Effectiveness of physical rehabilitation on physical functioning and quality of life for long-term care residents with dementia: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to evaluate the effectiveness of physical rehabilitation versus non-rehabilitation comparators on physical functioning and quality of life for long-term care (LTC) residents with dementia. INTRODUCTION: LTC residents living with dementia often have impaired physical functioning and quality of life. Physical rehabilitation can improve physical functioning and quality of life for individuals living with dementia; however, many LTC residents with dementia do not receive physical rehabilitation and providers are unsure what interventions to employ. A synthesis of studies examining physical rehabilitation will help guide practice in the LTC sector where most residents live with dementia. Previous syntheses have focused on all residents in LTC, specific professions, interventions, or people with dementia in the community. Our review focuses on LTC residents with dementia and a broader definition of physical rehabilitation. INCLUSION CRITERIA: This review includes studies that evaluate physical rehabilitation in comparison with non-rehabilitation controls among LTC residents with any severity of dementia. We included studies that measure the effect on activities of daily living, performance-based physical functioning, and self- or proxy-rated quality of life. METHODS: Searches were conducted in APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), PubMed (National Library of Medicine), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviews assessed the studies against the inclusion criteria. Two independent reviewers extracted data and conducted a quality assessment using a structured extraction form. Certainty of evidence was ascertained using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Where possible, studies were pooled in meta-analyses; otherwise, a narrative synthesis was performed. RESULTS: Thirty-three studies were included (n = 3072 participants); 27 were randomized control trials and the remaining 6 were non-randomized trials. The overall risk of bias of the included studies was low to unclear. Many of the included studies focused on increasing activity or walking, while few were individually tailored or at an intensity appropriate to induce therapeutic effects on physical function. Physical function was also measured via several outcome measures, limiting our ability to pool results. There was low certainty evidence that physical rehabilitation improved activities of daily living (12 RCTs, 1348 participants, SMD 0.78; 95% CI 0.27 to 1.30) and the Short Physical Performance Battery Score (3 RCTs, 258 participants, MD 3.01 points; 95% CI 1.37 to 4.66) compared with non-rehabilitation interventions. There was low to moderate certainty evidence that physical rehabilitation demonstrated no change in the 30-Second Sit to Stand Test (2 RCTs, 293 participants, MD 0.79 repetitions; 95% CI -0.45 to 2.03), 6-Minute Walk Test (4 RCTs, 363 participants, MD 17.32 meters; 95% CI -29.41 to 64.05), gait speed (4 RCTs, 400 participants, MD 0.10 meters/seconds; 95% CI -0.02 to 0.22), Timed Up and Go Test (3 studies, 275 participants, MD -2.89 seconds; 95% CI -6.62 to 0.84), or quality of life (4 RCTs, 419 participants, SMD 0.20; 95% CI -0.08 to 0.47). CONCLUSIONS: This review demonstrates that physical rehabilitation may improve activities of daily living for LTC residents living with dementia, though the evidence is of low certainty. The effect of physical rehabilitation on specific functional tasks, like gait speed and quality of life, are less clear. Future research should examine the effects of individualized, progressive interventions on outcome measures that reflect the capacity and preferences of LTC residents with more advanced dementia. REVIEW REGISTRATION: PROSPERO CRD42022308444.

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. Design, Setting, and Participants: This cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium). Main Outcomes and Measures: Hospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS). Results: Of 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91). Conclusions and Relevance: This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study.

BACKGROUND: Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS: This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS: The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS: Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.

Oral health care and living environment for older people: a scoping review protocol.

OBJECTIVE: This scoping review will map the literature on the extent of knowledge on living environment oral health care (LIVEOR) by examining its different terminologies, its description, the stakeholders involved, the implementation characteristics, and the outcomes reported by the authors. INTRODUCTION: Older people want to receive oral health care in their current living environment. Although several authors have explored some aspects of LIVEOR for older people, there are still inconsistent findings regarding the extent of this model of care. INCLUSION CRITERIA: This scoping review will include quantitative, qualitative, and mixed method studies, as well as any type of knowledge synthesis on LIVEOR involving people aged 60 years and over. The search will not be limited by language, time frame, geographic location, or publication date. METHODS: We will use the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The search will include MEDLINE, CINAHL, Embase, Web of Science, and the Cochrane Library. A hand-search of the references of the included studies, and a gray literature search will also be conducted. Two independent reviewers will screen titles, abstracts, and full texts of selected studies, and perform data extraction. Findings are expected to explore what is known of LIVEOR targeting older people and to identify any knowledge gaps for future studies. We will disseminate our findings mostly through peer-reviewed publications. REVIEW REGISTRATION: Open Science Framework https://osf.io/e7fm2.

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. The Test of Masticating and Swallowing Solids was administered at baseline and while the endoscope was in the hypopharynx. A repeated measures ANOVA was used to determine the effect of endoscope insertion on SFR and SSF. A paired samples t-test was used to determine the effect of endoscope insertion on total mastication time and number of masticatory cycles required with a cracker bolus. Statistical significance was set at α = 0.05. RESULTS: SFR was found to be significantly increased during endoscope placement in the hypopharynx (M = 0.471 g/min, SD = 0.175, p = 0.002) as well as following endoscope removal (M = 0.481 g/min, SD = 0.231, p = 0.004), as compared to baseline (M = 0.310 g/min, SD = 0.130). Total mastication time and number of masticatory cycles required with a cracker bolus were significantly decreased when the endoscope was present in the hypopharynx, as compared to baseline t(14) = 3.054, p = 0.009; t(14) = 3.250, p = 0.006, respectively. CONCLUSIONS: Visualization of swallowing during FEES is an important method for objectively evaluating several anatomical and functional parameters of the pharynx and larynx. Insertion of the endoscope into the hypopharynx during FEES may stimulate salivary secretion and improve ME, which could influence interpretation of FEES and resulting clinical recommendations.

Effectiveness of programs that offer individualized, multifactorial support to community-dwelling older people with ongoing health and social care needs: a systematic review protocol.

OBJECTIVE: The objective of this review is to assess the effectiveness of programs that offer individualized, multifactorial support to community-dwelling older people with ongoing health and social care needs and to report how these programs affect quality of life and health system outcomes. INTRODUCTION: As people age, they often have multiple chronic conditions and functional impairment, and as a result, they need support to live well. Nursing homes and other residential facilities provide care for people with such needs; however, they can be expensive and older people generally prefer to remain at home, in their community. There is growing interest in programs that offer individualized, multifactorial support in the community for people with complex health and social care needs. INCLUSION CRITERIA: This review will focus on the effectiveness of programs that offer individualized, multifactorial support in the community for people over the age of 60 who are identified as having ongoing health and social care needs. The review will assess quality of life and health system outcomes, such as hospital admission. METHODS: This review will be conducted in accordance with the JBI methodology for systematic reviews of effectiveness. Ten databases will be searched for published and unpublished studies. Titles, abstracts, and full-text studies will be screened by 2 or more independent reviewers and assessed for methodological validity using the standard JBI critical assessment tools. Relevant data will be extracted using the JBI data extraction tools. The data will then be synthesized and reported using measures of evidence certainty. REVIEW REGISTRATION: PROSPERO CRD42022324061.

Prevalence, Incidence, and Predictors of Self-reported Swallowing Difficulties in Community-Dwelling Adults: A Population-Based Study from the Canadian Longitudinal Study on Aging (CLSA).

There is a paucity of evidence from population-based studies identifying prevalence and incidence of dysphagia, as well as health and sociodemographic risk factors that may contribute to its development. As such, the current study aimed to determine prevalence, incidence, and associated predictors of dysphagia in adults. The Canadian Longitudinal Study on Aging is a nationally representative population study that follows 51,338 Canadians over 45 years of age. Biological, medical, psychological, social, lifestyle and economic data are collected. A secondary analysis of the data was conducted to determine prevalence, incidence, and the predictors of self-reported swallowing difficulty in adults between 45 and 85 years of age. Rates of swallowing difficulty by demographic risk factor, as well as lifestyle and health factors were analyzed using descriptive statistics. Associations between lifestyle and health variables with dysphagia were tested using Chi-square tests or t tests, as appropriate. Logistic regression was used to determine the predictors of self-reported swallowing difficulties. Overall prevalence of self-reported swallowing difficulties in adults over the age of 45 was 10.6% and increased to 13.7% after 3 years. Significant differences (p < 0.001) in self-reported swallowing difficulty at baseline were apparent across smoking status, requiring help to prepare meals, life satisfaction, social participation, all disease categories except dementia, number of medications, cognition, oral health status, and frailty. Incidence of dysphagia was 8.6%. Regression analyses suggested the following independent predictors of reports of swallowing difficulty: older age; non-white ethnicity; female sex; poor oral health; malnutrition; and frailty. These predictors should be carefully considered to ensure we are screening at-risk populations. Social determinants of health, such as ethnicity, must also be considered to ensure equitable care across the population.

Scoping review of methods for engaging long-term care residents living with dementia in research and guideline development.

OBJECTIVES: To describe: (1) methods used to engage long-term care (LTC) residents living with dementia in research and guideline development; (2) the outcomes of engagement; and (3) barriers and facilitators to engagement. DESIGN: Scoping review. SEARCH STRATEGY: We conducted searches in Academic Search Premier (EBSCO), APA PsychInfo (EBSCO), CINAHL (EBSCO), Medline (OVID), Embase (Elsevier), Web of Science and the Cochrane database, and a structured grey literature search in July 2021 and updated in March 2023. We included studies that described or evaluated resident engagement, defined as including residents living with dementia in the process of developing healthcare guidelines or research which could include collaborators or partners in planning, execution or dissemination of the guideline or research. Title, abstracts and full-texts were screened for eligibility by two team members using a pilot-tested process. Data were extracted from included studies independently and in duplicate by two team members using a pre-tested data extraction form. Results were narratively synthesised according to the research question they addressed. RESULTS: We identified three studies for inclusion. Residents were engaged at the beginning of the research projects through interviews, focus groups, and consultations. None of the included articles described the outcomes of engagement. Barriers to engagement were predominantly at the resident level, including impaired verbal communication limiting resident's abilities to participate in discussions, while increased time to support engagement was reported as a barrier at the resident and research team levels. CONCLUSIONS: We found a small body of literature describing the engagement of LTC residents in health research and guideline development. Future work should explore alternative methods to engage LTC residents living with dementia, including art-based methods, and the effect of including resident engagement. Guideline developers and researchers should ensure adequate time and human resources are allocated to support engagement.

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. While differences exist among these models and tools, a common unifying theme is a focus on physical function and activity. Notably absent across many available conceptual models and clinical tools are items directly related to oral and swallowing function. This is an important oversight as widespread changes to both oral and swallowing function are evident in older adults. Indeed, emerging evidence suggests many of the functional domains affected in frail older adults, such as nutrition and sarcopenia, have cyclical relationships with impairments in oral (oral hypofunction) and swallowing function (dysphagia) as well. The increasing appreciation for the interrelationships among oral hypofunction, dysphagia and frailty provides an opportunity for refinement of frailty assessment and characterisation in older adults to incorporate metrics specific to oral and swallowing function.

Effectiveness of physical rehabilitation in improving physical functioning and quality of life for long-term-care residents with dementia: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of physical rehabilitation versus non-rehabilitation control in improving physical functioning and quality of life in long-term care residents with dementia. INTRODUCTION: Many long-term-care residents live with dementia and have impaired physical function and poor quality of life. Physical rehabilitation can improve physical function and quality of life for people living with dementia, yet many long-term-care residents with dementia do not receive this intervention, and health care providers are unsure of which rehabilitation interventions are effective. Studies synthesizing effective rehabilitation programs are needed to guide practice in the long-term-care sector where many residents live with dementia. Previous studies have focused broadly on long-term care, specific professions, interventions or outcomes, or people with dementia in the community. Our review will focus on long-term-care residents living with dementia and a broader definition of physical rehabilitation. INCLUSION CRITERIA: This review will include studies that evaluate physical rehabilitation in comparison with non-rehabilitation controls among long-term-care residents with any severity of dementia. We will include studies that measure the effect on performance-based physical functioning and self- or proxy-reported quality of life. METHODS: Searches will be conducted in APA PsycINFO (EBSCO), CINAHL (EBSCO), MEDLINE (Ovid), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviewers will conduct a critical appraisal of eligible studies, assess methodological quality, and extract the data. Where possible, studies will be pooled in a statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022308444.

Protocol for a scoping review on the methods for engaging long-term care residents with dementia in research and guideline development.

INTRODUCTION: Patient engagement is important when developing health guidelines to ensure high-quality and patient-centred recommendations. However, patient engagement in research and guideline development remains suboptimal, particularly for vulnerable populations, including residents with dementia living in long-term care (LTC) who are often not included in research and guideline development because of perceived and actual challenges with their health, memory, concentration and communication. Optimal strategies and methods for engaging LTC residents with dementia in research and guideline development remain unknown. METHODS AND ANALYSIS: We will conduct a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension to answer the research questions: (1) What methods have been used to engage LTC residents with dementia in research and guideline development? (2) What are the outcomes of resident engagement? (3) What are the barriers and facilitators to resident engagement? Systematic searches for peer-reviewed articles will be conducted in: Academic Search Premier (EBSCO), APA PsycINFO (EBSCO), CINAHL (EBSCO), Medline (OVID), Embase (Elsevier), Web of Science, and Cochrane Database and in grey literature. Two team members will screen articles and extract data. Results will be presented according to the research question they address. We will engage stakeholders including residents, family members, healthcare providers and representatives from relevant organisations throughout the study. ETHICS AND DISSEMINATION: The scoping review will synthesise what is known about resident engagement in research and guideline development. It may identify gaps in the literature about the optimal methods to engage residents in performing research and developing guidelines and reveal opportunities for new methods. The results will be helpful for researchers and policy-makers seeking to develop guidelines and researchers engaging in topics that reflect the priorities and experiences of people with dementia. Results of the scoping review will be disseminated via publication in a peer-reviewed journal and conference presentations, and a one-page lay summary will be shared with our engaged stakeholders.

Certified Nursing Assistants Want to Use External Memory Aids for Residents With Dementia: Survey Results Within an Implementation Science Framework.

Purpose The purpose of this study was to assess the self-perceived knowledge and self-efficacy of certified nursing assistants (CNAs) when using external memory aids to enhance the communication and independence of residents with dementia living in skilled nursing facilities (SNFs). Method One hundred forty-four CNAs completed a measure pertaining to self-perceived knowledge and self-efficacy of external memory aids. Results CNAs had favorable beliefs about the usefulness of external memory aids to help both conversation and independence in activities of daily living for residents with dementia ( M = 4.0, SD = 0.84; M = 3.92, SD = 0.85) on a 5-point Likert scale, with 5 = strongly agree and 1 = strongly disagree. There were no statistically significant differences between CNAs who reported being trained to use external memory aids with residents with dementia and CNAs who reported they were not trained according to items related to self-efficacy ( U = 2203.5, z = -1.483, p = .138; U = 2179, z = -1.547, p = .122; U = 2115, z = -1.82, p = .069; U = 2320, z = -0.942, p = .346). Conclusions Results of this study indicated that the lack of uptake of external memory aids for residents with dementia in SNFs may not solely be due to lack of buy-in or lack of time on the part of the CNA. Speech-language pathologists should provide this training to support the uptake of external memory aids for residents with dementia; however, these data suggest that current training methods may not be considerate of the nuances of implementation. Speech-language pathologists and researchers should consider the finer aspects of theoretically grounded facilitation techniques as next steps to the broader implementation of this intervention for residents with dementia living in SNFs.

Inferring the effects of saliva on liquid bolus flow using computer simulation.

Computer simulation of liquid bolus flow is used to test the assumption that a slip boundary condition approximates a healthy swallow due to the presence of saliva lubricating the bolus. Six dynamic, 320-row area detector CT (ADCT) sequences of normal subjects swallowing thin, nectar, and honey-thick liquids are used in this work. The aerodigestive tract is segmented from the images in order to create a dynamic 3D geometry, which is subsequently used to drive a Smoothed Particle Hydrodynamics (SPH) fluid simulation of the bolus. The results show that the no-slip simulation, approximating no-lubrication, provides a closer match to the ADCT bolus images than the slip simulation, particularly in the oral phase. This finding suggests that the role of saliva in swallowing liquid boluses is not to lubricate the aerodigestive tract, and that there is another reason for its importance in normal swallowing of liquids.

Swallowing Preparation and Execution: Insights from a Delayed-Response Functional Magnetic Resonance Imaging (fMRI) Study.

The present study sought to elucidate the functional contributions of sub-regions of the swallowing neural network in swallowing preparation and swallowing motor execution. Seven healthy volunteers participated in a delayed-response, go, no-go functional magnetic resonance imaging study involving four semi-randomly ordered activation tasks: (i) "prepare to swallow," (ii) "voluntary saliva swallow," (iii) "do not prepare to swallow," and (iv) "do not swallow." Results indicated that brain activation was significantly greater during swallowing preparation, than during swallowing execution, within the rostral and intermediate anterior cingulate cortex bilaterally, premotor cortex (left > right hemisphere), pericentral cortex (left > right hemisphere), and within several subcortical nuclei including the bilateral thalamus, caudate, and putamen. In contrast, activation within the bilateral insula and the left dorsolateral pericentral cortex was significantly greater in relation to swallowing execution, compared with swallowing preparation. Still other regions, including a more inferior ventrolateral pericentral area, and adjoining Brodmann area 43 bilaterally, and the supplementary motor area, were activated in relation to both swallowing preparation and execution. These findings support the view that the preparation, and subsequent execution, of swallowing are mediated by a cascading pattern of activity within the sub-regions of the bilateral swallowing neural network.

Meta-Analysis of Salivary Flow Rates in Young and Older Adults.

OBJECTIVES: To determine whether salivary flow decreases as a function of aging. DESIGN: Meta-analysis. SETTING: Literature review. PARTICIPANTS: Individuals aged 18 and older reported to be free of major systemic disease. MEASUREMENTS: Relevant studies were identified through a literature search of several databases, from their inception to June 2013. Studies were included if saliva had been collected on at least one occasion in subjects aged 18 and older and if the data were presented in a manner that enabled comparisons of younger and older participants. Differences in salivary flow rates between age groups were calculated for each salivary source and condition and reported as standardized mean differences (SMDs), standard errors (SEs) and 95% confidence intervals (CIs). The results were pooled using a random effects model. A separate analysis examining medication use was also conducted. RESULTS: Forty-seven studies were included. Whole (SMD = 0.551, SE = 0.056, 95% CI = 0.423-0.678, P < .001) and submandibular and sublingual (SMSL) (SMD = 0.582, SE = 0.123, 95% CI = 0.341-0.823, P < .001) salivary flow rates were reduced significantly in older participants and in unstimulated and stimulated conditions. In contrast, parotid and minor gland salivary flow rates were not significantly reduced with increasing age. Additionally, unstimulated and stimulated SMSL, and unstimulated whole salivary flow rates were significantly lower in older adults, regardless of medication usage. CONCLUSION: The aging process is associated with reduced salivary flow in a salivary-gland-specific manner; this reduction in salivary flow cannot be explained on the basis of medications. These findings have important clinical implications for maintaining optimal oral health in older adults.

Occurrences of yawn and swallow are temporally related.

Yawning is a stereotyped motor behavior characterized by deep inhalation and associated dilation of the respiratory tract, pronounced jaw opening, and facial grimacing. The frequency of spontaneous yawning varies over the diurnal cycle, peaking after waking and before sleep. Yawning can also be elicited by seeing or hearing another yawn, or by thinking about yawning, a phenomenon known as "contagious yawning". Yawning is mediated by a distributed network of brainstem and supratentorial brain regions, the components of which are shared with other airway behaviors including respiration, swallowing, and mastication. Nevertheless, the possibility of behavioral coordination between yawning and other brainstem-mediated functions has not been examined. Here we show, with a double-blind methodology, a greater-than-fivefold increase in rest (saliva) swallowing rate during the 10-s period immediately following contagious yawning elicited in 14 adult humans through the viewing of videotaped yawn stimuli. Sixty-five percent of yawns were followed by a swallow within 10 s and swallows accounted for 26 % of all behaviors produced during this post-yawn period. This novel finding of a tight temporal coupling between yawning and swallowing provides preliminary evidence that yawning and swallowing are physiologically related, thus extending current models of upper airway physiology and neurophysiology. Moreover, our finding suggests the possibility that yawning plays a role in eliciting rest swallowing, a view not considered in previous theories of yawning. As such, the present demonstration of a temporal association between yawning and swallowing motivates a re-examination of the longstanding question, "Why do we yawn?".

A systematic review and meta-analysis examining pneumonia-associated mortality in dementia.

BACKGROUND: Although it is generally accepted that deaths associated with pneumonia are more common in patients with dementia, no comprehensive reviews on the subject have previously been published. SUMMARY: Relevant studies were identified through a literature search of the PubMed, EMBASE, Scopus, and ISI Web of Science databases for publications up to August 2013. Studies were included if (1) a group of adult subjects with dementia and a (comparison) group composed of subjects without dementia were included, (2) the cause(s) of death was/were reported, and (3) pneumonia was identified as one of the possible causes of death. The occurrence of death due to pneumonia associated with dementia was expressed as an odds ratio (OR) with 95% confidence interval (CI). Thirteen studies were included. The odds of death resulting from pneumonia were significantly increased for persons with any form of dementia compared with those without dementia (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). In a subgroup analysis, using the results from 8 studies that restricted inclusion to persons with Alzheimer's disease, the odds of death resulting from pneumonia were also significantly higher (OR = 1.70, 95% CI 1.12-2.58, p = 0.013). Key Messages: The odds of pneumonia-associated mortality were increased more than 2-fold for patients with dementia.

Swallowing dysfunction and autonomic nervous system dysfunction in Alzheimer's disease: a scoping review of the evidence.

OBJECTIVES: To describe, synthesize, and interpret literature on swallowing impairment (dysphagia) and autonomic nervous system (ANS) dysfunction in Alzheimer's disease (AD) and to identify gaps in the existing literature. DESIGN: Scoping review of literature covering several study designs. SETTING: Literature review. PARTICIPANTS: Individuals with AD. MEASUREMENTS: Systematic searches of the PubMed, EBSCOhost, PsychINFO, Cochrane, EMBASE, and Scopus databases were conducted. Literature was identified and organized into categories. Studies were then evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria. After evaluation, the literature was synthesized to form conclusions and identify knowledge gaps. RESULTS: Ninety-five articles met the study criteria and were included in the review. Thirty-one studies examining dysphagia in AD provide preliminary evidence on the prevalence, nature, and treatment of dysphagia in AD; knowledge gaps were identified with respect to demographic characteristics, nature of dysphagia, functional significance, assessment, treatment, and underlying mechanisms of dysphagia in AD. Sixty-four studies of ANS dysfunction in AD were reviewed, of which 49 identified at least one variable reflecting ANS dysfunction in AD. Knowledge gaps were identified related to demographics, functional significance, and underlying neural mechanisms. No studies were found that examined both dysphagia and ANS dysfunction in AD. CONCLUSION: Current evidence indicates that swallowing impairment, as well as ANS dysfunction, may occur in AD. Potential relationships between dysphagia and ANS dysfunction in AD have not been examined. Future research should explore the possibility that swallowing and ANS dysfunction in AD are related.