Effects of aging on swallowing physiology with transient cortical disruption

描述（由申请人提供）：老年人不成比例地受到吞咽障碍或吞咽困难的影响，这种情况可导致发病率和死亡率增加。吞咽延迟开始是神经源性吞咽困难的一种常见和破坏性的病理生理，健康的老年人也会经历这种情况，使功能性吞咽不太安全。先前我们已经表明，健康的老年人有明显延迟吞咽发作，以及初级感觉运动皮层（SMI）的神经激活增加，这一现象在年轻人中不存在。然而，尚不清楚SMI激活的差异是否导致了吞咽开始的延迟或其随年龄增长的后果。本提案的目标是；(1)了解SMI在吞咽启动中的功能作用；(2)研究衰老对吞咽起始的影响，并观察短暂性皮质损伤；(3)让亨伯特博士获得神经科学、感觉运动控制和衰老吞咽生理学方面的专门培训。总的假设是，短暂的重度精神障碍会在年轻人和老年人中产生可测量的吞咽开始延迟，但老年人会有更明显的缺陷。我们将采用单脉冲经颅磁刺激（TMS）对双侧重度咽喉炎患者在不同时间间隔吞咽时的喉部表现进行同步视频透视和肌电图（EMG）检查，以检查健康年轻人和老年人吞咽发作的变化。这项研究将确定皮层区域是否参与启动吞咽，以及时间对这一功能的重要性。我们也将能够通过测试年轻人和老年人来确定老年人是否有能力降低对重度精神分裂症的干扰。这项研究的结果具有重要意义，因为老年人群更容易因阿尔茨海默病、中风和帕金森病等神经损伤而出现吞咽困难。在这项研究中获得的知识将成为制定科学合理战略的基础，以减少这一负担我们社会的共同卫生保健问题。相关性（见说明）：这项调查与公共卫生有关，因为它将确定老年人是否有能力降低对大脑的干扰，导致吞咽延迟。这一点很重要，因为老年人群更容易因阿尔茨海默病、中风和帕金森病而出现吞咽障碍。在这项研究中获得的知识将有助于制定干预措施，以减少这一负担我们社会的常见卫生保健问题。

DESCRIPTION (provided by applicant): Older adults are disproportionately affected by swallowing impairment, or dysphagia, a condition that can lead to increased morbidity and death. Delayed initiation of swallowing is a common and devastating pathophysiology of neurogenic dysphagia, and is also experienced by healthy older adults, making functional swallowing less safe. Previously we have shown that healthy older adults have significantly delayed swallowing onset as well as increased neural activation in the primary sensory-motor cortex (SMI), a phenomenon absent in younger adults. However, it is still not known if differences in activation of SMI are responsible for delays in swallowing initiation or its consequence with advancing age. The goals of this proposal are; (1) to understand the functional role of SMI on swallowing initiation; (2) to characterize the effect of aging on swallowing initiation with transient cortical disruption; and, (3) for Dr. Humbert to obtain specialized training in neuroscience, sensory-motor control, and aging swallowing physiology. The overall hypothesis is that transient disruption of SMI will produce measurable delays in swallowing initiation in young and old adults, but older adults will have more pronounced deficits. We will apply single-pulse transcranial magnetic stimulation (TMS) to the bilateral SMI laryngeal representation with concurrent video fluoroscopy and electromyography (EMG) during swallowing at various temporal intervals to examine changes in swallowing onset in healthy young and old adults. This investigation will determine whether cortical areas are involved in initiating swallowing as well as the importance of timing on this function. We will also be able to determine whether older adults have a decreased ability to counteract the disruptions to SMI by testing young and old adults. The results from this proposed investigation is significant because the geriatric population is more prone to developing dysphagia due to neurological impairment such as Alzheimer's disease, stroke, and Parkinson's disease. The knowledge gained in this study will become the foundation to develop scientifically sound strategies to reduce this common health care problem that burdens our society. RELEVANCE (See instructions): This investigation is relevant to public health because it will determine whether older adults have a decreased ability to counteract disruptions to the brain, causing delays in swallowing. This is significant because the geriatric population is more likely to develop swallowing impairment due to Alzheimer's disease, stroke, and Parkinson's disease. The knowledge gained in this study will help to develop interventions to reduce this common health care problem that burdens our society.