Swallowing Caused by Dementia – Important Reason for ENT Management

S+S Spring 2023

Swallowing is often an issue for people with dementia. This bodily function is a very complex and orchestrated reflex that requires the neurologic system to be intact, said Dr. Sandra Stinnett, laryngologist and Assistant Professor of Otolaryngology at the University of Pittsburgh.

“There are many causes of dementia that could be secondary to stroke or other neurologic deficits,” she added. “This can lead to swallowing difficulty, also known as dysphagia, secondary to decreased sensation of the throat (pharynx and supraglottic area), decreased tongue strength, decreased transit movement of the food from the mouth to the throat, and delay in swallow reflex.”

According to Dr. Stinnett, people living with Alzheimer’s disease are at significant risk of having swallowing deficits secondary to a slower, delayed pharyngeal reflex and oral phase as well as difficulty clearing the food from the pharynx or throat. These swallow symptoms usually correlate with the degree of their dementia.

Symptoms to watch out for include evidence of coughing while eating, the presence of throat clearing, unintentional weight loss, pain or discomfort with swallowing, or a history of pneumonia. Caretakers may notice less chewing, an inability to feed themselves, or holding food in the mouth without swallowing for a prolonged time.

Having difficulty swallowing leads to other complications. Patients are at risk of losing significant weight, resulting in failure to thrive which can be life-threatening. Dehydration can be serious, especially if the patient is avoiding liquids. Other dangers include choking and aspiration pneumonia, which can result in death.

If swallowing difficulties are suspected, the patient should be evaluated by a multidisciplinary team, including an ENT or specifically, a laryngologist, with a speech language pathologist that specializes in swallowing. An assessment may be completed in the office, which can include a complete history and physical, and looking at any medications that may cause significant side effects such as dry mouth.

“Swallow therapy may be recommended contingent upon the deficits visualized,” Dr. Stinnett said. If any surgical intervention is warranted, this will be addressed as well. If severe, patients may need to undergo feeding tube placement to prevent life threatening complications of dysphagia.

Practical things that can be implemented include eliminating distractions during meals, emphasizing the importance of
good oral hygiene in order to mitigate pneumonia risk, implementing small meals with hydration breaks to ensure that they are well hydrated, incorporating a dietary consultant to ensure adequate caloric intake, and providing food choices for the individual as well as making it appetizing and appealing for them.

The good news is there are several new devices on the horizon to assist with oral intake of food and volume control to reduce the risk of aspiration. “There are also studies that are proving early intervention for strengthening exercises and respiratory exercises help to reduce the danger associated with aspiration,” Dr. Stinnett said.