| Background:Up to 40% of Alzheimer’s disease(AD)patients have dysphagia,which puts them at risk for pneumonia,aspiration,malnutrition,and other problems.There is an urgent need for dysphagia rehabilitation strategies.By the neural plasticity process,swallowing muscle group movement,the most fundamental rehabilitation technique for swallowing problems,can significantly alleviate patients’ swallowing abnormalities.There are,however,very few trials on structured swallowing instruction for dementia patients.Stepwise Swallowing Training(SST),which targets many levels of swallowing muscle groups,is intended to help AD patients with their swallowing difficulties.Objective:To explore the effect of stepwise swallowing training(SST)on swallowing function and rehabilitation prognosis of patients with dysphagia of Alzheimer’s disease.Methods:This was a parallel,multi-center randomized trial.From March 2021 to December 2022,103 eligible patients with Alzheimer’s disease complicated with dysphagia were included.53 patients were divided into intervention group and 50 patients in control group randomly.The control group was given routine swallowing guidance and nursing,while the intervention group was given stepwise swallowing training on the basis of routine care in the control group,and two groups were observed for four weeks.The swallowing function was assessed with the standard swallowing assessment(SSA),water swallowing test(WST)and modified Mann assessment of swallowing ability(MMASA),mini nutritional assessment-short form(MNA-SF)and Barthel index(BI)were adopted to evaluate nutrition status and ability of daily activities between groups.The evaluators were blinded with respect to the patients’ outcome.All data were analyzed by intention-to-treat population analysis(ITT)and per-protocol analysis(PP).SPSS software was used to carry out chi-square test,t-test and generalized estimation equation for the data.Results:There was no statistical difference in the general demographic data of the subjects,which was comparable(P>0.05),but the degree of cognitive impairment in the control group was more severe,and the proportion of illiterate people was more(P<0.05).The primary outcome was SSA,and WST,MMASA,MNA,BI were selected as secondary outcomes.No significant differences between the baseline efficacy indicators were found(P>0.05),means that two groups of patients were comparable in terms of swallowing function,nutritional status,and ability of daily living.After the adjusted generalized estimation equation analysis,we found that at the second and fourth weeks,the improvement of swallowing function in the intervention group was significantly higher than that in the control group(P<0.001),and it was not affected by the patient’s cognitive function and different center.The mean improvement of SSA and MMASA in the intervention group was 6.63±0.551(P<0.001),11.18±1.784(P<0.001),and WST improved significantly(1.39±0.092,P<0.001),respectively.The improvement in nutritional status in both groups after the intervention was higher than before the intervention(P<0.001),but the mean improvement in the intervention group was greater at the fourth week(3.38±0.293,P<0.001).At the same time,there was an interactive effect between changes in swallowing function,nutritional status and daily living ability,which means that the swallowing function,nutrition and daily living ability of the intervention group gradually improved with time(P<0.05).The intervention group had fewer adverse reactions and there was no significant difference compared to the control group(P>0.05).Conclusion:Stepwise swallowing training can significantly improve the swallowing disorder of dementia patients,the swallowing function,nutritional status,and ability of daily activities of patients improved effectively after intervention.Further promotion in hospitals,communities and nursing homes are needed. |
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