Why do people with dementia have trouble swallowing food?

Anyone who has a family member or acquaintance with Alzheimer’s disease will have faced this reality. People with dementia have problems swallowing food and also drinking. The truth is that it is as devastating as it is striking that there comes a time when they are not even able to chew and swallow.

Is it because their character changes? Is it perhaps because they lose the desire to eat? Absolutely. This phenomenon is called dysphagia and has a cerebral origin.

Dysphagia as a symptom of dementia

Dysphagia (or swallowing problems) occurs because the neurological mechanisms that regulate the movement of these basic areas during feeding are damaged. Another fact is added to this: The act of eating also requires carrying out cognitive tasks.

Cutting food, thinking about when to put a spoon or fork in our mouth, or even deciding when to start chewing or stop are highly complex cognitive processes. For us, acts are completely automated. However, it is enough to look closely at neurodegenerative diseases to become aware of many things.

This is not a problem that occurs in isolated situations, but rather affects a large percentage of patients with neurological diseases. In fact, it is estimated that Up to 84% of people with dementia will have dysphagia. However, the problem is not always detected in time.

Early detection is essential to avoid the risks associated with this difficulty swallowing associated with dementia:

Dehydration or malnutrition, because the person cannot ingest all the nutrients or amounts of food they need. And dysphagia makes it difficult for the patient to eat an adequate diet.Pneumonia due to aspiration of solids and liquids. It occurs when food accidentally sneaks into the trachea and reaches the lungs.

People with dementia have problems swallowing food: why is this?

Refusing to eat, closing your mouth or expelling everything that is put on a spoon. It is very common that, upon reaching the most advanced stages of Alzheimer’s disease, very complex phenomena appear during feeding. This is when the family comes into contact with the neurological condition of dysphagia for the first time.

Now, it is very possible that more than one person will say to themselves that “Well, I also choke during meals when drinking or eating something specific!». It’s true, it has happened to all of us at some point. These uncomfortable experiences are due to the fact that, although it may not seem like it, Eating and drinking are complex functions carried out by the brain and many of them require conscious control.

Early feeding problems in people with dementia

In the early stages, it is common to come into contact with very specific phenomena of dementia. We know how to recognize forgetfulness, spatial disorientation and also that progressive loss of expressing oneself and understanding language. However, to Sometimes, we go unnoticed some processes associated with food. They are the following:

When faced with the sensation of hunger or thirst, the person can react emotionally and not behaviorally. That is, instead of eating or drinking, they let themselves be carried away by a bad mood or irritability. Many lose fine motor skills and, in general, manual dexterity. This translates into problems cooking for themselves and also cutting food for themselves. They often put pieces that are too large in their mouths, which increases the risk of choking.Likewise, in the intermediate phases of Alzheimer’s dementia, swallowing problems already appear. Even if the person tries, sometimes they can’t. The automatic part of swallowing water or food is limited.Other times, the person is unable to form the bolus by not chewing.. That is, he remains with the portion of food in his mouth without doing anything.

People with dementia have trouble swallowing food because of dysphagia

According to a study, people with dementia have problems swallowing food in the early stages. While is true that Dysphagia as such appears in advanced stages of Alzheimer’s, swallowing problems appear earlier.

Likewise, it is important to note that these problems also arise in older adults. Nevertheless, When it comes to neurodegenerative diseases, we know that cortical and biomechanical changes arise.

There are neural networks that stop working, which results in swallowing difficulties and alterations in executive functions. Those through which the person decides when to swallow, when to chew, etc.

What happens when a patient with dementia has trouble swallowing

The person chokes because the throat becomes blocked and air cannot circulate properly. The uncontrollable cough that often accompanies swallowing problem, indicates that food has gone into the trachea instead of the esophagus. Some precautionary measures that can be taken to reduce this number of incidents are:

The patient should be sitting upright when fed. The person should be fed slowly and carefully, making sure their mouth is empty after giving each spoonful of food and drink. A special cup can be used to dysphagia, a cadet spoon and pisteros with different nozzles. It is necessary to give them small amounts of food. You have to take care of the texture of the food and the temperature. You have to observe what they like best. The ability to taste is lost, so sometimes food must be tastier. The patient must be given food in a quiet environment, in which he feels comfortable. Minimizing phlegm is very important, given that these people They can choke on their own fluids.

The caregiver must be attentive to the patient’s non-verbal language, since during choking the person is no longer able to speak or communicate.

MDTP therapy (McNeill Dysphagia Therapy Program)

MDTP is a therapy that works on the passage of food from the mouth to the stomach (swallowing).. It seeks to enable the person to better coordinate and control this process in the context of their daily eating activities.

Unlike other therapies, MDTP is not based on repeating a technique over and over again, but rather, after analyzing the patient’s situation and case, it focuses on develop and enhance physiological capacities that are still intact to improve strength, speed and coordination during food consumption.

This therapy uses hard swallow exercise and a specific hierarchy of nutrition with tasks that challenge the patient’s swallowing system. The program provides detailed guidelines to the therapist to advance, maintain or regress a patient based on her performance.

As the therapy progresses, demands increase through a progressive increase in resistance, speed, time and specificity of movement when swallowing food.

What should I do if my family member has swallowing problems?

We know that people with dementia have problems swallowing food. What to do then if we have a family member with this great limitation?

It is a highly complex reality in which there is a fear of choking.. In these situations it is necessary to consult with speech therapists and experts in nutrition associated with Alzheimer’s.

In general, the following guidelines are very useful:

Ensure that the person feeds with his back straight and his head slightly inclined. to avoid choking. Choose Prepare foods that have a texture suitable for swallowing. For example, purees must cover all the water and energy needs of the person. We will also avoid sticky foods like honey or fibrous foods like artichokes, even if we have prepared them puree. Be aware that feeding your family member will require more time and patience. We will give the food in small quantities with a spoon or dessert spoon and making sure that the mouth is empty after each bite. It is important to remember that the spoon should touch the base of the tongue, since this stimulates swallowing. Special cups can also be used for dysphagia.follow a routine regarding meal times, place, position and tasks before and after the meal. Feed the patient in a quiet space without distractions.Keep the person with their back straight after meals and for an hour to facilitate digestion.

What should I do if my family member chokes?

Assess the situation and make sure if choking has partially or completely obstructed the airway. To know the degree of obstruction you just have to observe. If you are able to talk, scream, or cough, it is partial choking. In these cases you should let her cough until she eliminates what is blocking her on her own.. Do not tap your dog’s back because you run the risk of the piece of food becoming lodged deeper and causing a complete blockage.

When the obstruction is complete, the person is not able to have any of the behaviors above. (cough, scream, talk). In addition, he grabs his neck with his hands and his lips turn purple due to the absence of oxygen. In these cases, what you should do is reassure the person, let them know that you are there to help, and encourage them to cough to clear their airways. Stay alert in case it is necessary to apply first aid.

However, to conclude, we remember that in these circumstances it is decisive to always have the support of experts. For this reason, try to consult with speech therapists and other specialists. They may recommend easy-to-swallow, nutrient-enriched shakes, or implement exercises with the patient that improve their swallowing ability. Promoting the quality of life of our families is the main objective.

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