Introduction

Population aging is now a worldwide phenomenon and a permanent trend. The number of elderly people increased by 2.4% between 1950 and 2005, much faster than the total population, the growth rate of which was 1.2 per cent between 2000 and 2005. The number of people aged 65 and over in 2010 was 7.3 per cent of the world population and is expected to exceed the number of people under age five in a little more than a decade(1).

Aging is accompanied by several functional changes, including neurobiological ones. These changes in the central nervous system include atrophy of neuronal groups with dilation of ridges and ventricles, reduced synaptic activity, decreased plasticity, increased glial activity, accumulation of metabolic products, deposits of beta-amyloid protein, and granulovacuolar degeneration, which appear early in the medial temporal regions and spread throughout the neocortex(2). These changes, particularly the latter, can develop into some types of dementia.

You are viewing: Which Patient Is Least At Risk For Dysphagia

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Currently over 25 million people are affected by dementia, most of whom suffer from Alzheimer’s disease (AD), and about 5 million new cases of dementia occur per year(3).The number of people with dementia is expected to double every 20 years and the prevalence of AD nearly doubles every 5 years beyond the age of 65. Hence, as it is the most prevalent progressive neurodegenerative illness worldwide, there is a need to study the pathophysiology of this disease as well as the risks and problems associated with it(4-5).

A previous study showed that the cognitive deficits found in neurological diseases, such as AD, may cause interruption to the present and preparatory actions required for swallowing(6). The main alterations to swallowing found in these patients are lingual motor dysfunction, delayed triggering of the swallowing reflex, failed oral motor control of the bolus, retention of food in the vallecula and pyriform sinuses, penetration and aspiration – especially of liquids, and absent mastication(7).

This impaired swallowing can result in what is known as dysphagia, which is a common clinical manifestation in patients with Alzheimer-type dementia, affecting about 28% to 32% of these patients(8). Swallowing disorders in patients with dementia may lead to the risk of malnutrition and death, due to low caloric intake and aspiration of food(7). Dysphagia has also been correlated with the development of pneumonia, which is a common cause of morbidity and mortality, especially in elderly people with dementia(9).

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Studies have also shown that AD patients have a worse nutritional status when compared with a control group without dementia, with weight loss, and, often, inadequate caloric intake(10-12). As nutritional status is often impaired in elderly people with AD, nutritional care and interventions regarding mealtime difficulties are essential; it is important to note that the second aspect is relevant to the clinical nursing practice(13-14).

Although the most significant problems of dysphagia are found in the moderate and severe stages of AD, there is one study that reports swallowing difficulties during the early stages of the disease(10). This study clearly shows the increased risk of dysphagia in AD patients, however, few studies have correlated dysphagia with the developmental stages of AD, malnutrition and food intake in these patients.

From the above arose the guiding question of this study: “What is the relationship between the stage of development of AD and the risk of dysphagia and nutrition issues (nutritional status and caloric intake)?” Understanding this issue may improve measures of healthcare professionals for elderly people with dementia, including nursing professionals, who are often responsible for the care of AD patients. Accordingly, the present study aimed to assess and verify the relationship between the risk of dysphagia, nutritional status, caloric intake, and the stage of Alzheimer’s disease.

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