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      The effects of sarcopenic dysphagia on the dynamics of swallowing organs observed on videofluoroscopic swallowing studies

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          Abstract

          Objectives

          The aim of the present study was (a) to determine the relationship of videofluoroscopic swallowing study (VFSS) findings of the swallowing musculature with the diagnostic criteria for sarcopenic dysphagia and (b) to examine the usefulness of VFSS for diagnosing sarcopenic dysphagia.

          Methods

          The participants were 132 patients (mean age, 80.4 ± 8.8 years). Their skeletal muscle mass, nutritional status and swallowing functions as assessed by VFSS findings were measured. Also, the relationship between the VFSS findings and sarcopenia was examined.

          Results

          Of all the participants, 20 men (mean age, 83.2 ± 6.9 years) and 27 women (mean age, 85.3 ± 6.9 years) were diagnosed with sarcopenia. In men, the amount of laryngeal upward movement (ALUM) was significantly lower and the pharyngeal area was significantly wider in the sarcopenia group than in the non‐sarcopenia group. In women, the pharyngeal area was significantly wider in the sarcopenia group than in the non‐sarcopenia group. In a logistic regression model, ALUM (odds ratio [OR] 1.135, 95% confidence interval [CI] 1.037‐1.241, P = .006) and pharyngeal area (OR 0.028, 95% CI 0.001‐0.670, P = .027) was a significant independent factor for the presence or absence of sarcopenia.

          Conclusions

          The decline in swallowing function of sarcopenia patients was characterised by lower laryngeal movement and enlargement of the pharyngeal cavity due to decreased skeletal muscle mass and decreased muscle strength. The present study suggested the usefulness of measuring ALUM during swallowing and measuring the pharyngeal area with VFSS as indicators of decreased swallowing muscle function in sarcopenia.

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          Most cited references17

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          Skeletal muscle quality assessed from echo intensity is associated with muscle strength of middle-aged and elderly persons.

          Enhanced echo intensity (EI) on an ultrasound image of skeletal muscle indicates changes in muscle quality, including increases in intramuscular fibrous and adipose tissues. However, it is not known whether muscle quality assessed from the EI of computer-aided gray-scale analysis of an ultrasound image is associated with the muscle strength or body composition of a subject. The objectives of this study were to investigate whether muscle quality assessed from EI measured using gray-scale analysis is associated with muscle strength independently of age or muscle thickness (MT), and to examine the relationship between muscle EI and body composition. Ninety-two healthy women with a mean age of 70.4 ± 5.5 years (range, 51-87 years) dwelling in Kyoto, Japan, participated in the study. The MT, subcutaneous fat thickness (FT), and EI of the quadriceps femoris on the right extremity were assessed from transverse ultrasound images. Knee extensor isometric strength was used as a measure of the quadriceps femoris muscle strength. EI was significantly correlated with quadriceps strength independently of age or MT, and stepwise regression analysis revealed that MT and EI were independently associated with quadriceps strength. Importantly, EI showed no significant correlations with FT, percentage of body fat (%BF), or body mass index (BMI), while FT, BMI, and %BF did not significantly influence muscle strength. These data suggest that muscle quantity (i.e., MT) and muscle quality assessed from EI measured using computer-aided gray-scale analysis independently contribute to muscle strength in middle-aged and elderly persons.
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            Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale.

            Dysphagia is one of the most prevalent and distressing symptoms among palliative care patients, and a practical assessment tool is required.
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              Presbyphagia and Sarcopenic Dysphagia: Association between Aging, Sarcopenia, and Deglutition Disorders.

              Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Age-related loss of swallowing muscle mass becomes evident in the geniohyoid muscle and tongue. Elderly subjects with both sarcopenia and dysphagia may have not only disease-related dysphagia but also sarcopenic dysphagia. In cases of aspiration pneumonia, deterioration in activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles may develop into sarcopenic dysphagia. Assessment of sarcopenic dysphagia includes evaluation of both dysphagia and sarcopenia. The 10-item Eating Assessment Tool (EAT-10) and a water test combined with pulse oximetry are useful for dysphagia screening. Assessment of the multi-factorial causes of sarcopenia including nutritional review is important, because rehabilitation of sarcopenic dysphagia differs depending on its etiology. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. Rehabilitation for sarcopenic dysphagia includes treatment of both dysphagia and sarcopenia. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. The causes of adult malnutrition may also contribute to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition management is indispensable for sarcopenic dysphagia rehabilitation. In cases of sarcopenia with numerous complicating causes, treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking.
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                Author and article information

                Contributors
                kikutani@tky.ndu.ac.jp
                Journal
                J Oral Rehabil
                J Oral Rehabil
                10.1111/(ISSN)1365-2842
                JOOR
                Journal of Oral Rehabilitation
                John Wiley and Sons Inc. (Hoboken )
                0305-182X
                1365-2842
                09 February 2020
                May 2020
                : 47
                : 5 ( doiID: 10.1111/joor.2020.47.issue-5 )
                : 584-590
                Affiliations
                [ 1 ] Division of Clinical Oral Rehabilitation The Nippon Dental University School of Life Dentistry at Tokyo Tokyo Japan
                [ 2 ] Department of Rehabilitation for Speech and Swallowing Disorders Tama Oral Rehabilitation Clinic The Nippon Dental University School of Life Dentistry at Tokyo Koganei Japan
                Author notes
                [*] [* ] Correspondence

                Takeshi Kikutani, Division of Clinical Oral Rehabilitation, Tama Oral Rehabilitation Clinic, The Nippon Dental University School of Life Dentistry at Tokyo, 4‐44‐19, Higashicho, Koganei Shi, Tokyo 184‐0011, Japan.

                Email: kikutani@ 123456tky.ndu.ac.jp

                Author information
                https://orcid.org/0000-0002-8850-1525
                https://orcid.org/0000-0003-3815-5545
                Article
                JOOR12936
                10.1111/joor.12936
                7317742
                31976566
                e4bb746b-30ff-4a75-a122-872abd7ecfcd
                © 2020 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 November 2019
                : 08 January 2020
                : 15 January 2020
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 4674
                Funding
                Funded by: Japan Society for the Promotion of Science , open-funder-registry 10.13039/501100001691;
                Award ID: JP18H03017
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                May 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:26.06.2020

                Dentistry
                larynx,pharyngeal muscles,sarcopenia,swallowing
                Dentistry
                larynx, pharyngeal muscles, sarcopenia, swallowing

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