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Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives

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Abstract

Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing‐related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of “sarcopenic dysphagia” and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly.

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References

  1. Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9. https://doi.org/10.1177/0194599814549156.

    Article  PubMed  Google Scholar 

  2. Barczi SR, Sullivan PA, Robbins JA. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang. 2000;21(4):347–61. https://doi.org/10.1055/s-2000-8387.

    Article  CAS  PubMed  Google Scholar 

  3. Lee A, Sitoh YY, Lieu PK, Phua SY, Chin JJ. Swallowing impairment and feeding dependency in the hospitalised elderly. Ann Acad Med Singapore. 1999;28(3):371–376. https://pubmed-ncbi-nlm-nih-gov.beilinson-ez.medlcp.tau.ac.il/10575521/. Accessed 25 Feb 2021.

  4. Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia. 1997;12(1):43–51. https://doi.org/10.1007/PL00009517.

    Article  CAS  PubMed  Google Scholar 

  5. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. https://doi.org/10.1093/ageing/afy169.

    Article  PubMed  Google Scholar 

  6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: european consensus on definition and diagnosis. Age Ageing. 2010;39(4):412–23. https://doi.org/10.1093/ageing/afq034.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Baijens LWJ, Clavé P, Cras P, et al. European society for swallowing disorders - European union geriatric medicine society white paper: Oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11(1):1403–28. https://doi.org/10.2147/CIA.S107750.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujishima I, Fujiu-Kurachi M, Arai H, et al. Sarcopenia and dysphagia: position paper by four professional organizations. Geriatr Gerontol Int. 2019;19(2):91–7. https://doi.org/10.1111/ggi.13591.

    Article  PubMed  Google Scholar 

  9. Cruz-Jentoft AJ, Landi F, Topinková E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010;13(1):1–7. https://doi.org/10.1097/MCO.0b013e328333c1c1.

    Article  PubMed  Google Scholar 

  10. Abu-Ghanem S, Chen S, Amin MR. Oropharyngeal dysphagia in the elderly: evaluation and prevalence. Curr Otorhinolaryngol Rep. 2020;8(1):34–42. https://doi.org/10.1007/s40136-020-00258-x.

    Article  Google Scholar 

  11. Wakabayashi H. Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J frailty aging. 2014;3(2):97–103. https://doi.org/10.14283/jfa.2014.8.

    Article  CAS  PubMed  Google Scholar 

  12. Wakabayashi H, Takahashi R, Murakami T. The prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation. J Nutr Health Aging. 2019;23(1):84–8. https://doi.org/10.1007/s12603-018-1117-2.

    Article  CAS  PubMed  Google Scholar 

  13. Cha S, Kim WS, Kim KW, et al. Sarcopenia is an independent risk factor for dysphagia in community-dwelling older adults. Dysphagia. 2019;34(5):692–7. https://doi.org/10.1007/s00455-018-09973-6.

    Article  PubMed  Google Scholar 

  14. Maeda K, Akagi J. Treatment of sarcopenic dysphagia with rehabilitation and nutritional support: a comprehensive approach. J Acad Nutr Diet. 2016;116(4):573–7. https://doi.org/10.1016/j.jand.2015.09.019.

    Article  PubMed  Google Scholar 

  15. Wakabayashi H, Uwano R. Rehabilitation nutrition for possible sarcopenic dysphagia after lung cancer surgery: a case report. Am J Phys Med Rehabil. 2016;95(6):e84–9. https://doi.org/10.1097/PHM.0000000000000458.

    Article  PubMed  Google Scholar 

  16. Hashida N, Shamoto H, Maeda K, Wakabayashi H, Suzuki M, Fujii T. Rehabilitation and nutritional support for sarcopenic dysphagia and tongue atrophy after glossectomy: a case report. Nutrition. 2017;35:128–31. https://doi.org/10.1016/j.nut.2016.11.003.

    Article  PubMed  Google Scholar 

  17. Yoshimura Y, Wakabayashi H, Nagano F, Bise T, Shimazu S, Shiraishi A. Chair-stand exercise improves post-stroke dysphagia. Geriatr Gerontol Int. 2020;20(10):885–91. https://doi.org/10.1111/ggi.13998.

    Article  PubMed  Google Scholar 

  18. Mori T, Fujishima I, Wakabayashi H, et al. Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia. JCSM Clin Rep. 2017;2(2):1–10. https://doi.org/10.17987/jcsm-cr.v2i2.17.

    Article  Google Scholar 

  19. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101. https://doi.org/10.1016/j.jamda.2013.11.025.

    Article  PubMed  Google Scholar 

  20. Kunieda K, Fujishima I, Wakabayashi H, et al. Relationship between tongue pressure and pharyngeal function assessed using high-resolution manometry in older dysphagia patients with sarcopenia: a pilot study. Dysphagia. 2020;36(1):33–40. https://doi.org/10.1007/s00455-020-10095-1.

    Article  PubMed  Google Scholar 

  21. Miyashita T, Kikutani T, Nagashima K, Igarashi K, Tamura F. The effects of sarcopenic dysphagia on the dynamics of swallowing organs observed on videofluoroscopic swallowing studies. J Oral Rehabil. 2020;47(5):584–90. https://doi.org/10.1111/joor.12936.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Nagano A, Maeda K, Shimizu A, et al. Association of sarcopenic dysphagia with underlying sarcopenia following hip fracture surgery in older women. Nutrients. 2020. https://doi.org/10.3390/nu12051365.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ogawa N, Mori T, Fujishima I, et al. Ultrasonography to measure swallowing muscle mass and quality in older patients with sarcopenic dysphagia. J Am Med Dir Assoc. 2018;19(6):516–22. https://doi.org/10.1016/j.jamda.2017.11.007.

    Article  PubMed  Google Scholar 

  24. Wakabayashi H, Matsushima M, Momosaki R, et al. The effects of resistance training of swallowing muscles on dysphagia in older people: A cluster, randomized, controlled trial. Nutrition. 2018;48:111–6. https://doi.org/10.1016/j.nut.2017.11.009.

    Article  PubMed  Google Scholar 

  25. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5):990S-991S.

    Article  CAS  Google Scholar 

  26. Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059–64. https://doi.org/10.1093/gerona/61.10.1059.

    Article  PubMed  Google Scholar 

  27. Hathaway B, Baumann B, Byers S, Wasserman-Wincko T, Badhwar V, Johnson J. Handgrip strength and dysphagia assessment following cardiac surgery. Laryngoscope. 2015;125(10):2330–2. https://doi.org/10.1002/lary.25175.

    Article  PubMed  Google Scholar 

  28. Kunieda K, Ohno T, Fujishima I, Hojo K, Morita T. Reliability and validity of a tool to measure the severity of dysphagia: the food intake LEVEL scale. J Pain Symptom Manage. 2013;46(2):201–6. https://doi.org/10.1016/j.jpainsymman.2012.07.020.

    Article  PubMed  Google Scholar 

  29. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2014;30(1):80–7. https://doi.org/10.1007/s00455-014-9577-y.

    Article  PubMed  Google Scholar 

  30. Tamura F, Kikutani T, Tohara T, Yoshida M, Yaegaki K. Tongue thickness relates to nutritional status in the elderly. Dysphagia. 2012;27(4):556–61. https://doi.org/10.1007/s00455-012-9407-z.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Butler SG, Stuart A, Leng X, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66A(4):452–8. https://doi.org/10.1093/gerona/glq234.

    Article  PubMed Central  Google Scholar 

  32. Fukuoka T, Ono T, Hori K, et al. Tongue pressure measurement and videofluoroscopic study of swallowing in patients with parkinson’s disease. Dysphagia. 2019;34(1):80–8. https://doi.org/10.1007/s00455-018-9916-5.

    Article  PubMed  Google Scholar 

  33. Chen YC, Chen PY, Wang YC, Wang TG, Han DS. Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study. BMC Geriatr. 2020;20(1):1–6. https://doi.org/10.1186/s12877-020-01832-0.

    Article  CAS  Google Scholar 

  34. Kurosawa Y, Hara K, Tohara H, et al. Calf circumference is a useful index for assessing dysphagia among community dwelling elderly recipients of long-term care. Tohoku J Exp Med. 2019;248(3):201–8. https://doi.org/10.1620/tjem.248.201.

    Article  PubMed  Google Scholar 

  35. Maeda K, Koga T, Nasu T, Takaki M, Akagi J. Predictive accuracy of calf circumference measurements to detect decreased skeletal muscle mass and European Society for Clinical Nutrition and Metabolism-defined malnutrition in hospitalized older patients. Ann Nutr Metab. 2017;71:10–5. https://doi.org/10.1159/000478707.

    Article  CAS  PubMed  Google Scholar 

  36. Sakai K, Nakayama E, Rogus-Pulia N, et al. Submental muscle activity and its role in diagnosing sarcopenic dysphagia. Clin Interv Aging. 2020;15:1991–9. https://doi.org/10.2147/CIA.S278793.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Maeda K, Takaki M, Akagi J. Decreased skeletal muscle mass and risk factors of sarcopenic dysphagia: a prospective observational cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(9):1290–4. https://doi.org/10.1093/gerona/glw190.

    Article  PubMed  Google Scholar 

  38. Miyauchi N, Nakamura M, Nakamura I, Momosaki R. Effect of early versus delayed mobilization by physical therapists on oral intake in patients with sarcopenic dysphagia after pneumonia. Eur Geriatr Med. 2019;10(4):603–7. https://doi.org/10.1007/s41999-019-00169-1.

    Article  PubMed  Google Scholar 

  39. Sakai K, Nakayama E, Tohara H, et al. Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: a cross-sectional observational study. Clin Nutr. 2018;38(1):303–9. https://doi.org/10.1016/j.clnu.2018.01.016.

    Article  PubMed  Google Scholar 

  40. Maeda K, Ishida Y, Nonogaki T, et al. Development and predictors of sarcopenic dysphagia during hospitalization of older adults. Nutrients. 2020. https://doi.org/10.3390/nu12010070.

    Article  PubMed  PubMed Central  Google Scholar 

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Abu-Ghanem, S., Graf, A. & Govind, J. Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives. Dysphagia 37, 1093–1102 (2022). https://doi.org/10.1007/s00455-021-10371-8

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