Oropharyngeal dysphagia: a narrative review towards an integrated neurogeriatric perspective

Oropharyngeal dysphagia, prevalent in neurogeriatric populations, increases the risks of malnutrition, pneumonia, and mortality. Oropharyngeal dysphagia manifests as a multi-aetiological syndrome with diverse phenotypes. We advocate for a neurogeriatric perspective that integrates specific neurological insights with geriatric care principles to improve dysphagia management. This approach highlights the diagnostic value of disease-specific neurological dysphagia manifestations and recognises the condition as a potential target for neurological therapies, as shown by the benefits that acetylcholinesterase inhibitors in myasthenia gravis and dopaminergic agents in Parkinson's disease have against the syndrome. Age-related factors such as presbyphagia, which includes reduced pharyngeal sensation, sarcopenia, and decreased neuroplasticity, further contribute to the pathophysiology of oropharyngeal dysphagia. Cross-disease treatment strategies encompass oral hygiene, nutritional support, dietary modifications, individualised interventions to improve swallowing physiology, and emerging neurostimulation techniques that are currently under investigation. Current research aims to refine assessment protocols tailored to these interventions, identify outcome predictors to contextualise dysphagia findings, and evaluate the potential of neurostimulation or pharmacological agents, with the aim to improve quality of life and reduce mortality.