[Dysphagia] Swallowing and the patient with dementia

[eripley at yahoo.com (Irene Campbell-Taylor)]

It is always disturbing to find "research" on swallowing and dementia for several reasons. As I've said many times, there first has to be a determination that it truly is dementia and not delirium, and secondly, what type of dementia. But overall, the most disturbing issue is tha lack of attention paid to the fact that many, if not most of these patients are on heavy doses of antipsychotics meds - that in and of themselves CAUSE swallowing dysfunction.It has been insisted for years that only the "old" ones e.g. haloperidol, do this and that the newer, atypical antipsychotics don't have the same adverse effects. It has been obvious to many of us that they certainly do and finally, a review, published today, confirms what has been a clinical certainty for a long time. When treating a "demented" (or any other patient for that matter) PLEASE consider the medications being consumed and see the following:(The complete article is available at www.bmj.com  - current issue)

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review Philip E Lee, Sudeep S Gill,, Morris Freedman,, Susan E Bronskill,  Michael P Hillmer, Paula A Rochon BMJ  2004;329:75 (10 July), doi:10.1136/bmj.38125.465579.55 (published 11 June 2004)  
Objective To review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD). 

Data sources Medline, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials. 

Study selection Double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD. 

Review methods Two reviewers assessed trial validity independently. 

Results 77 abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified.. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait. 
Conclusions Although atypical antipsychotic drugs are being used with increasing frequency, few randomised trials have evaluated their use for BPSD. Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs.


Dr I Campbell-Taylor
Clinical Neuroscientist
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