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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.
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Objective:To evaluate the reliability and validity of the Chinese version of the Ohkuma questionnaire.Methods:The Ohkuma questionnaire was translated and revised, before it was used to investigate 70 elderly patients. Cronbach′s alpha coefficient, Cohen′s kappa coefficient and Pearson correlation were used to evaluate the scale′s internal reliability, sub-item retest reliability and total score retest reliability. KMO and Bartlett tests were used to evaluate the validity. The correlation between the Chinese version of the Ohkuma questionnaire and ratings from video fluoroscopy before and after treatment was used to evaluate the scale′s discrimination ability.Results:The Cronbach′s alpha of the Chinese version of Ohkuma questionnaire was 0.831, with 0.814 in the initial evaluation and 0.808 in a second evaluation. The Cohen′s kappas of the 15 sub-items ranged from 0.728 to 1.000. The Pearson correlation coefficient of the total score was 0.914. The scale′s KMO value was 0.701. A t-test of the Ohkuma scores before and after treatment showed a statistically significant difference.Conclusion:The revised Chinese Ohkuma questionnaire has good reliability, validity and discriminatory power. It can be used to screen for dysphagia among the elderly.
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Objective To determine the prevalence of dysphagia among elderly population and patients with stroke,head and neck cancer or neurodegenerative diseases in China.Methods Patients with stroke,head and neck cancer and neurodegenerative diseases,as well as elderly people older than 65 were selected.They were surveyed using the Sydney or Ohkuma swallowing questionnaire and evaluated using the Kubota's water swallow test and videofluoroscopic swallowing study (VFSS).The incidence of dysphagia among patients with the three diseases and elderly population was recorded,and its relationship with age,gender and economic status was also observed.Results For 7000 people surveyed,6102 met the inclusion criteria.Of all the included participants,2363 (38.7％) were identified as having swallowing abnormalities.Dysphagia was found in 46.3％ of stroke patients at the acute phase,56.9％ of stroke patients at the chronic phase,40.8％ of Alzheimer's disease patients,46.2％ of Parkinson's disease patients,12.5％ of multiple sclerosis patients,50.0％ of amyotrophic lateral sclerosis patients,36.6％ of nasopharyngeal cancer sufferers,58.4％ of laryngeal cancer sufferers.The prevalence of oropharyngeal dysphagia was 26.4％ and 13.9％ in nursing home-and community-dwelling elderly people.The average prevalence rate of deglutition disorder in the midland (55.0％) was significantly higher than the east coast (38.6％),still significantly higher than the western areas (32.5％) of China (x2=116.2,P＜0.001),representing 3 different economic development status.This study demonstrated that the prevalence of the male (40.0％) was higher than the female (36.3％).Moreover,the prevalence increased with age.Conclusion Dysphagia is of high prevalence among patients with stroke,head and neck cancers or neurodegenerative diseases,as well as the elderly in China.Its prevalence has significant correlations with age,gender and economic status.