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Review
. 2023 Dec 27;13(1):156.
doi: 10.3390/jcm13010156.

Management and Treatment for Dysphagia in Neurodegenerative Disorders

Rumi Ueha  1   2 , Carmel Cotaoco  2   3 , Kenji Kondo  2 , Tatsuya Yamasoba  2   4
Affiliations
Review

Management and Treatment for Dysphagia in Neurodegenerative Disorders

Rumi Ueha et al. J Clin Med. .

Abstract

Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.

Keywords: Alzheimer’s disease; Parkinson’s disease; amyotrophic lateral sclerosis; dysphagia; multiple system atrophy; neurodegenerative disorders; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart for evaluating the underlying cause of dysphagia based on the presence of consciousness disorders.
Figure 2
Figure 2
Flowchart for differentiating the etiology of dysphagia according to whether the onset is acute or slow-progressive.
Figure 3
Figure 3
Swallowing improvement surgeries address specific sites in the swallowing mechanism.
Figure 4
Figure 4
Aspiration prevention surgeries: (A) normal; (B) total laryngectomy; (C) central-part laryngectomy; (D) tracheoesophageal diversion; (E) laryngotracheal separation; (F) supraglottic laryngeal closure; (G) glottic laryngeal closure; and (H) subglottic laryngeal closure. (This figure has been modified from reference [50]).
Figure 5
Figure 5
Procedures to facilitate oral intake after aspiration prevention surgery. UES, upper esophageal sphincter; CP, cricopharyngeal myotomy.
See this image and copyright information in PMC

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