Strategies for the Treatment of Dysphagia in Patients with Alzheimer's Disease

阿尔茨海默病患者吞咽困难的治疗策略

• 批准号: 8510848
• 负责人: JERILYN A LOGEMANN
• 金额: $ 22.31万
• 依托单位: NORTHWESTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-15 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510848
• 关键词: Affect; Age; Agreement; Alzheimer' s Disease; Back; Barium swallow; Bolus Infusion; Carbonates; Caregivers; Clinical; Data; Deglutition; Deglutition Disorders; Dementia; Diagnosis; Effectiveness; Food; Goals; Height; Hydration status; Intake; Judgment; Length; Lifting; Liquid substance; Location; Measures; Movement; Oral; Oral cavity; Oropharyngeal; Patients; Penetration; Perception; Pharyngeal structure; Physiology; Positioning Attribute; Preventive Intervention; Questionnaires; Residual state; Sensory; Taste Perception; Techniques; Time; Tongue; Translational Research; age effect; age related; feeding; healthy aging; improved; meetings; normal aging; novel; nutrition; public health relevance; treatment strategy

DESCRIPTION (provided by applicant): Normal healthy aging has been found to have statistically significant effects on the oropharyngeal swallow. In patients with Alzheimer's disease, since most are 60+ years old, we can see these normal aging effects on swallow physiology but also significant changes in sensory perception including poor recognition of food on a plate or liquid in a cup, poor recognition of food in the mouth and apraxia of swallow, meaning they cannot coordinate tongue movements to initiate a swallow in the mouth or to propel the food back to the pharynx. Since they don't recognize food as food in their mouth, Alzheimer's patients do not respond to commands to swallow and can take a very long time to be fed by a caregiver, often resulting in inadequate nutrition and hydration. This project proposes to identify the ability of selected taste (sour) and carbonation to heighten the Alzheimer's patients' ability to recognize liquid in the mouth, produce a timelier and motorically normal swallow, and increase their hydration and nutrition. This proposal will meet the goals of the "T1 Translational Research: Novel Interventions for Prevention and Treatment of Age-Related Conditions" by examining the impact of two types of sensory-enhanced bolus swallows in dysphagic patients with Alzheimer's disease: 1. For each patient with Alzheimer's disease, select either the carbonated or the sour bolus type as best for the patient, and determine whether selected measures of oropharyngeal swallow function from videofluoroscopy (VFG) and the modified barium swallow (MBS), will improve significantly while swallowing selected 3 and 10 ml thin liquid as compared to the same measures in each patient's baseline 3 and 10 ml liquid swallows of non-sensory enhanced boluses. 2. Measure whether sensory changes are maintained after 1 swallow of a sensory bolus followed by 4 swallows of the same 3 and 10 ml volumes of thin liquid without the sensory enhancement, whether volume effects the extent of change in swallow measures and if the same effects are maintained at 2 days, 2 weeks, and 1 month after the baseline study and therefore continue to improve the oropharyngeal swallow. 3. Determine whether length of time since diagnosis of Alzheimer's disease or patient age correlate with the effectiveness of each of the two sensory-enhanced liquids. 4. Determine agreement between results of the clinical judgments made during the MBS and the lab assessment of these measures and observations from the MBS. 5. Determine if caretaker judgment about ease of feeding on the caregiver questionnaire correlates with changes in swallow measures and observations, and to examine caregiver compliance with introduction of the selected liquid type.

描述（由申请方提供）：已发现正常健康衰老对口咽吞咽具有统计学显著影响。在患有阿尔茨海默病的患者中，由于大多数都是60岁以上，我们可以看到这些对吞咽生理学的正常老化影响，但也可以看到感官知觉的显著变化，包括对盘子中的食物或杯子中的液体的识别不良，对口中食物的识别不良和吞咽失用症，这意味着他们不能协调舌头的运动来启动口中的吞咽或将食物推回咽部。由于他们不承认食物是嘴里的食物，阿尔茨海默氏症患者对吞咽的命令没有反应，并且可能需要很长时间才能由护理人员喂食，通常导致营养和水合作用不足。该项目旨在确定选定的味道（酸味）和碳酸化的能力，以提高阿尔茨海默氏症患者识别口中液体的能力，产生更及时和运动正常的吞咽，并增加他们的水合作用和营养。该提案将通过检查两种类型的感觉增强丸剂吞咽对阿尔茨海默病吞咽困难患者的影响来实现“T1转化研究：预防和治疗阿尔茨海默病相关疾病的新型干预措施”的目标：1.对于每位阿尔茨海默病患者，选择最适合患者的碳酸或酸丸类型，并确定所选的口咽吞咽功能指标是否来自视频荧光透视（VFG）和改良钡剂吞咽（MBS），当吞咽选定的3和10 ml稀液体时，与每个患者的基线3和10 ml液体的相同测量相比，吞下非感官强化剂2.测量在1次吞咽感觉团，随后4次吞咽相同的3和10 ml体积的无感觉增强的稀液体后感觉变化是否得以维持，体积是否影响吞咽测量的变化程度，以及在基线研究后2天、2周和1个月是否维持相同的效果，从而继续改善口咽吞咽。3.确定自阿尔茨海默病诊断以来的时间长度或患者年龄是否与两种感觉增强液体中的每一种的有效性相关。4.确定MBS期间做出的临床判断结果与MBS中这些测量和观察结果的实验室评估之间的一致性。5.确定看护者对看护者问卷中喂养容易性的判断是否与吞咽测量和观察结果的变化相关，并检查看护者对引入所选液体类型的依从性。