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Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162:129-140. [PMID: 38615499 DOI: 10.1016/j.clinph.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). METHODS Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA). RESULTS 83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD). CONCLUSIONS OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response. SIGNIFICANCE These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
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Affiliation(s)
- Nicolau Guanyabens
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Bindels KL, Verhoeff MC, Su N, Knijn FV, Aarab G, Fuh JL, Lin CS, Lobbezoo F. Swallowing performance in older adults: Associated cognitive, neuroanatomical and demographic factors. J Oral Rehabil 2024; 51:296-304. [PMID: 37705384 DOI: 10.1111/joor.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/09/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Swallowing problems are frequently seen in older adults, especially in individuals with cognitive impairment (CI). The brain plays a crucial role in both cognition and swallowing. Using magnetic resonance imaging (MRI) data, researchers identified regions associated with swallowing. However, it is not yet fully elucidated which factors influence the swallowing performance in older adults. OBJECTIVES The current study investigated which factors, such as cognitive function, neuroanatomical factors (e.g., the cortical thickness and volume of specific brain regions) and demographical factors are associated with swallowing performance in older adults. Secondly, it was investigated whether there is a difference in neuroanatomical factors between individuals with and without CI. RESEARCH DESIGN AND METHODS In total, 15 CI individuals (73.1 ± 9.1 years; 46.7% male) and 48 non-CI controls (69.0 ± 5.1 years; 29.2% male) were included. The repetitive saliva swallowing test (RSST) was performed, and an MRI scan was acquired from the participants. RESULTS Multivariate linear regression analysis showed that the cortical thickness of the right supramarginal gyrus and female gender were positively associated, and a higher age was negatively associated with the RSST in older adults (p < .05). CI was not significantly associated with swallowing performance. Furthermore, it was found that the cortical volume differs more frequently between CI and non-CI than the cortical thickness. CONCLUSION A thinner cortex of the right supramarginal gyrus and being an older female are associated with poorer swallowing performance. Secondly, cortical volume was more often found to differ between CI and non-CI individuals than cortical thickness.
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Affiliation(s)
- K L Bindels
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N Su
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - F V Knijn
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J L Fuh
- Division of General Neurology, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C-S Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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3
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Functional MRI in Radiology—A Personal Review. Healthcare (Basel) 2022; 10:healthcare10091646. [PMID: 36141258 PMCID: PMC9498519 DOI: 10.3390/healthcare10091646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
We, here, provide a personal review article on the development of a functional MRI in the radiology departments of two German university medicine units. Although the international community for human brain mapping has met since 1995, the researchers fascinated by human brain function are still young and innovative. However, the impact of functional magnetic resonance imaging (fMRI) on prognosis and treatment decisions is restricted, even though standardized methods have been developed. The tradeoff between the groundbreaking studies on brain function and the attempt to provide reliable biomarkers for clinical decisions is large. By describing some historical developments in the field of fMRI, from a personal view, the rise of this method in clinical neuroscience during the last 25 years might be understandable. We aim to provide some background for (a) the historical developments of fMRI, (b) the establishment of two research units for fMRI in the departments of radiology in Germany, and (c) a description of some contributions within the selected fields of systems neuroscience, clinical neurology, and behavioral psychology.
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4
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Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
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5
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Domin M, Mihai GP, Platz T, Lotze M. Swallowing function in the chronic stage following stroke is associated with white matter integrity of the callosal tract between the interhemispheric S1 swallowing representation areas. Neuroimage Clin 2022; 35:103093. [PMID: 35772193 PMCID: PMC9253494 DOI: 10.1016/j.nicl.2022.103093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 06/19/2022] [Indexed: 11/06/2022]
Abstract
Swallowing performance was tested in dysphagic patients following stroke. M1 and S1 callosal tracts relevant for swallowing was mapped in the HCP-dataset. S1 and M1 swallowing tracts were overlapping between in house and HCP datasets. Swallowing specific callosal tracts showed lower FA for patients compared to HCs. Integrity of S1 callosal fibres (FA) was associated with swallowing performance.
Sensorimotor representations of swallowing in pre- and postcentral gyri of both cerebral hemispheres are interconnected by callosal tracts. We were interested in (1) the callosal location of fibers interconnecting the precentral gyri (with the primary motor cortex; M1) and the postcentral gyri (with the primary somatosensory cortex; S1) relevant for swallowing, and (2) the importance of their integrity given the challenges of swallowing compliance after recovery of dysphagia following stroke. We investigated 17 patients who had almost recovered from dysphagia in the chronic stage following stroke and age-matched and gender-matched healthy controls. We assessed their swallowing compliance, investigating swallowing of a predefined bolus in one swallowing movement in response to a ‘go’ signal when in a lying position. A somatotopic representation of swallowing was mapped for the pre- and postcentral gyrus, and callosal tract location between these regions was compared to results for healthy participants. We applied multi-directional diffusion-weighted imaging of the brain in patients and matched controls to calculate fractional anisotropy (FA) as a tract integrity marker for M1/S1 callosal fibers. Firstly, interconnecting callosal tract maps were well spatially separated for M1 and S1, but were overlapped for somatotopic differentiation within M1 and S1 in healthy participants’ data (HCP: head/face representation; in house dataset: fMRI-swallowing representation in healthy volunteers). Secondly, the FA for both callosal tracts, connecting M1 and S1 swallowing representations, were decreased for patients when compared to healthy volunteers. Thirdly, integrity of callosal fibers interconnecting S1 swallowing representation sites was associated with effective swallowing compliance. We conclude that somatosensory interaction between hemispheres is important for effective swallowing in the case of a demanding task undertaken by stroke survivors with good swallowing outcome from dysphagia.
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Affiliation(s)
- M Domin
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany
| | - G P Mihai
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany; AICURA Medical GmbH, Berlin, Germany
| | - T Platz
- BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, "An-Institut", University of Greifswald, Greifswald, Germany; Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
| | - M Lotze
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany
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Abstract
The global population of 80 years and older is predicted to reach 437
million by 2050. As overall brain structure and function progressively degrades,
older and younger adults show differences in sensorimotor performance and brain
activity in the sensorimotor regions. Oral sensorimotor functions are an
important area of focus in natural aging and Alzheimer’s Disease (AD)
because oral health issues are commonly found in both elderly and AD
populations. While human behavioral studies on changes in oral sensorimotor
functions abound, very little is known about their neuronal correlates in normal
and pathological aging.
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7
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Lin CS. Functional Adaptation of Oromotor Functions and Aging: A Focused Review of the Evidence From Brain Neuroimaging Research. Front Aging Neurosci 2020; 11:354. [PMID: 31998112 PMCID: PMC6962247 DOI: 10.3389/fnagi.2019.00354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
“Practice makes perfect” is a principle widely applied when one is acquiring a new sensorimotor skill to cope with challenges from a new environment. In terms of oral healthcare, the traditional view holds that restoring decayed structures is one of the primary aims of treatment. This assumes that the patient’s oromotor functions would be recovered back to normal levels after the restoration. However, in older patients, such a structural–functional coupling after dental treatment shows a great degree of individual variations. For example, after prosthodontic treatment, some patients would adapt themselves quickly to the new dentures, while others would not. In this Focused Review, I argue that the functional aspects of adaptation—which would be predominantly associated with the brain mechanisms of cognitive processing and motor learning—play a critical role in the individual differences in the adaptive behaviors of oromotor functions. This thesis is critical to geriatric oral healthcare since the variation in the capacity of cognitive processing and motor learning is critically associated with aging. In this review, (a) the association between aging and the brain-stomatognathic axis will be introduced; (b) the brain mechanisms underlying the association between aging, compensatory behavior, and motor learning will be briefly summarized; (c) the neuroimaging evidence that suggests the role of cognitive processing and motor learning in oromotor functions will be summarized, and critically, the brain mechanisms underlying mastication and swallowing in older people will be discussed; and (d) based on the current knowledge, an experimental framework for investigating the association between aging and the functional adaptation of oromotor functions will be proposed. Finally, I will comment on the practical implications of this framework and postulate questions open for future research.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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8
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Salvato G, Mercurio M, Sberna M, Paulesu E, Bottini G. A very light lunch: Interoceptive deficits and food aversion at onset in a case of behavioral variant frontotemporal dementia. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:750-754. [PMID: 30480080 PMCID: PMC6240841 DOI: 10.1016/j.dadm.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Patients affected by the behavioral variant frontotemporal dementia (bvFTD) frequently experience, at a delayed onset, abnormal eating behavior involving increased food intake. Although delusional food-related symptoms have attracted much attention, the behavioral and neural features of food aversion manifestations in bvFTD remain poorly documented. Methods We describe the rare case of a patient with bvFTD presenting with lack of interoception for swallowing and digestion, coupled with a dramatic food aversion at onset. We also compared his MRI scan to 84 healthy individuals using a voxel-based morphometry approach. Results We found gray matter density reductions involving the postcentral gyrus bilaterally, insulae, and right medial orbitofrontal cortex. Discussion Our results shed new light on the behavioral and neuroanatomical features of food aversion and interoception deficits in bvFTD, suggesting that besides orbitofrontal cortex, also a distributed system associated with interoception might play a role in such behavioral manifestation.
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Affiliation(s)
- Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milan, Italy.,NeuroMi, Milan Centre for Neuroscience, Milano, Italy
| | - Matteo Mercurio
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Sberna
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Eraldo Paulesu
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milan, Italy.,NeuroMi, Milan Centre for Neuroscience, Milano, Italy
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Lin CS, Wu CY, Wu SY, Lin HH, Cheng DH, Lo WL. Age-Related Difference in Functional Brain Connectivity of Mastication. Front Aging Neurosci 2017; 9:82. [PMID: 28420981 PMCID: PMC5376560 DOI: 10.3389/fnagi.2017.00082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/16/2017] [Indexed: 02/03/2023] Open
Abstract
The age-related decline in motor function is associated with changes in intrinsic brain signatures. Here, we investigated the functional connectivity (FC) associated with masticatory performance, a clinical index evaluating general masticatory function. Twenty-six older adults (OA) and 26 younger (YA) healthy adults were recruited and assessed using the masticatory performance index (MPI) and resting-state functional magnetic resonance imaging (rs-fMRI). We analyzed the rs-fMRI FC network related to mastication, which was constructed based on 12 bilateral mastication-related brain regions according to the literature. For the OA and the YA group, we identified the mastication-related hubs, i.e., the nodes for which the degree centrality (DC) was positively correlated with the MPI. For each pair of nodes, we identified the inter-nodal link for which the FC was positively correlated with the MPI. The network analysis revealed that, in the YA group, the FC between the sensorimotor cortex, the thalamus (THA) and the cerebellum was positively correlated with the MPI. Consistently, the cerebellum nodes were defined as the mastication-related hubs. In contrast, in the OA group, we found a sparser connection within the sensorimotor regions and cerebellum and a denser connection across distributed regions, including the FC between the superior parietal lobe (SPL), the anterior insula (aINS) and the dorsal anterior cingulate cortex (dACC). Compared to the YA group, the network of the OA group also comprised more mastication-related hubs, which were spatially distributed outside the sensorimotor regions, including the right SPL, the right aINS, and the bilateral dACC. In general, the findings supported the hypothesis that in OA, higher masticatory performance is associated with a widespread pattern of mastication-related hubs. Such a widespread engagement of multiple brain regions associated with the MPI may reflect an increased demand in sensorimotor integration, attentional control and monitoring for OA to maintain good mastication.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming UniversityTaipei, Taiwan
| | - Ching-Yi Wu
- School of Dentistry, Institute of Oral Biology, National Yang-Ming UniversityTaipei, Taiwan.,Division of Family Dentistry, Department of Stomatology, Taipei Veterans General HospitalTaipei, Taiwan
| | - Shih-Yun Wu
- Department of Dentistry, School of Dentistry, National Yang-Ming UniversityTaipei, Taiwan.,Division of Family Dentistry, Department of Stomatology, Taipei Veterans General HospitalTaipei, Taiwan
| | - Hsiao-Han Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming UniversityTaipei, Taiwan
| | - Dong-Hui Cheng
- Division of Prosthodontics, Department of Stomatology, Taipei Veterans General HospitalTaipei, Taiwan
| | - Wen-Liang Lo
- Department of Dentistry, School of Dentistry, National Yang-Ming UniversityTaipei, Taiwan.,Division of Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General HospitalTaipei, Taiwan
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10
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Yoneda M, Saitoh K. Nonspecific effects of gap paradigm on swallowing. Physiol Behav 2017; 169:141-146. [PMID: 27932241 DOI: 10.1016/j.physbeh.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 11/25/2016] [Accepted: 12/03/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Analogous to the gap paradigm in experiments for saccadic eye movements with very short reaction times, we hypothesized that the initiation of oropharyngeal swallowing movements guided by visual cues are encouraged under experimental conditions using a similar gap paradigm. METHODS A red visual cue indicating to hold a bolus in the mouth and a blue one indicating to swallow the bolus were sequentially provided on a computer display to 11 healthy participants. The gap period between these cues varied from 0 to 800ms. Swallowing kinetics and kinematics were recorded using surface electromyography and a laser displacement sensor, respectively. RESULTS In comparison with the no-gap paradigm, the delay from the onset of muscle activities to initiation of movement significantly decreased with a 100- (p<0.01) and 200-ms (p<0.005) gap period. With other gap periods, no significant change was detected in the delay. CONCLUSIONS Initiation of visually guided swallowing was enhanced by a gap paradigm of 100-200ms. Wrist flexion was boosted in a similar manner. Thus, the gap effect may be a generalized warning effect. SIGNIFICANCE Our findings might provide insights into the contribution of the basal ganglia to volitional swallowing.
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Affiliation(s)
- Masaki Yoneda
- Lifelong Sports and Welfare Course, Faculty of Education, Kumamoto University, 2-40-1, Kurokami, Chuo-ku, Kumamoto-shi, Kumamoto, Japan
| | - Kazuya Saitoh
- Lifelong Sports and Welfare Course, Faculty of Education, Kumamoto University, 2-40-1, Kurokami, Chuo-ku, Kumamoto-shi, Kumamoto, Japan.
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11
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Grunkina V, Holtz K, Klepzig K, Neubert J, Horn U, Domin M, Hamm AO, Lotze M. The Role of Left Hemispheric Structures for Emotional Processing as a Monitor of Bodily Reaction and Felt Chill - a Case-Control Functional Imaging Study. Front Hum Neurosci 2017; 10:670. [PMID: 28111546 PMCID: PMC5216041 DOI: 10.3389/fnhum.2016.00670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/16/2016] [Indexed: 12/11/2022] Open
Abstract
Background: The particular function of the left anterior human insula on emotional arousal has been illustrated with several case studies. Only after left hemispheric insula lesions, patients lose their pleasure in habits such as listening to joyful music. In functional magnetic resonance imaging studies (fMRI) activation in the left anterior insula has been associated with both processing of emotional valence and arousal. Tight interactions with different areas of the prefrontal cortex are involved in bodily response monitoring and cognitive appraisal of a given stimulus. Therefore, a large left hemispheric lesion including the left insula should impair the bodily response of chill experience (objective chill response) but leave the cognitive aspects of chill processing (subjective chill response) unaffected. Methods: We investigated a patient (MC) with a complete left hemispheric media cerebral artery stroke, testing fMRI representation of pleasant (music) and unpleasant (harsh sounds) chill response. Results: Although chill response to both pleasant and unpleasant rated sounds was confirmed verbally at passages also rated as chilling by healthy participants, skin conductance response was almost absent in MC. For a healthy control (HC) objective and subjective chill response was positively associated. Bilateral prefrontal fMRI-response to chill stimuli was sustained in MC whereas insula activation restricted to the right hemisphere. Diffusion imaging together with lesion maps revealed that left lateral tracts were completely damaged but medial prefrontal structures were intact. Conclusion: With this case study we demonstrate how bodily response and cognitive appraisal are differentially participating in the internal monitor of chill response.
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Affiliation(s)
- Viktoria Grunkina
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald Greifswald, Germany
| | - Katharina Holtz
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of GreifswaldGreifswald, Germany; Department of Psychology, University of GreifswaldGreifswald, Germany
| | - Kai Klepzig
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of GreifswaldGreifswald, Germany; Department of Psychology, University of GreifswaldGreifswald, Germany
| | - Jörg Neubert
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of GreifswaldGreifswald, Germany; Department of Psychology, University of GreifswaldGreifswald, Germany
| | - Ulrike Horn
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald Greifswald, Germany
| | - Martin Domin
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald Greifswald, Germany
| | - Alfons O Hamm
- Department of Psychology, University of Greifswald Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald Greifswald, Germany
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A Longitudinal Study of Symptoms of Oropharyngeal Dysphagia in an Elderly Community-Dwelling Population. Dysphagia 2016; 31:560-6. [PMID: 27307155 PMCID: PMC4938845 DOI: 10.1007/s00455-016-9715-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/27/2016] [Indexed: 01/25/2023]
Abstract
Dysphagia has been estimated to affect around 8–16 % of healthy elderly individuals living in the community. The present study investigated the stability of perceived dysphagia symptoms over a 3-year period and whether such symptoms predicted death outcomes. A population of 800 and 550 elderly community-dwelling individuals were sent the Sydney Swallow Questionnaire (SSQ) in 2009 and 2012, respectively, where an arbitrary score of 180 or more was chosen to indicate symptomatic dysphagia. The telephone interview cognitive screen measured cognitive performance and the Geriatric Depression Scale measured depression. Regression models were used to investigate associations with dysphagia symptom scores, cognition, depression, age, gender and a history of stroke; a paired t test was used to examine if individual mean scores had changed. A total of 528 participants were included in the analysis. In 2009, dysphagia was associated with age (P = 0.028, OR 1.07, CI 1.01, 1.13) and stroke (P = 0.046, OR 2.04, CI 1.01, 4.11) but these associations were no longer present in 2012. Those who had symptomatic dysphagia in 2009 (n = 75) showed a shift towards improvement in swallowing (P < 0.001, mean = −174.4, CI −243.6, −105.3), and for those who died from pneumonia, there was no association between the SSQ derived swallowing score and death (P = 0.509, OR 0.10, CI −0.41, −0.20). We conclude that swallowing symptoms are a temporally dynamic process, which increases our knowledge on swallowing in the elderly.
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Mihai PG, Otto M, Domin M, Platz T, Hamdy S, Lotze M. Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study. NEUROIMAGE-CLINICAL 2016; 12:1013-1021. [PMID: 27995067 PMCID: PMC5153603 DOI: 10.1016/j.nicl.2016.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
Neurogenic dysphagia frequently occurs after stroke and deglutitive aspiration is one of the main reasons for subacute death after stroke. Although promising therapeutic interventions for neurogenic dysphagia are being developed, the functional neuroanatomy of recovered swallowing in this population remains uncertain. Here, we investigated 18 patients post-stroke who recovered from dysphagia using an event related functional magnetic resonance imaging (fMRI) study of swallowing. Patients were characterized by initial dysphagia score (mild to severe), lesion mapping, white matter fractional anisotropy (FA) of the pyramidal tracts, and swallowing performance measurement during fMRI scanning. Eighteen age matched healthy participants served as a control group. Overall, patients showed decreased fMRI-activation in the entire swallowing network apart from an increase of activation in the contralesional primary somatosensory cortex (S1). Moreover, fMRI activation in contralesional S1 correlated with initial dysphagia score. Finally, when lesions of the pyramidal tract were more severe, recovered swallowing appeared to be associated with asymmetric activation of the ipsilesional anterior cerebellum. Taken together, our data support a role for increased contralesional somatosensory resources and ipsilesional anterior cerebellum feed forward loops for recovered swallowing after dysphagia following stroke. Recovered dysphagic stroke patients showed decreased fMRI-activation of swallowing network. Contralesional S1 activation was higher in patient vs. control group and positively associated with initial dysphagia score. Ipsilesional anterior cerebellum was asymmetrically activated with severe lesions of pyramidal tract.
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Affiliation(s)
- Paul Glad Mihai
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany
| | - Mareile Otto
- BDH-Klinik Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, University of Greifswald, Germany
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany
| | - Thomas Platz
- BDH-Klinik Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, University of Greifswald, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, UK
| | - Martin Lotze
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany
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