Dysphagia Outcomes from a Multidisciplinary Clinic for Persons with Dementia
Joanne P. Yee, Danielle Brates, Amelia Barczi, Meredith Mackowicz‐Torres, Lindsay R. Clark, Ellen Wanninger, Brian Lee Young Lewis, Aaron Kuntz, Raele Donetha Robison, Sara Gustafson, Amy J. Kind, Nicole M. Rogus‐Pulia- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
The Cognitive Care Clinic (CCC) provides multidisciplinary evaluation for Veterans with dementia and their care partners. Swallowing dysfunction (dysphagia) is estimated to be highly prevalent in this population. However, dysphagia is often considered an end‐stage sequelae of disease progression. Speech‐language pathology (SLP) has been incorporated into the CCC team to facilitate pro‐active dysphagia diagnosis and management. The purpose of this study was to describe the frequency of dysphagia in persons with dementia (PWD) seen in CCC and to determine relationships among patient report of dysphagia and clinical screening results.
Multidisciplinary assessments led to consensus diagnosis of dementia subtype. Validated dysphagia screening tools included the Eating Assessment Tool‐10 (EAT‐10), water swallow test (WST), and Test of Masticating and Swallowing Solids (TOMASS). Descriptive statistics were calculated for dementia subtype, stage, and dysphagia measures. Independent samples t‐tests were used to compare the relationship between patient‐reported dysphagia symptoms (mean EAT‐10 scores) with risk for aspiration (WST results).
71 Veterans with dementia were evaluated between 2017 and 2022 (mean age = 77, 4% female). The majority had Alzheimer’s disease or mixed etiology (68%) and were in the mild disease stage (52%) using the Functional Assessment Staging Tool. 16 of 58 patients (28%) who completed the EAT‐10 scored 3 or higher indicating risk for dysphagia. 23 of 68 patients (34%) failed the WST. There were no significant differences in EAT‐10 scores between those who passed and failed the WST (mean = 1.4; SD = 3.4 versus mean = 2.8; SD = 2.7). 31 of 63 patients (49%) demonstrated inefficient mastication based on length of total masticatory time on the TOMASS.
We found that over half of this predominantly mild‐stage cohort demonstrated clinical signs or reported symptoms of swallowing impairment. This suggests that dysphagia occurs at earlier stages, which is in contrast to typical beliefs about when changes to swallow function present in PWD. Additionally, there were no differences in EAT‐10 scores based on WST outcome and average EAT‐10 scores were low overall, suggesting possible underreporting of dysphagia. Findings from this novel clinic highlight the necessity of incorporating SLPs as part of a dementia care team to provide early identification and management of dysphagia in PWD.