AGE AND AGE-RELATED DISEASE EFFECTS ON SWALLOWING

最近的证据表明，吞咽受到正常衰老的影响。 以来 特定年龄的变化没有得到很好的定义或理解， 知识使老年人吞咽困难的准确诊断复杂化， 伴随吞咽问题的慢性衰弱性疾病发生于 增加频率。 该项目的长期目标是 增加对正常衰老对吞咽影响的理解 生理学，以促进诊断和治疗 年龄相关疾病中的口咽吞咽障碍。 拟议 工作将建立运动参数的规范数据库，包括 口咽吞咽的显著特征与结构性 脑定量，获得磁共振成像，在整个 成年人的年龄间隔为45至95岁。 一个有待检验的假设是，口咽吞咽将不同 随着年龄的增长，在范围，持续时间和运动方向方面。 在解决这个假设时，各种参数的量化 将扩大吞咽生理学的理解， 年龄对它的影响。关于具体的定量信息很少 在吞咽过程中的口腔运动参数已获得使用 荧光透视。 这在很大程度上是由于荧光透视固有的局限性 口咽软组织结构，特别是舌头的成像。 同时促进舌点位置跟踪的技术 最近，在吞咽的荧光镜记录期间， 并开发了一个定制的计算机系统 以便于软组织结构的运动并提供可靠的 运动测量源。 这些新方法将用于 拟议的项目。 此外，最大舌头强度因年轻人和老年人而异的假设 个体和吞咽时使用的最大舌力百分比 随着年龄的增长将受到考验。 压力传感器，设计用于 测量吞咽时使用的舌头力量随着年龄的增长而增加， 测试. 一个压力传感器，旨在测量舌头的力量， 吞咽将被用来检验舌压是 预测咽部运动学参数、丸剂传输和咽部运动学参数 还将研究法线测试组中的运动学。 标准数据与吞咽曲线的比较（丸剂通过时间， 舌压力和口咽运动学测量及其 相互关系）和单侧卒中的临床解剖学相关性 将研究有和没有吞咽主诉的患者。 在这 另一个主要目的是区分神经运动的变化， 过程及其与大脑解剖学变化的关系， 由于神经运动缺陷和临床解剖学原因， 与年龄相关的疾病，在这种情况下中风， 具体涉及吞咽机制。 的 吞咽生理学方面与营养参数的关系 在不同年龄的正常人和中风患者中， 存在吞咽困难的诊断标准。 拟议的审查 生理参数、营养成分、 参数，神经血管与正常和病理衰老相关， 将为发现的差异的潜在机制提供见解， 并将指导适合年龄的治疗发展。 最后是软组织 成像和口腔压力测量和分析技术将是 在这个项目的几年里，大大改善了，提供了更好的 方法和工具，为今后的吞咽调查。

Recent evidence suggests swallowing is affected by normal aging. Since age-specific change are not well-defined or understood, this limited knowledge complicates accurate dysphagia diagnosis in the elderly, in whom chronic debilitating diseases accompanied by swallowing problems occur with increased frequency. The long-term objective of this project is to increase understanding of the effects of normal aging on swallowing physiology in an effort to advance the diagnosis and treatment of oropharyngeal swallowing disorders in age-related disease. The proposed work will establish a normative data base of movement parameters comprising salient features of oropharyngeal swallowing in conjunction with structural brain quantification, obtained with magnetic resonance imaging, throughout the adult age interval of 45 to 95 years. One hypothesis to be tested is that oropharyngeal swallowing will differ with increasing age in terms of range, duration and direction of motion. In addressing this hypothesis, the quantification of various parameters will be expanded as will understanding of swallowing physiology and the effects of age on it. Little quantitative information on the specific parameters of oral movements during swallowing has been obtained using fluoroscopy. This is largely due to limitations inherent in fluoroscopic imaging of oropharyngeal soft tissue structures, particularly the tongue. Techniques to facilitate lingual point place tracking simultaneously with bolus tracking during fluoroscopic recording of swallowing have recently been established and a customized computer-based system has been developed to facilitate movement of soft tissue structures and provide a reliable source of kinematic measurement. These new methodologies will be used tin the proposed project. Also, the hypothesis that maximum tongue strength differs for young and old individuals and percent of maximum tongue strength used in swallowing increases with age will be tested. A pressure transducer, designed to measure tongue strength used in swallowing increases with age will be tested. A pressure transducer , designed to measure tongue strength during swallowing will be used to test the hypothesis that lingual pressure is predictive of pharyngeal kinematic parameters, bolus transit and pharyngeal kinematics in a test group of normals also will be studied. Comparison of normative data to swallowing profiles (bolus transit time, lingual pressure, and oropharyngeal kinematic measures and their interrelationships) and clinicoanatomic correlates of unilateral stroke patients with and without swallowing complaints will be studied. In this manner, another major objective, to distinguish changes in neuromotor processes and their relationship to anatomical changes in the brain that occur with normal aging from neuromotor deficiencies and clinicoanatomic correlates due to age-related disease, in this case stroke, will be addressed with specific regard to the swallowing mechanism. The relationship of aspects of swallowing physiology to nutritional parameters in normals of different ages and stroke patients also may contribute to diagnostic criteria for presence of dysphagia. The proposed examination of the interrelationships among physiologic parameters, nutritional parameters, and neurovascular correlates with normal and pathologic aging, will provide insights to the underlying mechanisms for differences found and will guide age-appropriate treatment development. Finally, soft tissue imaging and oral pressure measurement and analysis techniques will be substantially improved during the years of this project, providing better methodology and tools for future investigations of swallowing.