Impact of Novel Rehabilitative Approaches FOR Dysphagia in Patients with Alzheimer's Disease and Related Dementias

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PROJECT SUMMARY/ABSTRACT This career development proposal is designed to provide Nicole Rogus-Pulia, PhD, CCC-SLP, a Speech- Language Pathologist and an expert in dysphagia (swallowing dysfunction) at the University of Wisconsin- Madison School of Medicine and Public Health with the training required for success as an independent, clinician- scientist researching interventions to improve the care of dysphagia in patients with Alzheimer’s Disease and Related Dementias (ADRD). Dysphagia frequently develops in patients with ADRD and leads to serious health consequences, including increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Common treatments for dysphagia in patients with ADRD employ compensatory approaches that alter bolus flow to avoid aspiration (entrance of food or liquid into the airway). These approaches do not result in sustained improvements in swallowing physiology and often negatively affect quality of life. There are currently no effective treatments for dysphagia in patients with ADRD that can be practically applied or have lasting effects on the physiology of the swallow. The goal of Dr. Rogus-Pulia’s proposed research is to develop effective dysphagia rehabilitative interventions for patients with ADRD at risk for adverse health consequences. Progressive-resistance lingual strengthening and saliva substitute are two interventions that have been shown in preliminary studies to positively influence swallowing function in older adults. This proposal will consist of a small, prospective randomized clinical trial to determine the impact of two novel interventions on swallowing- related outcomes in patients with mild-moderate ADRD and identify subgroups of patients most likely to benefit from these interventions. Patient-caregiver dyads will be randomized to lingual strengthening, saliva substitute use, a combination of the two, or only usual care. Saliva and swallowing-related outcomes will be collected at baseline and following the 8 week intervention period. As a third aim, qualitative interviews with African American patients with ADRD and their caregivers will be analyzed to explore cultural adaptations to the study protocol or intervention materials to improve future trial participation among this underrepresented group. These data will support a large, multi-site R01 funded study to determine effectiveness of dysphagia interventions for prevention of adverse health outcomes in a diverse cohort of patients with ADRD. As a junior faculty member at an institution with extensive infrastructure to support early stage investigators, Dr. Rogus-Pulia is in an ideal environment to complete the proposed research and pursue advanced training. Her career development plan includes both coursework and mentored training in the areas of 1) clinical trials design and analysis, 2) ADRD clinical care and caregiving, 3) advanced statistical techniques, 4) qualitative methods, and 5) cultural competence. To ensure success, she has identified committed, expert mentors in these disciplines and secured protected time for this work. This award addresses a significant clinical dilemma and serious gap in ADRD research while affording the education and mentorship critical for Dr. Rogus-Pulia to lead an independent dysphagia research program.