Associations of cognitive function with feeding performance and swallowing function in elderly with dementia

Abstract

Introduction: Feeding difficulty and dysphagia are common problems in elderly patients with dementia. Malnutrition and aspiration pneumonia may result from feeding problem and swallowing dysfunction. There were limited previous reports on the course of cognitive functional decline and the relationship among cognitive function, feeding performance and swallowing function in dementia patients.

Objectives: The objectives of the present study were to investigate the association between cognitive function and feeding performance in elderly with dementia, and to investigate the association between cognitive function and severity of dysphagia in elderly with dementia.

Method: In this cross-sectional study, we recruited 215 Chinese participants from hospital clinics and old aged homes from March 2014 to July 2014. The participants were over 65-year-old, with diagnosis of dementia and without history of other neurological diseases. Sociodemographic information of the participant was interviewed. Medical records were reviewed for the diagnoses of dementia and associated medical conditions. The Abbreviated Mental Test (AMT) was adopted to assess participants’ cognitive function. The feeding performance was evaluated by the Chinese version of Edinburgh Feeding Evaluation in Dementia (EdFED) Scale. The swallowing function was assessed by the Gugging Swallowing Screen (GUSS) test and Therapy Outcome Measure (TOM) impairment scale.

Results: Significant negative correlation was demonstrated between AMT score with EdFED score (rho= -0.571, p<0.001). After adjustment of confounders, AMT score was an independent predictor of EdFED score (p=0.034), with age (p=0.016) and functional status (p=0.001) being two additional independent factors.

The AMT score manifested significant associations with the measures of severity of dysphagia from the bivariate analysis of results from GUSS (p<0.001) and TOM (p<0.001). After adjustment of confounders, the AMT score was not a significant independent predictor when the swallowing function was assessed by GUSS, but it was an independent predictor when the former was assessed by TOM (p=0.004). Age, functional status, male gender, living in old aged homes, caregivers being children/family members and maids were also independent factors of dysphagia. Conclusion: In this pilot study, we found the cognitive function of elderly with dementia was related to feeding performances. Those with the poorest cognitive function had the worst feeding performance. We also found poor cognitive function was related to poor swallowing function in elderly with dementia. Furthermore, age and functional status were also predictors of feeding performance in dementia. Future prospective studies are recommended to examine the effects of other possible confounding factors including co-morbid neurological diseases, medications and behavioral symptoms, on the association between cognitive function and feeding performance and swallowing function. Early assessment, education and intervention on feeding problem and dysphagia to elderly with dementia and their caregivers are recommended in daily clinical practice.