Evaluation of Dysphagia and Associated Factors in Patients with Neuromuscular Disorders: Do the Oral Factors Deserve Some Focus too?

Abstract

Aim: Dysphagia may occur during neuromuscular disorders. As it may cause serious morbidity and mortality, it is important to define the characteristics and burden of this problem among these individuals. This study aimed to evaluate the dysphagia status and associated factors in patients with neuromuscular disorders in a tertiary care center. Material and Method: Two-hundred fifty-two patients in the three groups were included in this study (59 Duchenne or Becker muscular dystrophies (DMD-BMD), 130 other muscular diseases, and 63 neuropathies). The patients were carefully assessed clinically, and their dysphagia status was evaluated using the EAT-10 questionnaire. Dysphagia prevalence was defined for each diagnosis, and patients in each group were compared in terms of their clinical characteristics, depending on the presence of dysphagia. Results: The prevalence of dysphagia was 17%, 18.4%, and 47.6% in the DMD-BMD, other muscular diseases, and neuropathy groups, respectively. Moreover, dysphagia was associated with worse ambulatory status, poor oral hygiene, dry mouth, dental implants, and pneumonia (p<0.05). Conclusion: Dysphagia is an important problem in neuromuscular diseases and requires inquiry and assessment by caregivers and clinicians. Studies focusing on more detailed evaluations, especially for oral health status, and the effectiveness of possible treatment methods will improve this problem.

Keywords

• Neuromuscular disorders
• dysphagia
• muscular dystrophy
• neuropathy
• oral health

Kaynakça

1. Burns TM, Graham CD, Rose MR, Simmons Z. Quality of life and measures of quality of life in patients with neuromuscular disorders. Muscle Nerve. 2012;46:9-25.
2. Dowling JJ, D. Gonorazky H, Cohn RD, Campbell C. Treating pediatric neuromuscular disorders: the future is now. Am J Med Genet A. 2018;176:804-41.
3. Damian MS, Wijdicks EF. The clinical management of neuromuscular disorders in intensive care. Neuromuscul Disord. 2019;29:85-96.
4. Willig T, Paulus J, Saint JL, et al. Swallowing problems in neuromuscular disorders. Arch Phys Med Rehabil. 1994;75:1175-81.
5. Chaudhry V, Umapathi T, Ravich WJ. Neuromuscular diseases and disorders of the alimentary system. Muscle Nerve. 2002;25:768-84.
6. Toussaint M, Davidson Z, Bouvoie V, et al. Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management. Disabil Rehabil. 2016;38:2052-62.
7. Barbiera F, Condello S, De Palo A, et al. Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients. Radiol Med. 2006;111:818-27.
8. Cheney DM, Siddiqui MT, Litts JK, et al. The ability of the 10-item eating assessment tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol. 2015;124:351-4.

9. Regan J, Lawson S, De Aguiar V. The eating assessment tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia. 2017;32:714-20.
10. Tieleman AA, van Vliet J, Jansen JB, et al. Gastrointestinal involvement is frequent in myotonic dystrophy type 2. Neuromuscul Disord. 2008;18:646-9.
11. Leighton S, Burton M, Lund W, Cochrane G. Swallowing in motor neurone disease. J R Soc Med. 1994;87:801-5.
12. Hanayama K, Liu M, Higuchi Y, et al. Dysphagia in patients with Duchenne muscular dystrophy evaluated with a questionnaire and videofluorography. Disabil Rehabil. 2008;30:517-22.
13. Murono S, Hamaguchi T, Yoshida H, et al. Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis. Auris Nasus Larynx. 2015;42:213-7.
14. Furuta M, Yamashita Y. Oral health and swallowing problems. Curr Phys Med Rehabil Rep. 2013;1:216-22.
15. Al‐Allaq T, DeBord TK, Liu H, et al. Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center. Spec Care Dentist. 2015;35:15-21.
16. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients. Phys Ther. 1986;66:1530-9.
17. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919-24.
18. Demir N, Arslan SS, İnal Ö, Karaduman AA. Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31:644-9.
19. Quade D. Rank analysis of covariance. Journal of the American Statistical Association. 1967;62:1187-200.
20. Jaffe K, McDonald CM, Ingman E, Haas J. Symptoms of upper gastrointestinal dysfunction in Duchenne muscular dystrophy: case-control study. Arch Phys Med Rehabil. 1990;71:742-4.
21. Rönnblom A, Forsberg H, Danielsson Å. Gastrointestinal symptoms in myotonic dystrophy. Scand J Gastroenterol. 1996;31:654-7.
22. Lecointe-Besancon I, Leroy F, Devroede G, et al. A comparative study of esophageal and anorectal motility in myotonic dystrophy. Dig Dis Sci. 1999;44:1090-9.
23. Romero-Gangonells E, Virgili-Casas MN, Dominguez-Rubio R, et al. Evaluation of dysphagia in motor neuron disease. review of available diagnostic tools and new perspectives. Dysphagia. 2021;36:558-73.
24. Hathaway B, Vaezi A, Egloff AM, et al. Frailty measurements and dysphagia in the outpatient setting. Ann Otol Rhinol Laryngol. 2014;123:629-35.
25. Maeda K, Ishida Y, Nonogaki T, et al. Development and predictors of sarcopenic dysphagia during hospitalization of older adults. Nutrients. 2020;12:70.
26. Tanıgör G, Eyigör S. Evaluation of dysphagia in patients with sarcopenia in a rehabilitation setting: Insights from the vicious cycle. Eur Geriatr Med. 2020;11:333-40.
27. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015;30:80-7.
28. Papadopoulou S, Exarchakos G, Beris A, Ploumis A. Dysphagia associated with cervical spine and postural disorders. Dysphagia. 2013;28:469-80.
29. Azzolino D, Damanti S, Bertagnoli L, et al. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res. 2019;31:799-805.
30. Langmore SE, Terpenning MS, Schork A, et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia. 1998;13:69-81.
31. Dray TG, Hillel AD, Miller RM. Dysphagia caused by neurologic deficits. Otolaryngol Clin North Am. 1998;31:507-24.
32. Tieleman A, Knuijt S, Van Vliet J, et al. Dysphagia is present but mild in myotonic dystrophy type 2. Neuromuscul Disord. 2009;19:196-8.
33. Poisson P, Laffond T, Campos S, et al. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology. 2016;33:161-8.
34. Ortega O, Parra C, Zarcero S, et al. Oral health in older patients with oropharyngeal dysphagia. Age and Ageing. 2014;43:132-7.
35. Sørensen RT, Rasmussen RS, Overgaard K, et al. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosci Nurs. 2013;45:139-46.
36. Murray J, Scholten I. An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation. Gerodontology. 2018;35:18-24.
37. Nazlıel H. Oral and dental health in elderly. Turk J Geriatr. 1999;2:14-21.
38. Robbins JA, Levine R, Wood J, et al. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50:M257-62.
39. Chalmers J, King P, Spencer A, et al. The oral health assessment tool—validity and reliability. Aust Dent J. 2005;50:191-9.