Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(01): 08-14
DOI: 10.1590/0004-282X20200060
ARTICLE

Swallowing in behavioral variant frontotemporal dementia

Deglutição na variante comportamental da demência frontotemporal
Sheilla de Medeiros Correia MARIN 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
2   Universidade de São Paulo, Departamento de Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
,
Letícia Lessa MANSUR 
2   Universidade de São Paulo, Departamento de Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
,
Fabricio Ferreira de OLIVEIRA 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Luis Fabiano MARIN 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
José Roberto WAJMAN 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Valéria Santoro BAHIA 
3   Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
,
Paulo Henrique Ferreira BERTOLUCCI 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Background: Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. Objective: To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. Methods: Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: “Mini-Mental State Examination”, “Severe Mini-Mental State Examination”, “FTLD-modified Clinical Dementia Rating”, “Neuropsychiatric Inventory”, “Frontal Assessment Battery”, “Index of Independence in Activities of Daily Living”, “Swallowing Rating Scale” and “Assessment of Feeding and Swallowing Difficulties in Dementia”. Results: Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage. Conclusion: Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.

RESUMO

Introdução: Os problemas na situação de alimentação e deglutição podem ocorrer com a progressão da variante comportamental da demência frontotemporal (DFT-vc) e alterar as fases antecipatória e preparatória oral da deglutição. Objetivo: Caracterizar os problemas de deglutição e a situação de alimentação de pacientes com DFT-vc e correlacionar os problemas de deglutição com a funcionalidade, funções executivas, aspectos cognitivos e comportamentais. Métodos: Foram recrutados pacientes ambulatoriais com DFT-vc nas fases leve, moderada e grave da demência, e seus respectivos cuidadores. Os pacientes e cuidadores foram avaliados com as escalas: “Mini-Exame do Estado Mental”, “Mini-Exame do Estado Mental Grave”, “Escala de Avaliação Clínica da Demência Modificada - DFT”, “Inventário Neuropsiquiátrico”, “Bateria de Avaliação Frontal”, “Índice de Independência nas Atividades da Vida Diária”, “Escala Funcional de Avaliação da Deglutição” e “Avaliação das Dificuldades de Alimentação e Deglutição na Demência”. Resultados: Foram incluídos 30 pacientes com DFT-vc, e seus cuidadores. Pacientes com DFT-vc apresentaram dificuldades de alimentação e deglutição como: confusão na alimentação, passividade, tosse e asfixia, dificuldades com algumas consistências alimentares e alimentos específicos. Problemas de deglutição na DFT-vc correlacionaram-se com funcionalidade prejudicada (p<0,05) e cognição (p<0,05), disfunção executiva (p<0,01) e características comportamentais (p<0,01). Os cuidadores tiveram grande dificuldade em gerenciar a situação de alimentação diante de diferentes problemas em cada fase da demência. Conclusão: Pacientes com DFT-vc apresentaram velocidade de alimentação inapropriada, passividade, tosse e engasgos já na fase leve da doença, com piora na fase grave. As correlações indicaram que as alterações de deglutição tendem a seguir o declínio cognitivo e comportamental na DFT-vc.

Keywords:

Frontotemporal Dementia - Deglutition Disorders - Feeding Behavior - International Classification of Functioning, Disability and Health - Cognition Disorders

Palavras-chave:

Demência Frontotemporal - Transtornos da Deglutição - Comportamento Alimentar - Classificação Internacional de Funcionalidade, Incapacidade e Saúde - Transtornos Cognitivos

Authors’ contributions:

Marin SMC: study conception; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical revision. Mansur LL: study conception and design; analysis and interpretation; drafting of manuscript; critical revision. Oliveira FF: drafting of manuscript; critical revision. Marin LF: drafting of manuscript; critical revision. Wajman JR: drafting of manuscript; critical revision. Bahia VS: drafting of manuscript; critical revision. Bertolucci PHF: study conception and design; analysis and interpretation of data; drafting of manuscript; critical revision.




Publication History

Received: 17 February 2020

Accepted: 31 May 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Leopold NA, Kagel MC. Dysphagia--ingestion or deglutition?: a proposed paradigm. Dysphagia. 1997 Aug;12(4):202-6. https://doi.org/10.1007/pl00009537
  • 2 Correia Sde M, Morillo LS, Jacob Filho W, Mansur LL. Swallowing in moderate and severe phases of Alzheimer’s disease. Arq Neuropsiquiatr. 2010 Dec;68(6):855-61. https://doi.org/10.1590/s0004-282x2010000600005
  • 3 Marin Sde M, Bertolucci PH, Marin LF, de Oliveira FF, Wajman JR, Bahia VS, et al. Swallowing in primary progressive aphasia. NeuroRehabilitation. 2016 Feb;38(1):85-92. https://doi.org/10.3233/nre-151299
  • 4 Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011 Sep;134(Pt 9):2456-77. https://doi.org/10.1093/brain/awr179
  • 5 Cerami C, Scarpini E, Cappa SF, Galimberti D. Frontotemporal lobar degeneration: current knowledge and future challenges. J Neurol. 2012 Nov;259(11):2278-86. https://doi.org/10.1007/s00415-012-6507-5
  • 6 Pressman PS, Miller BL. Diagnosis and management of behavioral variant frontotemporal dementia. Biol Psychiatry. 2014 Apr;75(7):574-81. https://doi.org/10.1016/j.biopsych.2013.11.006
  • 7 Nyatsanza S, Shetty T, Gregory C, Lough S, Dawson K, Hodges JR. A study of stereotypic behaviours in Alzheimer’s disease and frontal and temporal variant frontotemporal dementia. J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1398-402. https://doi.org/10.1136/jnnp.74.10.1398
  • 8 Ikeda M, Brown J, Holland AJ, Fukuhara R, Hodges JR. Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2002 Oct;73(4):371-6. https://doi.org/10.1136/jnnp.73.4.371
  • 9 Ahmed RM, Irish M, Kam J, van Keizerswaard J, Bartley L, Samaras K, et al. Quantifying the eating abnormalities in frontotemporal dementia. JAMA Neurol. 2014 Dec;71(12):1540-6. https://doi.org/10.1001/jamaneurol.2014.1931
  • 10 Langmore SE, Olney RK, Lomen-Hoerth C, Miller BL. Dysphagia in Patients With Frontotemporal Lobar Dementia. Arch Neurol. 2007 Jan;64(1):58-62. https://doi.org/10.1001/archneur.64.1.58
  • 11 Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994 Mar;52(1):1-7. https://doi.org/10.1590/S0004-282X1994000100001
  • 12 Wajman JR, Oliveira FF, Schultz RR, Marin Sde M, Bertolucci PH. Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination. Arq Neuropsiquiatr. 2014 Apr;72(4):273-7. https://doi.org/10.1590/0004-282x20140002
  • 13 Gerrard P. The hierarchy of the activities of daily living in the Katz index in residents of skilled nursing facilities. J Geriatr Phys Ther. 2013 Apr-Jun;36(2):87-91. https://doi.org/10.1519/jpt.0b013e318268da23
  • 14 Beato R, Amaral-Carvalho V, Guimarães HC, Tumas V, Souza CP, Oliveira GN, et al. Frontal assessment battery in a Brazilian sample of healthy controls: normative data. Arq Neuropsiquiatr. 2012 Apr;70(4):278-80. https://doi.org/10.1590/s0004-282x2012005000009
  • 15 Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994 Dec;44(12):2308-14. https://doi.org/10.1212/wnl.44.12.2308
  • 16 Borroni B, Agosti C, Premi E, Cerini C, Cosseddu M, Paghera B, et al. The FTLD-modified Clinical Dementia Rating scale is a reliable tool for defining disease severity in Frontotemporal Lobar Degeneration: evidence from a brain SPECT study. Eur J Neurol. 2010 May;17(5):703-7. https://doi.org/10.1111/j.1468-1331.2009.02911.x
  • 17 Kindell J. Assessment and management of feeding and swallowing. In: Kindell J, editor. Feeding and swallowing disorders in dementia. Bicester (Oxon): Speechmarck; 2002. p. 25-76.
  • 18 American Speech-Language-Hearing Association. Clinical Indicators for Instrumental Assessment of Dysphagia. ASHA Supplement. 2000;20:18-9. https://doi.org/10.1044/policy.gl2000-00047
  • 19 Snowden JS, Bathgate D, Varma A, Blackshaw A, Gibbons ZC, Neary D. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. J Neurol Neurosurg Psychiatry . 2001 Mar;70(3):323-32. https://doi.org/10.1136/jnnp.70.3.323
  • 20 Liu W, Miller BL, Kramer JH, Rankin K, Wyss-Coray C, Gearhart R, et al. Behavioral disorders in the frontal and temporal variants of frontotemporal dementia. Neurology. 2004 Mar;62(5):742-8. https://doi.org/10.1212/01.wnl.0000113729.77161.c9
  • 21 Volicer L, Bass EA, Luther SL. Agitation and resistiveness to care are two separate behavioral syndromes of dementia. J Am Med Dir Assoc. 2007 Oct;8(8):527-32. https://doi.org/10.1016/j.jamda.2007.05.005