Dementia Care Research and Psychosocial Factors.

Background: Caregiver burden, or the impact of caregiving, commonly occurs in caregivers of persons with dementia (PWD); however, prior research focused on caregiver burden in this population has not considered the impact of dysphagia. Therefore, the purpose of this study was to measure dysphagia-specific burden in caregivers of PWD and examine its relationship to general caregiver burden, as well as the PWD's current diet level and dementia severity.

Method: Data were collected from PWD-caregiver dyads participating in a prospective, dysphagia-focused clinical trial at the initial study visit.

Safety and toxicity of Iopofosine I 131 (CLR 131) with external beam radiation therapy in recurrent or metastatic head and neck cancer: results of a phase 1 single-centre, open-label, single-arm, dose escalation and dose expansion study.

Background: Re-irradiation of recurrent head and neck cancer (HNC) is often limited by tumour adherence to critical structures and/or radiation tolerance of critical normal tissues. Iopofosine I 131 (CLR 131) is a targeted small molecular phospholipid ether (PLE) drug conjugate that delivers iodine-131 selectively to tumour cells. We conducted a phase 1, single-centre, open-label study to determine whether CLR 131 given with reduced dose of external beam radiation therapy (EBRT) would be tolerable and feasible.

Reliability and Confidence of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Rating Among Research and Clinical Speech Pathologists Before and After Implementation of a Training Manual: A Multi-site Study.

DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training.

Exercise-Based Dysphagia Treatment: A Proposed Checklist.

Purpose: Oropharyngeal swallowing exercise-based interventions are frequently utilized to target physiologic mechanisms with the goal of improving swallowing function. However, study replicability and evidence synthesis regarding effects of interventions are limited due to inconsistent reporting on factors known to influence treatment delivery. In order to promote consistency of reporting factors associated with replicability, the authors constructed a set of preferred parameters focused on dysphagia as part of the initial version of the larger tool (Framework for RigOr aNd Transparency In REseaRch on Swallowing or FRONTIERS).

A Proposed Framework for Rigor and Transparency in Dysphagia Research: Prologue.

Purpose: Scientific transparency and rigor are essential for the successful translation of knowledge in clinical research. However, the field of oropharyngeal dysphagia research lacks guidelines for methodological design and reporting, hindering accurate interpretation and replication. This article introduces the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a new critical appraisal tool intended to support optimal study design and results reporting.

Accuracy of Dysphagia Screening by Non-clinical Research Staff in the Emergency Department.

Although the emergency department (ED) is the initial care setting for the majority of older adults requiring hospital admission, there is a paucity of ED-based dysphagia research in this at-risk population. This is driven by barriers to dysphagia evaluation in this complex care environment. Therefore, we assessed the reliability of trained, non-clinical ED research staff in administering dysphagia screening tools compared to trained speech pathologists (SLPs).

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia.

Importance: Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.

Objectives: To determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.

Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity.

The aim of this study was to examine the role of pre-existing dysphagia as a risk factor for COVID-19 severity among adults ≥50 years of age presenting to the emergency department (ED). This was a retrospective cohort study that used electronic health record data from two Midwestern EDs in the same health care system. The sample included patients ≥50 years of age who tested positive for SARS-COV-2 during an ED visit between March 15, 2020 and November 19, 2020.

Ready for Discharge, but Are They Ready to Go Home? Examining Neighborhood-Level Disadvantage as a Marker of the Social Exposome and the Swallowing Care Process in a Retrospective Cohort of Inpatients With Dementia.

Purpose: Socioeconomically disadvantaged areas are more resource poor, impacting adherence to swallowing care recommendations. Neighborhood-level disadvantage metrics, such as the Area Deprivation Index (ADI), allow for examination of social determinants of health (SDOH) in a precise region. We examined ADI in a cohort of persons living with dementia (PLWD) to determine representation of those residing in areas of socioeconomic disadvantage (high ADI), distribution of swallowing care provided, and frequency of SDOH-related counseling or resource linking prior to discharge.

Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study.

Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS.

Functionality of bone marrow mesenchymal stromal cells derived from head and neck cancer patients - A FDA-IND enabling study regarding MSC-based treatments for radiation-induced xerostomia.

Purpose: Salivary dysfunction is a significant side effect of radiation therapy for head and neck cancer (HNC). Preliminary data suggests that mesenchymal stromal cells (MSCs) can improve salivary function. Whether MSCs from HNC patients who have completed chemoradiation are functionally similar to those from healthy patients is unknown.

Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia.

Background: Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre-hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia.

Use of deep learning to segment bolus during videofluoroscopic swallow studies.

Anatomical segmentations generated using artificial intelligence (AI) have the potential to significantly improve video fluoroscopic swallow study (VFS) analysis. AI segments allow for various metrics to be determined without additional time constraints streamlining and creating new opportunities for analysis. While the opportunity is vast, it is important to understand the challenges and limitations of the underlying AI task.

The Impact of Modifiable Preoral Factors on Swallowing and Nutritional Outcomes in Healthy Adults: A Scoping Review.

Purpose: Swallowing has previously been characterized as consisting of four phases; however, it has become apparent that these four phases are not truly discrete and may be influenced by factors occurring prior to bolus entrance into the oral cavity (i.e., preoral factors).

Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices.

Purpose Of Review: Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions.

Recent Findings: Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis.

Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): A pilot, first-in-human study of interferon gamma-stimulated marrow mesenchymal stromal cells for treatment of radiation-induced xerostomia.

Background Aims: Xerostomia, or the feeling of dry mouth, is a significant side effect of radiation therapy for patients with head and neck cancer (HNC). Preliminary data suggest that mesenchymal stromal/stem cells (MSCs) can improve salivary function. We performed a first-in-human pilot study of interferon gamma (IFNγ)-stimulated autologous bone marrow-derived MSCs, or MSC(M), for the treatment of radiation-induced xerostomia (RIX).

Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation.

Purpose: Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program.

Method: Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program.

The effects of endoscope placement in the hypopharynx on swallowing-related measures in healthy adults.

Purpose: The purpose of this study was to determine whether transnasal passage of a flexible endoscope results in changes in salivary flow rate (SFR), spontaneous swallow frequency (SSF), and masticatory efficiency (ME) in healthy adults.

Methods: Data were collected from 15 healthy adults, 20-63 years of age. SFR and SSF were measured at baseline, after endoscope insertion, and after endoscope removal.

Predictors of Swallowing-Related Quality of Life in United States Veterans with Dysphagia.

While both dysphagia and poor health-related quality of life frequently occur in United States (US) Veterans, swallowing-related quality of life in this population has not been systematically examined. This retrospective clinical observation study aimed to determine the independent predictors of swallowing-related quality of life for a sample of US Veterans. We examined the following variables in a multivariate analysis to determine the predictors of Swallowing Quality of Life Questionnaire scores: demographic information, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale scores, anterior lingual pressures, and Functional Oral Intake Scale scores.

Dysphagia in Parkinson Disease: Part II-Current Treatment Options and Insights from Animal Research.

Purpose Of Review: Dysphagia is highly prevalent in Parkinson disease (PD) but is not typically identified nor treated until later in the disease process. This review summarizes current pharmacological, surgical, and behavioral treatments for PD-associated dysphagia and contributions from translational animal research.

Recent Findings: Swallowing is a complex physiologic process controlled by multiple brain regions and neurotransmitter systems.

Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial.

Background: Swallowing impairments resulting from stroke have few rehabilitative options. Prior evidence suggests lingual strengthening exercise may provide some benefit, but more randomized controlled trials are required. The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke.

New horizons in understanding oral health and swallowing function within the context of frailty.

Frailty is a complex and multidimensional condition wherein declines in physiologic reserve and function place individuals in a state of heightened vulnerability and decreased resiliency. There has been growing interest in both research and clinical settings to understand how to best define, assess and characterise frailty in older adults. To this end, various models and clinical assessment tools have been used to define and measure frailty.