Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia.

Takashi Mori, Ichiro Fujishima, Hidetaka Wakabayashi, Masataka Itoda, Kenjiro Kunieda, Jun Kayashita, Shinta Nishioka, Akiko Sonoda, Yoshitoshi Kuroda, Minoru Yamada, Sumito Ogawa

Abstract


Background

Sarcopenic dysphagia is characterized by difficulty swallowing because of the loss of whole-body skeletal and swallowing muscle mass and function. Despite multiple reports regarding sarcopenic dysphagia, no verified diagnostic methods exist. The purpose of this study was to develop a diagnostic algorithm for sarcopenic dysphagia and to subsequently verify its reliability.

Methods

Firstly, the Working Group on Sarcopenic Dysphagia as our research group developed a diagnostic algorithm for sarcopenic dysphagia. Patients 65 years and older who could follow commands were eligible to be assessed using the algorithm. Patients without whole-body sarcopenia, with normal swallowing function, and with obvious causative disease of dysphagia were judged as not having sarcopenic dysphagia. Then, swallowing muscle strength was assessed by tongue pressure using a maximum tongue pressure measurement instrument (JMS, Hiroshima, Japan) because this measurement  is feasible in clinical practice, and decreased tongue pressure is thought to be associated with sarcopenia and sarcopenic dysphagia. We set the cutoff value for low swallowing muscle strength at less than 20 kPa of tongue pressure. People with low swallowing muscle strength are judged as being at probable risk for sarcopenic dysphagia, and people with normal swallowing muscle strength are judged as being at a possible risk for sarcopenic dysphagia. Secondly, we applied the algorithm to 65years and older inpatients and investigate characteristics, muscle mass, muscle strength, motor function, swallowing muscle strength, swallowing function, and nutritional status. We investigated the reliability of the algorithm by analyzing intra-class and inter-class correlation coefficients using kappa statistics.

Results

A total of 119 patients were participated in this study. The mean age was 86.1 years and 55 (46%) were men. The majority of the causative diseases at admission were hip fractures (24) and pneumonia (21).  Among the 119 patients, 32 were categorized as having possible sarcopenic dysphagia, 18 as probable sarcopenic dysphagia, and 69 as no sarcopenic dysphagia. The intra-class coefficient of the algorithm was 0.87(95% confidence interval [CI]: 0.73-1.01), and the inter-class coefficient was 0.98 (95% CI: 0.92-1.02), indicating high intra-rater and inter-rater reliability.

Conclusions

A diagnostic algorithm for sarcopenic dysphagia was developed and the reliability was verified. All older patients with sarcopenia or dysphagia should be assessed for sarcopenic dysphagia, as it requires treatment that involves not only dysphagia rehabilitation but also nutritional improvement.


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DOI: http://dx.doi.org/10.17987/jcsm-cr.v2i2.17

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