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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

基本信息

批准号：
8633409
负责人：
BARBARA R. PAULOSKI
金额：
$ 18.54万
依托单位：
NORTHWESTERN UNIVERSITY
依托单位国家：
美国
项目类别：
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

项目摘要

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（申请人提供）：正常健康年龄对口咽吞咽有统计学显著影响。在阿尔茨海默病患者中，由于大多数是60岁以上的人，我们可以看到这些正常的衰老对吞咽生理的影响，但也可以看到感官知觉的显著变化，包括对盘子里的食物或杯子里的液体的识别能力差，对嘴里的食物的识别能力差以及吞咽失用症，这意味着他们不能协调舌头的运动来启动嘴里的吞咽或将食物推回咽。由于阿尔茨海默氏症患者无法识别嘴里的食物，他们对吞咽命令没有反应，而且需要很长时间才能由护理人员喂食，这往往导致营养和水合作用不足。本项目拟通过鉴定选定口味（酸味）和碳酸化的能力，提高阿尔茨海默病患者对口腔液体的识别能力，使其吞咽更及时、运动更正常，并增加其水分和营养。本提案将通过检查两种类型的感觉增强丸吞对阿尔茨海默病吞咽困难患者的影响来满足“T1转化研究：预防和治疗年龄相关疾病的新干预措施”的目标。对于每位阿尔茨海默病患者，选择碳酸型或酸型丸剂作为最适合患者的类型，并确定通过视频透视检查（VFG）和改良钡吞剂（MBS）所选择的口咽吞咽功能测量值，在吞咽选定的3 ml和10 ml稀液体时，与每位患者基线3 ml和10 ml液体吞下非感觉增强丸剂的相同测量值相比，是否会显著改善。2. 测量在1次吞下感觉丸后，4次吞下相同体积的3 ml和10 ml的稀液体后，感觉变化是否保持，体积是否影响吞咽测量变化的程度，以及在基线研究后2天、2周和1个月是否保持相同的效果，从而继续改善口咽吞咽。3. 确定诊断为阿尔茨海默病的时间长度或患者年龄是否与两种增强感觉的液体的有效性相关。4. 确定在MBS期间做出的临床判断结果与这些措施的实验室评估和MBS观察结果之间的一致性。5. 确定护理人员在护理人员问卷上对喂养容易程度的判断是否与吞咽测量和观察的变化相关，并检查护理人员对所选液体类型的依从性。