Dysphagia and dementia: disease severity and degree of dysphagia as assessed by fiberoptic endoscopy

Introduction: Quantative information about dysphagia in patients with dementive diseases is limited. Pneumonia due to aspiration is one of the major causes of death in dementia (Burns, 1992; Chouinard, 2000). Because the high prevalence of dementia and a shift towards an “older society“ exists, the problem of dysphagia and its sequelae is of great importance.

Methods: To assess a hypothesized correlation of dementia severity and the grading of dysphagia, we retrospectively analysed the clinical, cognitive and videoendoscopic data of 37 patients with the main diagnosis of a dementing illness who met the inclusion criteria.

Results: Only 3 patients (8.1%) had normal findings in endoscopic evaluation. Twenty-three had either prolonging of the oral phase and/or a prolonging of the swallowing reflex triggering. In 22 patients (59%) videoendoscopy showed signs of penetration (passage of material in the larynx without passing the vocal cords). Eleven patients (29.7%) showed clear signs of aspiration. In the patients with Alzheimer's disease, but not those with vascular dementia, there was a significant correlation of disease severity and the Penetration-Aspiration (P-A) Scale score level.

Conclusions: Videoendoscopic evaluation of swallowing was well tolerated by patients with dementia. In this preselected patient-pool, a complete normal swallowing was rare (8.1%).

In Alzheimer's disease, the degree of penetration or aspiration episodes and therefore the degree of dysphagia seemed to increase with dementia severity. This was not the case in patients with vascular dementia.