title: Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review.
abstract: BACKGROUND
  Dysphagia, or swallowing impairment, is a growing concern in dementia and can lead to malnutrition, dehydration, weight loss, functional decline, and fear of eating and drinking as well as a decrease in quality of life (QOL).
  
  
  OBJECTIVE
  The aim of this article is to do a systematic review of the literature to determine the patterns of swallowing deficits in different types of dementia and to look at the usefulness of different diagnostic and management strategies.
  
  
  METHODS
  An electronic literature search was done using five electronic databases from 1990 to 2011. One thousand and ten records were identified and 19 research articles met the inclusion criteria. These studies were heterogeneous in design and methodology, type of assessment and outcomes, so only descriptive analysis (narrative reporting) was possible.
  
  
  RESULTS
  Prevalence of swallowing difficulties in patients with dementia ranged from 13 to 57%. Dysphagia developed during the late stages of frontotemporal dementia (FTD), but it was seen during the early stage of Alzheimer's dementia (AD). Limited evidence was available on the usefulness of diagnostic tests, effect of postural changes, modification of fluid and diet consistency, behavioral management and the possible use of medications. Use of Percutaneous Endoscopic Gastrostomy (PEG) tubes in advanced dementia, did not show benefit with regards to survival, improvement in QOL, or reduction in aspiration pneumonia. Significant gaps exist regarding the evidence for the evaluation and management of dysphagia in dementia.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. KAlagiakri@aol.com
authors.forename: Kannayiram
authors.initials: K
authors.lastname: Alagiakrishnan
authors.forename: Rahima A
authors.initials: RA
authors.lastname: Bhanji
authors.forename: Mini
authors.initials: M
authors.lastname: Kurian
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000150:complications; D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003704:Dementia / Q000150:complications*; D004750:Enteral Nutrition; D057180:Frontotemporal Dementia / Q000150:complications; D006801:Humans