Patients with dementia develop dysphagia some time during the clinical course of their disease. The aim of this study was to compare the swallowing functions of the 2 most common types of dementia: Alzheimer disease (AD) and vascular dementia (VaD). Videofluoroscopic swallowing studies of the 2 patient groups were analyzed according to various oral, pharyngeal, and laryngeal variables of swallowing. The results indicate that there are some different patterns of swallowing disorders. The AD patients were significantly more impaired in "oral transit delay over 5 seconds" with liquids (chi2=7.065, df=1, P=0.008), whereas the VaD patients showed more deficits in "bolus formation and mastication" of semisolid food (chi2=4.64, df=1, P=0.039), "hyolaryngeal excursion" (chi2=4.102, df=1, P=0.043), "epiglottic inversion" (chi2=4.612, df=1, P=0.032), and "silent aspiration" (chi2=6.258, df=1, P=0.011). These results could indicate that the swallowing disorders of the AD group may result from sensory impairment in relation to dysfunctions in the temporoparietal areas, whereas the swallowing disorders of VaD group may primarily be caused by motor impairments due to disruptions in the corticobulbar tract. This study is noteworthy because it is one of the first attempts to differentiate between the swallowing symptoms of AD and VaD patients. A further study that includes patients with more severe degree of dementia (eg, patients over clinical dementia rating 3) might delineate additional discriminating swallowing patterns between the 2 dementia groups. In addition, a follow-up study exploring various kinematic characteristics of dysphagia would address physiologic issues of swallowing disorders as related to one of the most important clinical variables, laryngeal aspiration in the 2 dementia groups.

The study aimed to describe the properties of the Korean version of the Western Aphasia Battery (hereinafter K-WAB) and to present the normative data of normal individuals and patients. The K-WAB contains the same test contents and structure as the original WAB and the general test administration method was maintained. We administered the K-WAB to 224 normal adults in seven age groups (15–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75 years or older), in five educational levels (0, 1–6, 7–9, 10–12, and 13 years or more) and by gender. The age and educational levels were influential to the K-WAB performance. Accordingly, we formed six subgroups of the normal: two age groups (15–74, and 75 years or older groups) by three educational groups (0, 1–6, and 7 years or more). Two hundred thirty-eight patients were also evaluated using the K-WAB. The highest aphasia quotient (AQ), language quotient (LQ), and cortical quotient (CQ) were achieved by 15–74 age group with 7 or more years of education (M=97.11, M=95.51, M=95.57, respectively). Based on the receiver operating curve (ROC) analyses on AQ, LQ and CQ values, cut-off scores to optimally differentiate between the normal and the aphasic individuals were also provided.

Research from JAMA Neurology — Aspiration Subsequent to a Pure Medullary Infarction — Lesion Sites, Clinical Variables, and Outcome

Although subtle discourse declines in people with mild cognitive impairment (MCI) have been reported, heterogeneous measures and tasks among the MCI discourse studies have yielded widely varying outcomes. The present study aimed to first, identify discourse measures that aid the differentiation among people with amnestic MCI (aMCI), people with non-amnestic MCI (naMCI), and cognitively healthy control (HC) participants, and second, delineate the cognitive functions related to such discourse measures. Three discourse tasks (an episodic narrative, a planning task, and a picture description) were performed by 30 aMCI, 22 naMCI, and 21 HC participants. Samples were analyzed using six categories of 15 measures, namely coherence, cohesion, proposition, grammaticality, lexicality, and fluency. The statistical analyses included (1) a multivariate analysis of variance for group comparison; (2) binary simple logistic regression and receiver operating characteristic curve analysis for differentiation between two groups; (3) binary multiple logistic regression for being diagnosed with naMCI or aMCI with the minimum number of predictors; and (4) Pearson correlation analysis for identifying the cognitive functions associated with the discourse measures. The proportion of cohesive words and propositional density in aMCI participants were worse than those in naMCI participants. Global coherence, the proportion of cohesive words, and the proportion of dysfluencies and pauses in naMCI participants were lower than those in the HC participants. Global and local coherence and the proportion of cohesive words, cohesive ties per utterances, propositional density, and dysfluencies and pauses in aMCI participants were worse than those in the HC participants. The aforementioned measures were demonstrated to be effective predictors for classifying groups by receiver operating characteristic curve analysis. In addition, the proportions of cohesive words and pauses were common discourse measures for differentiation between naMCI and HC participants or between aMCI and HC participants using binary multiple logistic regression. According to the correlation analysis, memory and executive functions are needed for coherent, cohesive, and efficient discourse productions in MCI. The detailed description of discourse performances in this study will aid the characterization of the declined language abilities of MCI participants and also the understanding of the cognitive functions involved in discourse performance in MCI.

Difficulties with speech and swallowing occur in patients with Parkinsonism. Lee Silverman Voice Treatment (LSVT) is proven as an effective treatment for speech and swallowing function in idiopathic Parkinson’s disease (IPD). The effect of LSVT on swallowing function in multiple system atrophy-cerebellar type (MSA-C) is unknown. We sought to determine LSVT’s effect on swallowing function in MSA-C patients compared to IPD patients. LSVT-LOUD was performed on 13 patients with Parkinsonism (6 IPD and 7 MSA-C). Maximum phonation time (MPT), voice intensity, Speech Handicap Index-15 (SHI-15), Swallowing-Quality of Life (SWAL-QOL), National Institutes of Health-swallowing safety scale (NIH-SSS), and videofluoroscopic dysphagia scale (VDS) before and after LSVT were analyzed and reevaluated three months after treatment. The IPD and MSA-C groups showed significant improvements in overall speech and swallowing measures after LSVT. In particular, pharyngeal phase score and total score of VDS improved significantly in both groups. A two-way repeated-measure ANOVA revealed a significant main effect for time in the MPT, voice intensity, NIH-SSS, pharyngeal phase score and total score of VDS, psychosocial subdomain of SHI-15, and SWAL-QOL. The MSA-C group experienced less overall improvement in swallowing function, but the two groups had an analogous pattern of improvement. In conclusion, LSVT is effective for enhancing swallowing function, particularly in the pharyngeal phase, in both IPD and MSA-C patients. This study demonstrated that LSVT elicits significant improvements in MSA-C patients. We deemed LSVT to be an effective treatment for IPD and MSA-C patients who suffer from dysphagia.

Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.