Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults
Bendix Labeit, Paul Muhle, Jonas von Itter, Janna Slavik, Andreas Wollbrink, Peter B. Sporns, Thilo Rusche, Tobias Ruck, Anna Hüsing‐Kabar, Reinhold Gellner, Joachim Groß, Rainer Wirth, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup‐Krueger
Abstract
Background: "Presbyphagia" refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods: 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results: 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions: or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.