Abstract
Dysphagia is becoming increasingly more common in aging societies and, like the classical geriatric syndromes, it is a relevant functional impairment. The prevalence of dysphagia is highest in the group of old patients with neurological disorders, particularly in patients with stroke, dementia and Parkinson’s disease. In the various neurological diseases of older people disease-specific factors often have a decisive influence on the clinical management of dysphagia. In addition, the concept of primary and secondary presbyphagia plays an important role in understanding age-related dysphagia. Whereas at the organ level of the International Classification of Functioning, Disability and Health (ICF) model, the diagnosis and treatment of dysphagia in neurogeriatrics have already made progress, more research is needed on the levels of activity/mobility, social environment, personal factors and the environment. This article summarizes the pathophysiological aspects as well as the current evidence for diagnosis and treatment of neurogeriatric dysphagia. Due to its high clinical relevance dysphagia should be added to the geriatric syndromes as “impaired swallowing”.
Zusammenfassung
Schluckstörungen (Dysphagien) werden in alternden Gesellschaften zunehmend häufiger und stellen wie die klassischen geriatrischen Syndrome eine relevante funktionelle Beeinträchtigung dar. Am höchsten ist die Prävalenz von Dysphagien in der Gruppe alter Patienten mit neurologischen Erkrankungen, insbesondere im Rahmen eines Schlaganfalls, einer Demenz oder eines Morbus Parkinson. Bei den verschiedenen neurologischen Erkrankungen des älteren Menschen haben krankheitsspezifische Faktoren oft einen entscheidenden Einfluss auf das klinische Management von Dysphagien. Darüber hinaus kommt dem Konzept der primären und sekundären Presbyphagie eine wichtige Rolle für das Verständnis altersassoziierter Schluckstörungen zu. Während auf der Organebene des ICF-Modells die Diagnostik und Therapie von Schluckstörungen in der Neurogeriatrie bereits Fortschritte erzielt hat, gibt es auf den Ebenen Aktivität/Mobilität, soziales Umfeld, persönliche Faktoren und Umwelt noch weitreichenden Forschungsbedarf. Dieser Artikel fasst die pathophysiologischen Grundlagen sowie die derzeitige Evidenz für Diagnostik und Therapie neurogeriatrischer Dysphagien zusammen und kommt zu dem Ergebnis, dass Schluckstörungen aufgrund ihrer klinischen Relevanz den geriatrischen „I’s“ als „impaired swallowing“ hinzugefügt werden sollten.
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T. Warnecke, R. Dziewas, R. Wirth, J.M. Bauer and T. Prell declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.
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Warnecke, T., Dziewas, R., Wirth, R. et al. Dysphagia from a neurogeriatric point of view. Z Gerontol Geriat 52, 330–335 (2019). https://doi.org/10.1007/s00391-019-01563-x
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DOI: https://doi.org/10.1007/s00391-019-01563-x