Development of a candy-sucking test for evaluating oral function in elderly patients with dementia: A pilot study

Low tongue pressure and depression using Kihon Checklist for assessing frailty status among community-dwelling Japanese older adults: A pilot study

BACKGROUND

Evaluation of low tongue pressure is used to diagnose oral hypofunction. The pathophysiology of oral hypofunction is hypothesized to be associated with oral dysfunction related to ageing. Depression in older adults is a major problem and is related to handgrip strength, which is related to tongue pressure. We hypothesized that low tongue pressure could indicate depression mood in community-dwelling older adults.

OBJECTIVES

This study aimed to measure maximum tongue pressure and compare it to the responses to the Kihon Checklist (KCL), which is used to check mental and physical deterioration of community-dwelling older adults.

METHODS

A total of 49 community-dwelling independent older adults with stable dental condition (23 men, 26 women; median age, 79 years) answered the KCL, which contained questions on frailty status, cognitive function, nutritional and sarcopenia status. Oral function was measured to assess oral hypofunction. The relationship between tongue pressure differences and frailty status, cognitive function, nutritional and sarcopenia status was analysed using logistic regression analyses after adjusting for age and sex.

RESULTS

Nine participants (6 men and 3 women; median age, 81 years) had a tongue pressure <23.0 kPa, which was the lowest limit of the standard value of maximum tongue pressure in patients aged ≥70 years. Logistic regression analyses showed that only Question 21, which is related to a lack of fulfilment in daily life, was significantly associated with low tongue pressure (p = .027).

CONCLUSION

Low tongue pressure may be associated with sociopsychological factors in older adults.

Identification of eating, drinking and swallowing difficulties for people living with early-stage dementia: A systematic review

BACKGROUND

The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early-stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating.

AIMS

To identify reliable and clinically measurable indicators of EDS difficulty used in early-stage dementia.

METHODS & PROCEDURES

A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early-stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early-stage dementia.

OUTCOMES & RESULTS

Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full-text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early-stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early-stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non-amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk.

CONCLUSIONS & IMPLICATIONS

EDS difficulty in early-stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base.

WHAT THIS PAPER ADDS

What is already known on the subject Early identification of EDS difficulty in early-stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis. What this paper adds to existing knowledge A comprehensive range of studies related to EDS identification in early-stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early-stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy. What are the potential or actual clinical implications of this work? This study could help to develop pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration.

Development of the Sakiika Transport Test: A Practical Screening Method for Patients with Oral-phase Dysphagia

PURPOSE

This study aimed to develop a simple screening test for mastication, "the Sakiika (squid jerky) transport test (STT), which evaluates the vertical jaw movement coordinated with the lateral tongue movement during stage I transport, and investigate the possibility of its clinical application.

METHODS

The study included 73 people with dysphagia (mean age, 78.5 ± 7.8 years; median age, 79.0 years; interquartile range, 75.0-84.0). The STT evaluated the ability of a participant to transport a piece of squid jerky placed on the midline of the tongue to the molar region. The STT score was defined as the number of vertical jaw movements occurring as the tongue transported food to the molars. A cutoff value was set by comparing the STT scores with masticatory function evaluated via a videofluoroscopic swallowing study and with food texture evaluated using the Food Intake LEVEL Scale (FILS).

RESULTS

The STT scores counted by the two examiners had a κ coefficient of 0.79, indicating good reliability. The STT score was significantly associated with both the presence of masticatory movement ( p = 0.019) and food texture classified by FILS ( p = 0.032) at cutoff value of "3" (3 vertical movements). The STT showed 62% sensitivity and 75% specificity for masticatory movements.

CONCLUSION

The STT could be a useful screening test to assess the presence or absence of food transportation to the molars for mastication in older patients with dysphagia. In addition, the STT could be useful in identifying the need to modify food texture to meet functions.

Frequent Karaoke Training Improves Frontal Executive Cognitive Skills, Tongue Pressure, and Respiratory Function in Elderly People: Pilot Study from a Randomized Controlled Trial

We tested whether karaoke training improves cognitive skills and reduces the risk of physical function impairments. We conducted a single-blinded randomized controlled trial in 26 elderly participants at residential care facilities, who were generally healthy or required the lowest level of care. Participants were near the threshold for mild cognitive impairment with the Montreal Cognitive Assessment (MoCA) and close to the sarcopenia cut-off with the skeletal muscle mass index. Pulmonary function as measured with spirometry and tongue strength were used as markers for physical functions affected by sarcopenia. Karaoke training occurred once a week for two hours, with an hour of homework assigned weekly. Karaoke training significantly improved the Frontal Assessment Battery at bedside (FAB) compared with an active control group receiving scratch art training (F = 8.04, permutation p-value = 0.013). Subscore improved with inhibitory control (F = 7.63, permutation p-value = 0.015) and sensitivity to interference (F = 11.98, permutation p-value = 0.001). We observed improved tongue pressure (F = 4.49, permutation p-value = 0.040) and pulmonary function by a greater increase in FIV1 (F = 5.22, permutation p-value = 0.047). Engaging elderly people, especially those in care homes, with karaoke training exercises that are moderately physically challenging may be a key to slowing cognitive decline and preventing dysphagia by sarcopenia.

Association between buccal mucosa ridging and oral or occlusal status among older people

OBJECTIVES

This study aimed to evaluate the association between buccal mucosa ridging and oral or occlusal statuses among older people.

SUBJECTS AND METHODS

This cross-sectional study examined 262 independent older people (mean age, 74.2 ± 5.9 years) who participated in the Kyoto Elderly Physical Fitness Measurement Research Project. The predictor variables were oral statuses (number of present teeth and torus palatinus, torus mandibularis, temporomandibular joint noise, clenching, or grinding) and oral functions (occlusal pressure, cheek pressure, oral diadochokinesis, and tongue pressure). The outcome variable was the buccal mucosa ridging status (presence or absence). Additional variables were age, sex, body mass index, grip strength, and wearing dentures. We compared these variables between participants with and without buccal mucosa ridging using a univariate analysis and multiple logistic regression analysis.

RESULTS

Buccal mucosa ridging was present in 177 (67.6%) people. Multiple logistic regression analysis revealed a close association of buccal mucosa ridging with torus mandibularis, tooth clenching and grinding and occlusal pressure, and cheek pressure.

CONCLUSIONS

Over 50% of the participants showed buccal mucosa ridging; this was significantly associated with higher cheek pressure, lower occlusal pressure, torus mandibularis, and tooth clenching and grinding.

Candy eating behaviour to improve swallowing function in dementia subjects

OBJECTIVES

To develop and assess a dysphagia training method involving lollipop sucking training in older adults with dementia, clarify its effectiveness for improving oral function.

METHODS

Twenty-five older adults with dementia (5 males and 20 females, mean age 90.8 ± 6.7 years) were participated in this study. Participants were trained in lollipop sucking once a day, 3 times a week for 6 months. Mini-Mental State Examination (MMSE), Barthel Index (BI), Candy Sucking Test (CST), and BMI values were measured before and after the training. Participants were grouped into those who achieved >0.1 g/min increase in CTS value after the training (increase group) and those who did not (nonincrease group).

RESULTS

No significant change was observed after the training. The increase group contained 4 patients and the non-increase group contained 21 patients. There were no significant differences in MMSE, BI, or BMI between the two groups before and after the training. However, the CST values of the increase group before the training (0.31 ± 0.13 g/min) were significantly lower than non-increase group (0.69 ± 0.27 g/min) (p < 0.01). Respective changes in BMI before and after training were 1.13 ± 0.85 kg/m² and -0.53 ± 1.76 kg/m² in the increase and non-increase, and the difference in these changes was statistically significant (p = 0.04).

CONCLUSIONS

Our new rehabilitation method was well accepted by older adults with dementia, and there was an improvement in oral function as a result of the rehabilitation, which had some good influence on weight gain.