dysphagia and malnutrition in neurodegenerative disorders · vice president brain and malnutrition...
TRANSCRIPT
![Page 1: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/1.jpg)
Erica Cassani, MD
Nutrition specialist, Parkinson Institute ICP Milan, ItalyVice President Brain and Malnutrition Association
Accra, Ghana 15-18 September 2013
Dysphagia and Malnutrition in Neurodegenerative disorders
![Page 2: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/2.jpg)
Definition of Dysphagia
Difficulty in swallowing food: solid, liquid or both.
![Page 3: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/3.jpg)
Pathogenesis
•Presbyphagia(Physiological condition in the elderly)
•Many non neurological pathological conditions(oncology, gastroenterology…)
•Many neurological acute conditions(stroke)
•Neurological chronic diseases(Parkinsonism, Dementia and Motor Neuron Diseases)
![Page 4: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/4.jpg)
Parkinson’s Disease & Parkinsonism
•Prevalence 30-80% of patients
•Advanced stages of Parkinson’s disease (PD), early stages of parkinsonism (PSP)
• Impairment in muscular coordination, muscular rigidity
![Page 5: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/5.jpg)
Dementia
•Prevalence 45% of patients•Causes loss of the conscious part of chewing and
nonreflex swallowing, generally in advanced stages•Loss of appetite, and/or food avoidance
(coexistent mood disorders, e.g. apathy)
![Page 6: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/6.jpg)
Motor Neuron Disease
•Nearly all the patients (rare in early stages)
•Rapidly progressive
•Muscular weakness
![Page 7: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/7.jpg)
Main Symptoms
•Cough or choke before, during or after eating or drinking
•Trouble in moving food to the back of my mouth
•Taking a long time to eat a meal
•Changes in voice quality after eating or drinking
•Drooling (Sialorrhea)
![Page 8: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/8.jpg)
Non Specific Symptoms
•Fever
•Anorexia
•Weight Loss
• Increased incidence of infections
•Delay in wound healing
![Page 9: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/9.jpg)
•Malnutrition
•Aspiration Pneumonia (Ab ingestis)
• Increased co-morbidity and mortality
•Choking is rare
Complications
![Page 10: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/10.jpg)
Diagnosis
•Clinical examination
•Specific questionnaire (Swallowing Disturbance Questionnaire for PD Patients)
![Page 11: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/11.jpg)
Cut-off 11
![Page 12: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/12.jpg)
Diagnosis
Fibrolaryngoscopy:Fiberoptic nasal endoscopy to evaluate:
•Cough reflex
•Laryngeal anatomy
•Laryngeal muscular activity
![Page 13: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/13.jpg)
Videofluoroscopy:Videoradiographic method to study bolus transit
during the oral and pharyngeal phases of swallowing
Diagnosis
![Page 14: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/14.jpg)
Treatment
•Sit upright with trunk and legs at a 90 degree angle.
•Tilt your head slightly forward
•Don’t talk with food in the mouth, minimize distractions in the area where the patient is eating
•Eat slowly
![Page 15: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/15.jpg)
Treatment
•Use a tea spoon
•Lower your chin before swallowing
•Empty your mouth before eating another bite
•Cough gently or and swallow again before taking a breath
![Page 16: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/16.jpg)
Treatment
•Eat soft food•Avoid food that require chewing (raw vegetables
and fruit, bread, sticky meat)•Prefer: tapioca pudding, platanus, boiled
vegetables, soft fishes and meat
![Page 17: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/17.jpg)
Treatment
•Add oil to make the food more viscous
(e.g. palm oil)
•Make the food homogeneous and creamy (avoid rice and prefer tapioca pudding)
•Reduce spicy food
![Page 18: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/18.jpg)
Treatment
• In case of difficulty in swallowing liquid, thicken it, adding starch
![Page 19: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/19.jpg)
Our Data
Barichella et al. Nutrition 2013, 29: 470-473
![Page 20: Dysphagia and Malnutrition in Neurodegenerative disorders · Vice President Brain and Malnutrition Association Accra, Ghana 15-18 September 2013 Dysphagia and Malnutrition in Neurodegenerative](https://reader034.vdocuments.us/reader034/viewer/2022042308/5ed55bd97e78fe7494757c0f/html5/thumbnails/20.jpg)
Our Data
Dysphagia
21%