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Chróinín DN, Deane V, Pulikotil Zachariah R, Stott K, Shepherd B, Perkins M, Giang L, Shekhar R, Vueti V, Mayahi-Neysi M, Montgomery A, Rolls K, Frost SA. The likelihood of hospital-acquired complications in older people with dementia: a matched cohort study. Med J Aust 2024. [PMID: 39328172 DOI: 10.5694/mja2.52462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 02/28/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES To investigate whether the likelihood of hospital-acquired complications for older people in Australia differs by whether they have dementia. STUDY DESIGN Matched cohort study. SETTING, PARTICIPANTS People aged 60 years or older with dementia who were admitted to five public hospitals in the South Western Sydney Local Health District, New South Wales, 1 January 2010 to 31 December 2020, and people without dementia admitted during the same period, matched by age, sex, number of medical conditions, and presence of selected specific medical conditions, emergency admission status, history of falls, and admission from a nursing home. MAIN OUTCOME MEASURES Hospital-acquired complications (falls, pressure injuries, delirium, pneumonia, venous thromboembolism, new incontinence, malnutrition, in-hospital death), by dementia status. RESULTS A total of 217 459 people aged 60 years or older were admitted to the five hospitals during the study period. The mean age of the 11 393 patients with dementia (83 years; standard deviation [SD], 7.5 years) was higher than that of the 206 065 patients without dementia (73 years; SD, 8.9 years), and the proportion of women slightly larger (55% v 50%). Median hospital length of stay was longer for people with dementia (nine days; interquartile range [IQR], 4-19 days) than for people without dementia (three days; IQR, 1-9 days), and the number of in-hospital deaths higher (768, 7% v 584, 5%). After propensity score-based matching, the risks of falls (odds ratio [OR], 4.7; 95% confidence interval [CI], 3.8-5.7), pressure injury (OR, 1.4; 95% CI, 1.1-1.8), delirium (OR, 2.4; 95% CI, 2.0-3.0), and pneumonia (OR, 1.3; 95% CI, 1.01-1.7) were higher for people with dementia than for those without dementia; differences between the two groups in the risks of venous thromboembolism, malnutrition, and incontinence were not statistically significant. CONCLUSIONS Given the greater risk of many hospital-acquired complications for people with dementia, targeted models of person-centred care are needed to ensure the best outcomes for these patients.
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Affiliation(s)
- Danielle Ní Chróinín
- Liverpool Hospital, Liverpool, NSW
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW
| | | | | | | | | | | | | | | | | | | | | | - Kaye Rolls
- South Western Sydney Nursing and Midwifery Research Alliance, University of Wollongong, Liverpool, NSW
| | - Steven A Frost
- Liverpool Hospital, Liverpool, NSW
- University of Wollongong, Wollongong, NSW
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Tosun S, Karali FS, Kacar Kutukcu D, Cinar N, Kendirli S, Sen Aksut M, Albayrak I, Celik Y. Assessment of swallowing performance in patients with neurodegenerative disease: A hierarchical cluster analysis. Brain Behav 2024; 14:e70005. [PMID: 39197023 PMCID: PMC11354087 DOI: 10.1002/brb3.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/18/2024] [Accepted: 08/11/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Swallowing is a complex process that alters with age and neurological diseases; swallowing disorders can be a consequence of both of them. As an advanced multivariate statistical method, hierarchical cluster analysis (HCA) was utilized to make the dendrograms, which was used to find the relationship between the variables. The purpose of this study is to ascertain the type of clustering exhibited by the variables using HCA and to evaluate the approach to major neurodegenerative diseases (MND) with swallowing disorders based on the results obtained. METHODS Data were collected from a total of 173 patients from various neurological diagnoses, such as dementia, Parkinson's disease, stroke and polyneuropathy, aging between 42 and 104 (mean of age 72.85) by using the Montreal Cognitive Assessment, the Edinburgh Feeding Evaluation Scale (EdFED), the Eating Assessment Tool (EAT-10), and the Modified Mann Swallowing Ability test. From the collected data, dendrograms were formed by using HCA with Ward linkage method. RESULTS Based on cluster analysis results, clusters demonstrate statistical significance. They center around EdFED, EAT-10, and age in each MND. In healthy individuals, variables are not clustered as in the patient group. This study holds importance as it can give clinicians a different perspective on determining and managing the elderly population's swallowing problems. CONCLUSIONS The HCA method explicitly proposes which variables should be examined concurrently in the clinic for MND. This research is one of the pioneering studies conducted by using the HCA method.
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Affiliation(s)
- Samet Tosun
- Faculty of Health Sciences, Department of Speech and Language TherapyBiruni UniversityIstanbulTurkey
| | - Fenise Selin Karali
- Faculty of Health Sciences, Department of Speech and Language TherapyBiruni UniversityIstanbulTurkey
| | - Dilber Kacar Kutukcu
- Faculty of Health Sciences, Department of Speech and Language TherapyBiruni UniversityIstanbulTurkey
| | - Nilgün Cinar
- School of Medicine, Department of NeurologyMaltepe UniversityIstanbulTurkey
| | - Sude Kendirli
- School of Medicine, Department of NeurologyMaltepe UniversityIstanbulTurkey
| | - Meltem Sen Aksut
- Faculty of Health Sciences, Department of Speech and Language TherapyBiruni UniversityIstanbulTurkey
| | - Ilayda Albayrak
- Faculty of Health Sciences, Department of Speech and Language TherapyBiruni UniversityIstanbulTurkey
| | - Yusuf Celik
- School of Medicine, Department of Biostatistics and Medical InformaticsBiruni UniversityIstanbulTurkey
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Meade G, Machulda MM, Clark HM, Duffy JR, Botha H, Whitwell JL, Josephs KA, Utianski RL. Identifying and Addressing Functional Communication Challenges in Patients With Behavioral Variant Frontotemporal Dementia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1573-1589. [PMID: 38843453 PMCID: PMC11253250 DOI: 10.1044/2024_ajslp-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them. METHOD Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing. RESULTS At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5-6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP. CONCLUSIONS This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25933762.
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Affiliation(s)
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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4
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Camacho LO, Jahangiri L, Iseringhausen J, Goldstein GR. Parkinson's disease - The dentist's role as part of the healthcare team. J Prosthodont 2024. [PMID: 38689457 DOI: 10.1111/jopr.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain. While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs. Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients. Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.
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Affiliation(s)
- Liliana Ortiz Camacho
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Leila Jahangiri
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Jenna Iseringhausen
- Department of Neurology and Movement Disorders, New York University Langone Health, New York, New York, USA
| | - Gary R Goldstein
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
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5
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Ayhan Y, Yoseph SA, Miller BL. Management of Psychiatric Symptoms in Dementia. Neurol Clin 2022; 41:123-139. [DOI: 10.1016/j.ncl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bergström L, Cichero JA. Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:77-87. [PMID: 34328050 DOI: 10.1080/17549507.2021.1953592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Cervical auscultation (CA) uses a stethoscope or microphone to complement the clinical swallow examination by interpreting swallowing sounds and swallow-respiratory coordination. This study investigated the effects of structured CA training on CA-rating agreement with Flexible Endoscopic Evaluation of Swallowing (FEES) and CA rater reliability.Method: Thirty-nine speech-language pathologists participated in a structured CA training course at Gothenburg University. They rated nine swallow-respiratory sound recordings which were simultaneously recorded during FEES. Swallow sounds were rated six weeks prior to the CA-workshop using two binary yes/no questions, (1) Safe, (2) Dysphagia, and a third Dysphagia Severity rating. Swallow sounds were rated again (re-randomised) one month post CA-workshop.Result: Agreement with FEES (validity) improved significantly (p < 0.05) pre-post training for the Safe and Dysphagia questions, with post training sensitivities >90% and specificities at 76% and 85% respectively. Dysphagia severity rating improved non-significantly. Intra-rater reliability improved significantly with kappa statistics >0.90 post training. Improvements for inter-rater reliability were noted, though non-significant.Conclusion: Results demonstrate that with structured training, the validity of CA (to detect a Safe/Dysphagic swallow) significantly improves, as does intra-rater reliability. This is congruent with literature identifying the positive effects of structured training improving instrumental dysphagia assessment.
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Affiliation(s)
- Liza Bergström
- Institute of Neuroscience & Physiology, Department of Health & Rehabilitation, Speech and Language Pathology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg 405 30, Sweden
- Speech Therapy Clinic, Danderyd Hospital, Stockholm, Sweden
- REMEO Stockholm, Sköndal, Sweden
| | - Julie Ay Cichero
- School of Pharmacy, PACE, The University of Queensland, Woolloongabba, Australia
- Mater Research, South Brisbane, Australia
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Liang CS, Li DJ, Yang FC, Tseng PT, Carvalho AF, Stubbs B, Thompson T, Mueller C, Shin JI, Radua J, Stewart R, Rajji TK, Tu YK, Chen TY, Yeh TC, Tsai CK, Yu CL, Pan CC, Chu CS. Mortality rates in Alzheimer's disease and non-Alzheimer's dementias: a systematic review and meta-analysis. THE LANCET. HEALTHY LONGEVITY 2021; 2:e479-e488. [PMID: 36097997 DOI: 10.1016/s2666-7568(21)00140-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND People with dementia die prematurely. Identifying differences in mortality rates between different types of dementia might aid in the development of preventive interventions for the most vulnerable populations. The aim of this study was to compare the difference in mortality rates between individuals without dementia and individuals with various types of dementia. METHODS For this systematic review and meta-analysis, we did a systematic search of MEDLINE, PubMed, Embase, and Cochrane Library from inception to July 11, 2020, for cross-sectional or cohort studies that assessed mortality and survival-related outcomes among people with different types of dementia compared with people without dementia. Single-arm studies without comparison groups and autopsy studies or family studies that used a selected sample were excluded. The Newcastle-Ottawa Scale was used by two authors (D-JL and C-SC) independently to measure the methodological quality of included studies, and two authors (F-CY and P-TT) independently extracted data. We assessed differences in all-cause mortality rate and survival time from dementia diagnosis between individuals without dementia, individuals with Alzheimer's disease, and individuals with non-Alzheimer's disease dementias. The secondary outcomes were age at death and survival time from disease onset. Random-effects meta-analyses were done. Effect sizes included hazard ratios (HRs) and mean differences (MDs) with 95% CIs. Potential moderators, including age-associated moderators, were identified through meta-regression and subgroup analyses. This study is registered with PROSPERO, CRD42020198786. FINDINGS Our database search identified 11 973 records, and we included 78 eligible studies in our analyses, encompassing 63 125 individuals with dementia and 152 353 controls. Individuals with any type of dementia had a higher mortality rate than individuals without dementia (HR 5·90, 95% CI 3·53 to 9·86), and the HR for all-cause mortality was highest for Lewy body dementia (17·88, 5·87 to 54·46). After diagnosis, the mean survival time for people with Alzheimer's disease was 5·8 years (SD 2·0). Compared with people with Alzheimer's disease, a diagnosis of any non-Alzheimer's disease dementia was associated with a higher risk of all-cause mortality (HR 1·33, 1·21 to 1·46), a shorter survival time from diagnosis (MD -1·12 years, 95% CI -1·52 to -0·72), and a younger age at death (-1·76 years, -2·66 to -0·85). Survival time from disease onset was also shorter in people with non-Alzheimer's dementia, across types, compared with people with Alzheimer's disease, but the subgroup analysis revealed that this difference was only significant for vascular dementia (MD -1·27 years, -1·90 to -0·65) and dementia with Lewy bodies (MD -1·06 years, -1·68 to -0·44). The interactions between age and several survival-related outcomes were significant. 39 (50%) of the 78 included studies were rated as good quality, and large heterogeneity (I2>75%) was observed for most of the study outcomes. INTERPRETATION Alzheimer's disease is the most common type of dementia and one of the major causes of mortality worldwide. However, the findings from the current study suggest that non-Alzheimer's disease dementias were associated with higher morality rates and shorter life expectancy than Alzheimer's disease. Developing tailored treatment and rehabilitation programmes for different types of dementia is important for mental health providers, patients, and their families. FUNDING None.
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Affiliation(s)
- Chih-Sung Liang
- Department of Psychiaty, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Dian-Jeng Li
- Faculty of Nursing Department, Meiho University, Pingtung City, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joaquim Radua
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Mental Health Research Networking Center, Barcelona, Spain; Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, Canada; Toronto Dementia Research Alliance, Faculty of Medicine, University of Toronto, Toronto, Canada; Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ling Yu
- Department of Pharmacy, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chuan Pan
- Department of Psychiatry Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatric and Gerontology Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Eating Disorders in Frontotemporal Dementia and Alzheimer's Disease: Evaluation of Brain Perfusion Correlates Using 99mTc-HMPAO SPECT with Brodmann Areas Analysis. J Alzheimers Dis 2021; 80:1657-1667. [PMID: 33720894 DOI: 10.3233/jad-201434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Eating disorders (ED) in dementia represent a significant impairment affecting patients' and caregivers' lives. In frontotemporal dementia (FTD), ED include overeating, sweet food preference, stereotypical eating, and hyperorality, while in Alzheimer's disease (AD), anorexia and appetite loss are the most common ED. OBJECTIVE The aim of our study was to highlight Brodmann areas (BAs) implicated specifically in the appearance of ED in FTD and AD. METHODS We studied 141 patients, 75 with FTD and 66 with AD. We used the NeuroGamTM software on the reconstructed single photon emission computed tomography-SPECT data for the automated comparison of BAs perfusion on the left (L) and right (R) hemisphere with perfusion in corresponding BAs of a normal database. RESULTS The FTD group included 27 men and 48 women, age (mean±SD) 65.8±8.5 years, duration of disease 3.4±3.3 years, Mini-Mental State Examination (MMSE) 17.9±8.6, ED score on Neuropsychiatric Inventory (NPI) 4.7±8.5. ED in FTD were correlated with hypoperfusion in right anterior and dorsolateral prefrontal cortices (BAs 10R, 46R), left orbitofrontal cortex (BA 12L), orbital part of the right inferior frontal gyrus (BA 47R), and left parahippocampal gyrus (BA 36L). The AD group included 21 men and 45 women, age (mean±SD) 70.2±8.0 years, duration of disease 3.3±2.4 years, MMSE 20.2±6, ED-NPI score 2.7±3.9. ED in AD were correlated with hypoperfusion in left inferior temporal cortex (BA 20L). CONCLUSION SPECT imaging with automated mapping of brain cortex could contribute to the understanding of the neural networks involved in the manifestation of ED in dementia.
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Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Nikolaos Sifakis
- Nuclear Medicine Department, "Alexandra" General Hospital, Athens, Greece
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, Athens, Greece
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, Athens, Greece
| | | | - Dimitra Sali
- Neurology Department, Evrokliniki, Athens, Greece
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Ioannis Tsougos
- Medical Physics Department, Medical School, University of Thessaly, Greece
| | | | | | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, Athens, Greece.,Memory Disorders Clinic, Medical Center, Athens, Greece
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Lewis C, Keage M, Watanabe M, Schubiger D, Velakoulis D, Walterfang M, Vogel AP. Characterization of Dysphagia and Longitudinal Changes in Swallowing Function in Adults with Niemann-Pick Disease Type C Treated with Miglustat. Dysphagia 2020; 36:362-373. [PMID: 32562141 DOI: 10.1007/s00455-020-10145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Niemann-Pick disease type C (NPC) is a rare, autosomal recessive neurodegenerative disease, characterized by progressive psychiatric and neurological deficits. Neurological symptoms include cognitive decline and dysphagia. Aspiration pneumonia secondary to dysphagia is a leading cause of death in NPC. Miglustat is currently the only approved disease-specific treatment shown to be effective in stabilizing neurological symptoms. Miglustat has previously been reported to halt or improve early dysphagia and cognitive symptoms. Here we examine the characteristics of dysphagia, the relationship between dysphagia and the presence of cognitive impairment, and longitudinal changes in swallowing function during miglustat treatment in adult-and-adolescent-onset NPC. Retrospective analysis of videofluoroscopic swallow studies (VFSS) was completed for ten adults with NPC (mean age 28.44 years ± 9.34 years). Participants were recruited through the Royal Melbourne Hospital in Australia between 2008 and 2015. The Bethlehem Swallowing Scale and the Penetration-Aspiration Scale were used to quantify VFSS data. Dysphagia was present in 90% of participants at baseline with reduced lingual function and a delayed swallowing reflex as the most common symptoms. Swallow impairment appeared to stabilize during miglustat therapy for periods up to 66 months, with no significant changes in scores (p > 0.05). Data were in accordance with the literature and support the use of miglustat as an efficacious treatment for reducing swallowing impairment and stabilizing cognitive function. Findings provide detailed information on the impairments experienced by patients, give context to events leading to aspiration in NPC and, importantly, inform how management of dysphagia can complement pharmaceutical treatment.
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Affiliation(s)
- Courtney Lewis
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Miyuki Watanabe
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | | | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia.
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- Redenlab, Melbourne, Australia.
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10
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Ruggero L, Croot K, Nickels L. How Evidence-Based Practice (E 3BP) Informs Speech-Language Pathology for Primary Progressive Aphasia. Am J Alzheimers Dis Other Demen 2020; 35:1533317520915365. [PMID: 32223422 PMCID: PMC10623930 DOI: 10.1177/1533317520915365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Amelioration of communication impairment in primary progressive aphasia (PPA) is an area of clinical importance and current research. Speech-language pathologists (SLPs) have a range of skills and interventions to support communication in PPA; however, underrecognition of their role and low referral rates is an ongoing concern. The E3BP conceptualization of evidence-based practice comprises 3 components: research-based evidence, practice-based evidence, and informed patient preferences. Here, we will describe how evidence for managing the communication difficulties experienced by individuals with PPA exists at all 3 levels of the (E3BP) model, highlighting how this allows SLP interventions to be both evidence based and patient centered. We encourage health professionals to value and utilize the wide range of services that SLPs can offer when working with individuals with PPA, to educate, remediate everyday linguistic skills, increase daily participation, and maximize overall quality of life.
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Affiliation(s)
- Leanne Ruggero
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Croot
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, New South Wales, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
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