Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study.

OBJECTIVE: To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia. METHODS: A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively. RESULTS: The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis. CONCLUSION: The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.

Effectiveness of Chin Tuck on Laryngeal Penetration: Quantitative Assessment.

The effectiveness of the chin tuck maneuver is still controversial, despite being widely used in clinical practice. The chin tuck maneuver has been shown to be able to reduce or eliminate aspiration in a group of patients with a number of favorable conditions, but its effectiveness in preventing or managing penetration remains unclear. This study was designed to investigate whether the chin tuck maneuver is effective in reducing penetration. Images from a videofluoroscopic swallowing study (VFSS) taken from 76 patients with penetration were collected and reviewed retrospectively. The severity of penetration was assessed by the penetration ratio (ratio of the penetration depth to the length of the epiglottis) measured and calculated from the images in which the deepest penetration was observed. The penetration ratio was significantly decreased in the chin tuck posture compared with the ratio in the neutral position (p = 0.001). Significant reducing effect was observed in 26 (34.2%) out of 76 patients. When comparing other parameters of VFSS, residues in the vallecular and pyriformis sinuses were less severe in the effective group. Chin tuck significantly decreased residues in both effective and ineffective group. The results demonstrate that the chin tuck maneuver can reduce penetration, but its effectiveness is limited.

Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic.

OBJECTIVE: To investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients. METHODS: Sixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments. RESULTS: The initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients. CONCLUSION: Aphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.