Cognitive Decline can PRECEDE or FOLLOW Dysphagia
Taken from Winchester & Winchester, 2015.
Did you know that, between 2010 and 2030, the geriatric population will dramatically increase to ~70 million elderly residents, representing ~20% of the total American population? In addition to that, among the elderly, 10–15 million Americans will be over the age of 85 and are likely to be afflicted by progressively deteriorating neurocognitive diseases. Research has shown that approximately 10% of individuals over the age of 65yrs likely suffer from cognitive impairment or dementia and that cognitive decline is the most feared of the chronic diseases affecting American seniors.
We have also done extensive literature reviews, which demonstrate a strong correlation between cognitive impairment and dysphagia exists. This is due to the bidirectional influence of the metaphysical (e.g. thought, memories, functions, sensations, etc.) and the physical (e.g. our bodies).
Our body's ability to safely swallow food, liquids and/or medications involves a temporal arrangement of structures in our faces/mouths/throats spanning the respiratory, speech and gastrointestinal systems. These structures must work together to allow us to safely swallow and then recuperate their original configurations so we can keep breathing and talking.
While cognition involves much of the programming that spans the sensory, motor, executive functioning, memory and multisensory integration systems, much of the neurological control spans the brainstem, cerebellum, thalamic, spinal and cortical regions.
Healthy cognitive function in deglutition involves cognitive strategies for executing neurological functions, adapting behaviors for safe deglutition under various conditions, adjusting body positions, perceiving the body as unit, and perceiving the entire eating experience as a unit
“Awareness,” here, encompasses more than just being aware that the experience is taking place. It involves being aware of one’s body as a whole as well as a sum of its parts.
Effectively managing Cognitive Dysphagia, then, includes evaluating higher-level cognates, higher-level sensory reception and perception, attention, memory, cognitive organization, problem solving/judgment, reasoning, executive function, and neuropsychiatric disturbances such as agitation, impulsivity/dis-inhibition, and apathy that may interfere with effective oral intake.
Cognitive Dysphagia, then, can be defined as the breakdown of The Five Systems of Dysphagia, with cognitive decline preceding the breakdown of the remaining systems, or being the result of the breakdown of the remaining systems
There are roles for the entire Interdisciplinary Team in caring for this patient. See our additional content pertaining to the:
1. Nurse
2. Physician
3. PT
4. OT
5. CNA/PCT
6. Family/caregiver
7. Patient
If you are a SLP... check out our continuing educational opportunities at dysphagiamanagement.com/ce-courses to learn more!
