The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study.

BACKGROUND: Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD. METHODS: SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha. RESULTS: Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS. CONCLUSIONS: SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.

Association between adductor pollicis muscle thickness and nutritional parameters in hospitalized elderly patients / Asociación entre el espesor del músculo aductor del pulgar y parámetros nutricionales en pacientes ancianos hospitalizados

Introduction: the measurement of the adductor pollicis muscle thickness (APMT) has been investigated as an anthropometric parameter; however, there are few studies related to hospitalized elderly patients. Objective: to analyze the association between APMT and nutritional parameters in hospitalized elderly patients. Method: cross-sectional study made in 331 hospitalized elderly patients. The following variables have been assessed: APMT, Mini Nutritional Assessment® (MNA®), body mass index (BMI), arm circumference (AC), calf circumference (CC) and handgrip strength (HGS).Results: the mean age was 78.4 ± 9.7 years and 56.8% were women. The women had showed APMT mean values significantly lower than the men (12.67 ± 4.13 mm vs 15.26 ± 4.01 mm), as well as the elderly patients ≥ 80 years old showed APMT values lower than the younger patients (12.62 ± 4.38 mm vs 14.83 ± 3.90 mm). In relation to the APMT classification, the women were more frequently below P5 than the men (89.9% vs 37.1%). In the univariate analysis, the mean values of APMT were significantly lower in the malnourished elderly patients (MNA®), thinness (BMI), AC < 21 cm, CC < 31 and HGS < P5, regardless of gender. In the multivariate analysis, APMT remained as a factor independently associated with all nutritional indicators, even when adjusted to age and gender. Conclusion: APMT has associated with all the nutritional parameters investigated, regardless of gender and age, reinforcing its applicability in the nutritional assessment of elderly people

Introducción: la medida del espesor del musculo aductor del pulgar (EMAP) ha sido investigada como parámetro antropométrico, pero son escasos los estudios en ancianos hospitalizados. Objetivo: analizar la asociación entre EMAP y parámetros nutricionales en ancianos hospitalizados. Método: estudio transversal con 331 ancianos hospitalizados. Se evaluaron las siguientes variables: EMAP, Mini Nutricional AssessmentR (MNAR), índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia de la pantorrilla (CP) y fuerza de prensión palmar (FPP). Resultados: el promedio de edad fue de 78,4 ± 9,7 anos y el 56,8% eran mujeres. Las mujeres tenían valores medios de EMAP significativamente menores que los hombres (12,67 ± 4,13 mm frente a 15,26 ± 4,01 mm), asi como los ancianos ≥ 80 anos tenían valores de EMAP inferiores a los mas jóvenes (12,62 ± 4,38 mm frente a 14,83 ± 3,90 mm). En cuanto a la clasificación de la EMAP, las mujeres se encontraban con mas frecuencia por debajo del P5 que los hombres (89,9% frente al 37,1%). En el análisis univariado, los niveles medios de la EMAP se mostraron mucho mas pequeños en los ancianos con desnutrición (MNAR), delgadez (IMC), CB < 21 cm, CP < 31 cm y FPP < P5, independientemente del sexo. En el análisis multivariado, la EMAP permaneció como factor independiente asociado a todos los parámetros nutricionales, incluso cuando se ajusto para edad y sexo. Conclusiones: la EMAP se asocio con todos los para metros nutricionales investigados, independientemente del sexo y de la edad, reforzando su aplicabilidad en la evaluación nutricional de ancianos

Healthy eating index of elderly: description and association with energy, macronutrients and micronutrients intake

The purpose of this study was to define the Healthy Eating Index (HEI) of the elderly of Southern Brazil and its association with energy, macronutrients and micronutrients intake. A cross-sectional study was conducted with 186 elderly aged 60 and older of the Geriatric Service of São Lucas Hospital, Porto Alegre , Brazil. Dietary data were collected by two 24-hour recalls, and diet quality was assessed by HEI adapted to the Brazilian population. The HEI total score was divided into three categories: inadequate diet (below 51 points), diet needs improvement (between 51 and 80 points), and healthy diet (over 80 points). The results showed that the mean HEI score was 58.8±10.5 points (ranging from 31.4 to 79.8). Most elderly (74.2%) showed a diet that needed modification and no elderly individual had a healthy diet. The quality of the diet was associated with greater intake of carbohydrates, and lower intake of total lipids, saturated fatty acids, cholesterol, and sodium. Consumption of vitamins C and D and calcium was shown to be positively correlated with the quality of the diet. Less than 1.1% of the elderly consumed a varied diet. The findings suggest that the diet of the majority of the elderly needs improvement, reinforcing the importance of care in relation to adequate nutrition in this population, and can help in guiding the activities and programs of nutritional education and public policies that stimulate increasingly healthy eating.

Índice de alimentação saudável de idosos: descrição e associação com ingestão de energia, macronutrientes e micronutrientes. O objetivo deste estudo foi descrever o Índice de Alimentação Saudável (IAS) de idosos do Sul do Brasil e sua associação com a ingestão de energia, macronutrientes e micronutrientes. Foi realizado um estudo transversal com 186 idosos com 60 anos ou mais, do Serviço de Geriatria do Hospital São Lucas, Porto Alegre, Brasil. Os dados relativos ao consumo alimentar foram coletados através de dois recordatórios de 24 horas, e a qualidade da dieta foi avaliada pelo IAS, adaptado à população brasileira e o escore total foi dividido em três categorias: dieta inadequada (abaixo de 51 pontos), dieta necessitando de adequação (entre 51 e 80 pontos), e dieta saudável (mais de 80 pontos). Os resultados mostraram que a média do IAS foi 58,8±10,5 pontos (variando de 31,4 a 79,8 pontos). A maioria dos idosos (74,2%) apresentou uma dieta que necessitava de modificação e nenhum idoso tinha uma dieta saudável. A qualidade da dieta foi associada com maior ingestão de carboidrato e baixa ingestão de gordura total, gordura saturada, colesterol e sódio. O consumo de vitaminas C e D e cálcio mostrou-se positivamente correlacionado com a qualidade da dieta. Menos de 1,1% dos idosos consumia uma dieta variada. Os resultados sugerem que a dieta da maioria dos idosos necessita de adequação, reforçando a importância dos cuidados em relação à nutrição adequada desta população e podem auxiliar na orientação de atividades e programas de educação nutricional e políticas públicas que estimulem a prática de uma alimentação mais saudável.

Healthy eating index of elderly: description and association with energy, macronutrients and micronutrients intake.

The purpose of this study was to define the Healthy Eating Index (HEI) of the elderly of Southern Brazil and its association with energy, macronutrients and micronutrients intake. A cross-sectional study was conducted with 186 elderly aged 60 and older of the Geriatric Service of São Lucas Hospital, Porto Alegre, Brazil. Dietary data were collected by two 24-hour recalls, and diet quality was assessed by HEI adapted to the Brazilian population. The HEI total score was divided into three categories: inadequate diet (below 51 points), diet needs improvement (between 51 and 80 points), and healthy diet (over 80 points). The results showed that the mean HEI score was 58.8±10.5 points (ranging from 31.4 to 79.8). Most elderly (74.2%) showed a diet that needed modification and no elderly individual had a healthy diet. The quality of the diet was associated with greater intake of carbohydrates, and lower intake of total lipids, saturated fatty acids, cholesterol, and sodium. Consumption of vitamins C and D and calcium was shown to be positively correlated with the quality of the diet. Less than 1.1% of the elderly consumed a varied diet. The findings suggest that the diet of the majority of the elderly needs improvement, reinforcing the importance of care in relation to adequate nutrition in this population, and can help in guiding the activities and programs of nutritional education and public policies that stimulate increasingly healthy eating.