June is both Alzheimer’s & Brain Awareness Month and Dysphagia Awareness Month, which provides the opportunity to help raise dementia and dysphagia awareness and their related co-morbidities. Individuals with dementia may experience dysphagia characterized by oral deficits including oral holding (stasis), prolonged or non-productive chewing, and pharyngeal deficits, including delayed initiation of the swallow, reduced movement or elevation of muscles, and laryngeal penetration or aspiration, which may lead to aspiration pneumonia (Feinberg, Ekberg et al. 1992, Horner, Alberts et al. 1994, Priefer and Robbins 1997, Wada, Nakajoh et al. 2001, Garon, Sierzant et al. 2009, Suh, Kim et al. 2009, Humbert, McLaren et al. 2010, Affoo, Foley et al. 2013).
Individuals with dementia may experience dysphagia characterized by oral deficits including oral holding (stasis), prolonged or non-productive chewing, and pharyngeal deficits, including delayed initiation of the swallow, reduced movement or elevation of muscles, and laryngeal penetration or aspiration, which may lead to aspiration pneumonia
These individuals may also develop food agnosia (not recognizing food as food), perceptual and spatial deficits resulting in difficulties recognizing food and utensils (Logemann 1998).
Unfortunately, eating and swallowing disorders tend to increase in individuals as dementia progresses. In a study of 323 nursing home residents with advanced dementia observed for a period of 18 months, 86% were observed to have eating problems, including swallowing or chewing problems, refusal to eat or drink, suspected dehydration, and persistently reduced oral intake (Mitchell, Teno et al. 2009).
Dementia like many other progressive diseases, requires ongoing assessment and modifications to ensure that the individual continues to be safe and relatively free of the risk of aspiration pneumonia. Therefore, it is important that a speech-language pathologist performs regular screens on long-term patients to ensure they are on the safest, yet least restrictive diet possible.