Randomized Controlled Trial of Lingual Strengthening and Saliva Substitute Interventions for Dysphagia in Dementia

Background

• Dysphagia (swallowing dysfunction) is common in Alzheimer's Disease and Related Dementias (ADRD), increasing risks of aspiration pneumonia, malnutrition, and mortality.
• Traditional management relies on compensatory strategies, which have limited impact on clinical outcomes.
• The study targeted two modifiable factors: lingual strength and oral lubrication.

Study Aims

• Assess the feasibility of rehabilitative swallowing interventions in early-stage ADRD.
• Evaluate the impact of lingual strengthening and saliva substitute interventions on swallowing-related outcomes.

Methods

• Participants: Individuals with mild-moderate dementia and dysphagia.
• Randomized into four groups:
  1. Usual Care (UC): Compensatory recommendations only
  2. Lingual Strengthening (LS): Tongue press exercises, 3 days/week for 8 weeks
  3. Saliva Substitute (SS): Biotene application, 3x daily for 8 weeks
  4. Combination (LS + SS): Both interventions concurrently
• Comprehensive swallowing assessments, including videofluoroscopic swallow study (VFSS), at baseline and after 8 weeks.

Key Results

• Feasibility: Rehabilitative interventions were feasible for patients with early-stage ADRD.
• Lingual Strengthening:
  • Significant improvement in lingual pressure generation (p < .0001).
  • Reduction in pharyngeal residue for certain bolus types (p < .02).
• Saliva Substitute:
  • Significant increase in salivary flow rate (p < .05).
  • Reduction in pharyngeal residue for certain bolus types (p < .04).
• Usual Care:
  • Decline in salivary flow and lingual pressure compared to intervention groups.
• Combination Group:
  • Showed improvements similar to individual interventions.
• Secondary Outcomes:
  • Improvements in swallowing physiology and safety were observed, but changes in pharyngeal residue were mixed and dependent on bolus type.

Conclusions and Implications

• Rehabilitative interventions (lingual strengthening and saliva substitute) are practical and beneficial for early-stage ADRD patients with dysphagia.
• Lingual strengthening improves tongue strength; saliva substitute increases oral lubrication.
• Some swallowing outcomes improved relative to usual care, suggesting potential for better clinical management.
• Larger studies are needed to confirm findings and clarify long-term benefits.
• Future research will explore quality of life, care partner burden, and more detailed swallowing measures.

Example Implementation

• Incorporate lingual strengthening exercises and saliva substitutes into early-stage dementia care plans for dysphagia management.
• Monitor swallowing outcomes using objective assessments (e.g., VFSS) to track intervention effectiveness.