated with the severity of comorbidity (Odds Ratio 6.49, 95% Confidence Interval: 2.02–20.78), and cognitive impairment (OR 0.91, 95% CI: 0.88–10.62); in Model 2, the severity of clinical conditions-NEWS2 (OR 1.61, 95% CI: 1.23–2.13) was associated with dysphagia, besides the severity of comorbidity and cognitive impairment. In a subset of 300 patients, delirium was also associated with dysphagia. Conclusions The study provides novel information on dysphagia prevalence in patients admitted to an IC unit and its association with geriatric syndromes. Additional research is needed to further define the relationship between geriatric syndromes and dysphagia, and to adequately standardize speech therapist treatments.

Bagde A., Messiha M., Singh M.

Oropharyngeal dysphagia and pain are prevalent concerns in the geriatric population. Therefore, this study investigates advances in the development of cannabidiol (CBD) gummies using 3D printing technology and compares them to commercially available molded gummies for pain management. A gelatin-based CBD formulation was prepared and printed using a syringe-based extrusion 3D printer. The formulation’s rheological properties were assessed, and the printed gummies were characterized using a texture analyzer. Drug content was analyzed using HPLC, and in vitro dissolution studies were conducted in phosphate buffer (pH 1.2 and 6.8). Our results demonstrated that the gelatin-based formulation had shear-thinning rheological properties for 3D printing at a temperature of 38.00 °C, filament diameter of 26 mm and flow of 110%. The optimized printing parameters produced gummies with higher elasticity compared to marketed gummies and comparable toughness. Drug content analysis showed 98.14 ± 1.56 and 97.97 ± 2.14% of CBD in 3D-printed and marketed gummies, respectively. Dissolution studies revealed that both gummy types released 100% of the drug within 30 min in both pH 1.2 and 6.8 buffers. Overall, 3D printing enables customizable CBD gummies with optimized release and offer a personalized and patient-friendly alternative to traditional oral forms for geriatric care.

Su C., Zhang S., Zheng Q., Miao J., Guo J.

Background Sarcopenia, which is defined by a decline in skeletal muscle mass and strength associated with aging, is common among older individuals and presents considerable health dangers. Alzheimer’s disease (AD) is a prevalent degenerative brain condition linked to a decrease in cognitive function. The intersection of these conditions remains underexplored. The goal of this systematic review and meta-analysis was to establish the frequency of sarcopenia in individuals with AD and investigate the relationship between sarcopenia and AD. Methods We performed an extensive review of literature databases, including PubMed, Embase, Web of Science, and the Cochrane Library, through April 2024. The inclusion criteria included studies that provided data on the frequency of sarcopenia in patients with AD or that examined the odds ratios (ORs) associated with these comorbidities. R Studio (4.3.1) was utilized for conducting the statistical analyses. Results A total of 27 studies, comprising 3902 AD patients were included. In patients with AD, the combined occurrence of sarcopenia was 33.9%, with a confidence interval (CI) of 95%, ranging from 27.6% to 40.2%. Sarcopenia was found in 31.2% (95% CI: 0.223–0.402) and 41.9% (95% CI: 0.321–0.516) of patients with mild and moderate AD, respectively. The OR for the association between AD and sarcopenia was 2.670 (95% CI: 1.566–4.555), suggesting a robust correlation. Conclusion Sarcopenia is highly prevalent in AD patients, highlighting the need for integrated care approaches to address both cognitive and physical health issues. Further research is needed to elucidate the pathophysiological links between AD and sarcopenia.

Chen S., Dong Z., Xiang H., Chen Z., Chen T., Huang J., Liang C., Yu W.

BACKGROUND Gastric cancer is among the most prevalent malignancies worldwide. Despite significant advancements in chemoradiotherapy, targeted therapy, and neoadjuvant therapy, conventional surgical intervention remains the cornerstone of gastric cancer management. Improvements in surgical techniques, coupled with the use of staplers and other advanced instruments, have substantially reduced the incidence of complications and mortality following gastric cancer surgery. However, dysphagia remains a common postoperative complication. AIM To retrospectively investigate the potential factors contributing to dysphagia in patients who have undergone laparoscopic radical gastrectomy for gastric cancer and to explore effective strategies for its postoperative management. METHODS In this retrospective study, we analyzed data from patients who underwent elective laparoscopic total gastrectomy at Lihuili Hospital, Ningbo University, between January 2018 and May 2022. A total of 115 eligible postoperative patients were included. Postoperatively, patients completed questionnaires and were categorized into two groups based on their responses: The dysphagia group (Eating Assessment Tool-10 score ≥ 3) and the non-dysphagia group (Eating Assessment Tool-10 score < 3). Risk factors associated with dysphagia following total gastrectomy were assessed using χ 2 tests, Fisher’s exact tests, t -tests, Pearson correlation coefficients, and univariate and multivariate regression analyses. RESULTS Multivariate analysis further identified anastomotic style, prolonged intubation time, advanced age, and low albumin (ALB) levels as independent risk factors for postoperative dysphagia. Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life. CONCLUSION Univariate analysis revealed that anastomotic style, low serum ALB levels, advanced age, and prolonged intubation time were significantly associated with postoperative dysphagia in gastric cancer patients. Multivariate analysis further identified anastomotic style, prolonged intubation time, advanced age, and low ALB levels as independent risk factors for postoperative dysphagia. Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.

Liu S., Fan L., Tian H., Wei S., Zhang S., He M., Wei J.

Background and objectivesOropharyngeal dysphagia (OD) is an emergent health concern in older adults, with incidence rates escalating due to age-related and various neurological and physical conditions. This study identifies risk and protective factors for new-onset OD, with an emphasis on gender differences.MethodsUtilizing data from the National Health and Aging Trends Study (NHATS), this study analyzed 6,360 participants (58.1% women) across 2011–2014 and 2015–2018 periods. Employing a random forest feature selection, specifically recursive feature elimination and mean decrease impurity algorithm, we assessed 128 variables to identify critical factors including demographics, health, physical and neurological functionality, and environmental conditions. The study further applied logistic regression and explored factor interactions using restricted cubic splines, streamlining the analysis to focus on key determinants of oropharyngeal dysphagia.ResultsInitial findings show a decrease in new-onset OD from 15.62% in 2011 to 14.49% in 2015, with women more frequently affected. The analysis elucidates a constellation of highly predictive factors for OD, encompassing extremes of body mass index (BMI), socioeconomic challenges (as indicated by low income), diminished physical conditioning, and adverse emotional states. Notably, gender-specific disparities emerged, highlighting the critical role of cognitive function and mood in men, whereas in women, the overarching influence of general health status and comorbidities was more pronounced.ConclusionThis condensed examination highlights the complex, multifactorial nature of OD in older adults, influenced by sociodemographic, physical, and psychological factors, and underscores the need for gender-specific approaches in predicting, preventing, and managing OD.

Tian Y., Hu J., Wang Q., Qiao J., Wen H., Ye Q., Dou Z.

ABSTRACTIntroductionPrevious observational studies have implied a correlation between cognitive impairment and dysphagia, but some have indicated no correlation between the two. Such contradictory findings may have been influenced by small sample sizes and potential confounders. In this Mendelian randomization (MR) analysis, we genetically estimated a causal relationship between cognitive impairment and dysphagia.MethodsThe study included a large meta‐analysis of genome‐wide association studies (GWAS) of cognitive impairment in 269,867 individuals of European ancestry and pooled data from a GWAS of dysphagia in 165,765 individuals of European ancestry (cases 3497, controls 161,968). We then used five different complementary MR methods, including IVW, MR‐Egger, MR‐RAPS, weighted median, and weighted mean, to estimate causality between cognitive impairment and dysphagia and finally also assessed heterogeneity and horizontal pleiotropy by extensive sensitivity tests.ResultsNo evidence of heterogeneity in the effect of instrumental variables was found in Cochran's Q test; therefore, a fixed effects model was used. IVW analysis (OR: 1.206, 95% CI: [1.041, 1.371], p = 0.00508) found that cognitive impairment was associated with an increased risk of dysphagia and that there was a causal association between the two. Also, the weighted median (OR: 1.248, 95% CI: [1.012, 1.484], p = 0.0253), weighted mode (OR: 1.216, 95% CI: [1.043, 1.389], p = 0.0412), and MR‐RAPS (OR: 1.225, 95% CI: [1.069, 1.381], p = 0.00627) validated the conclusions. Furthermore, extensive sensitivity analyses found no evidence of heterogeneity or horizontal pleiotropy, confirming the reliability of this MR result.ConclusionOur MR study demonstrated a causal effect of cognitive impairment on dysphagia from a genetic perspective, suggesting that individuals with a history of cognitive impairment require specific clinical attention to prevent the development of dysphagia.

Wheless J.W., Richardson B., Rubinos C., Faught E., Vuong M.

Molimi M.B., Egan P., Adebo O.A.

Grigoriadis A., Saadi S.B., Munirji L., Jacobs R.