>> Michelle Tristani: Welcome to our training on Deciphering Oral Stasis: Managing the challenging combination of dementia and dysphagia – Part I. This first part will cover more on evaluation and our Part Two will cover more on what we can do for patients with the combination of dementia and dysphagia.
The disclosure for today is just for your information and an ASHA CEU requirement. I was paid an honorarium by SpeechPathology.com for this event.
Overview
We will include a brief introduction, a statement on cognitive hierarchy and cognitive skills, and the differential diagnosis between cognitive disorders of delirium, dementia, and depression. Then we will get into the prevalence of dysphagia in Alzheimer's disease. After that, we will cover dysphagia symptoms by stage of dementia (early, middle, and advanced dementia), and then we will discuss what we can do in our clinical exam and how to evaluate oral apraxia, acceptance, and oral preparatory and oral phases. We will cover some environmental factors that should be evaluated during meal time and we will also cover some research, conclusions, and then segue into Part Two.
Scope of Cognition
I am always humbled when I remind myself that if we are confused about those who are confused, we are not alone. The broad array of cognitive disorders and the number of patients that present with dementia as a comorbidity is huge. Cognition has a far-reaching impact; it is a clinical area with an opportunity to affect the majority of our patients. There are very few patients that are referred to us that I find are intact from a cognitive perspective. What we find is that patients with cognitive disorders, particularly dementia, who also experience pain, falls, positioning issues, wound care, dysphagia, and incontinence, are at a further disadvantage if they are cognitively impaired or have a diagnosis of dementia. Cognition problems combined with the other comorbidities listed above really put the patient, their family, and caregivers in a situation where they are more challenged, and we are more challenged because it is more difficult to figure out what is effective. On a positive note, if we make headway and make some improvements with patients with cognitive disorders and dysphagia, we are able to make a huge difference. Even though it is harder and more challenging when cognition is impaired and dementia is a diagnosis, if we do have success with some of the strategies that we are going to discuss today and later in Part Two, we will definitely make a difference with a good percentage of our patients with this combination of disorders.
