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A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease.

2008 Feb

Journal Article

Logemann, J.A.; Gensler, G.; Robbins, J.A.; Lindblad, A.S.; Brandt, D.; Hind, J.A.; Kosek, S.; Dikeman, K.; Kazandjian, M.; Gramigna, G.D.; Lundy, D.; McGarvey-Toler, S.; Gardner, P.J.Miller

J Speech Lang Hear Res






Aged; Aged, 80 and over; deglutition; Deglutition Disorders; dementia; Female; Fluoroscopy; Humans; Male; Middle Aged; Multivariate Analysis; Parkinson Disease; Pneumonia, Aspiration; Posture; Solutions

PURPOSE: This study was designed to identify which of 3 treatments for aspiration on thin liquids-chin-down posture, nectar-thickened liquids, or honey-thickened liquids-results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease.METHOD: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study.RESULTS: Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids.CONCLUSION: To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson's disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient's management plan. The longer-term impact of short-term prevention of aspiration requires further study.

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