Treatment of Sarcopenic Dysphagia with Rehabilitation and Nutritional Support: A Comprehensive Approach

Sarcopenia is a condition characterized by a decline in skeletal muscle mass and muscle strength. 1 Cruz-Jentoft A.J. Baeyens J.P. Bauer J.M. et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39: 412-423 Crossref PubMed Scopus (7480) Google Scholar Sarcopenia has many causes, including aging, poor nutrition, sedentary lifestyle, and underlying disease states. 1 Cruz-Jentoft A.J. Baeyens J.P. Bauer J.M. et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39: 412-423 Crossref PubMed Scopus (7480) Google Scholar Sarcopenia is a particular problem in countries with an aging population and is a predictive factor of poor outcomes, including mortality. 2 Landi F. Cruz-Jentoft A.J. Liperoti R. et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: Results from ilSIRENTE study. Age Ageing. 2013; 42: 203-209 Crossref PubMed Scopus (418) Google Scholar In addition, it is a risk factor for the alteration of nutrition because of changes in taste acuity, activities of daily living, and social isolation. Sarcopenia prevalence among older adults is high, ranging from 3% to 30%. 3 Baumgartner R.N. Koehler K.M. Gallagher D. et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998; 147: 755-763 Crossref PubMed Scopus (2800) Google Scholar , 4 Gillette-Guyonnet S. Nourhashemi F. Andrieu S. et al. Body composition in French women 75+ years of age: The EPIDOS study. Mech Ageing Dev. 2003; 124: 311-316 Crossref PubMed Scopus (59) Google Scholar , 5 Cesari M. Pahor M. Lauretani F. et al. Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2009; 64: 377-384 Crossref PubMed Scopus (255) Google Scholar Although the treatment of sarcopenia depends on its cause, the goal of treatment is to increase either muscle mass or function. 6 Wakabayashi H. Sakuma K. Rehabilitation nutrition for sarcopenia with disability: A combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle. 2014; 5: 269-277 Crossref PubMed Scopus (234) Google Scholar Nutrition therapy plays a central role in sarcopenia intervention, not only in patients who have developed sarcopenia from poor nutrition but also in those with age-, activity-, or disease-related sarcopenia. 6 Wakabayashi H. Sakuma K. Rehabilitation nutrition for sarcopenia with disability: A combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle. 2014; 5: 269-277 Crossref PubMed Scopus (234) Google Scholar With regard to nutritional support, dysphagia therapy and the treatment of patients with dysphagia is very important in improving nutritional status. Aging is associated with a decrease in the functionality of the swallowing muscle 7 Molfenter S.M. Amin M.R. Branski R.C. et al. Age-related changes in pharyngeal lumen size: A retrospective MRI analysis. Dysphagia. 2015; 30: 321-327 Crossref PubMed Scopus (49) Google Scholar ; this age-related change in swallowing function, known as presbyphagia, places older adults at risk for dysphagia and aspiration. In addition, presbyphagia and dysphagia are comorbid with many age-related diseases. 8 Wakabayashi H. Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging. 2014; 3: 97-103 PubMed Google Scholar Older adults with presbyphagia might be experiencing a loss of or decline in the functional reserves of swallowing. Many causes of dysphagia are possible, but stroke, dementia, and Parkinson’s disease are responsible for approximately 75% of all cases. 9 White G.N. O'Rourke F. Ong B.S. Cordato D.J. Chan D.K. Dysphagia: Causes, assessment, treatment, and management. Geriatrics. 2008; 63: 15-20 PubMed Google Scholar Several recent reports have described sarcopenia as the cause of dysphagia in some patients. 10 Maeda K. Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people [published online ahead of print March 21, 2015]. Geriatr Gerontol Int. 2015; http://dx.doi.org/10.1111/ggi.12486 Google Scholar , 11 Kuroda Y. Kuroda R. Relationship between thinness and swallowing function in Japanese older adults: Implications for sarcopenic dysphagia. J Am Geriatr Soc. 2012; 60: 1785-1786 Crossref PubMed Scopus (66) Google Scholar , 12 Murakami M. Hirano H. Watanabe Y. Sakai K. Kim H. Katakura A. Relationship between chewing ability and sarcopenia in Japanese community-dwelling older adults. Geriatr Gerontol Int. 2014; 15: 1007-1012 Crossref PubMed Scopus (104) Google Scholar Indeed, a systemic decline of skeletal muscle mass and strength may also affect the head and neck muscles, which perform eating and deglutition movements. 13 Maeda K. Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015; 30: 80-87 Crossref PubMed Scopus (162) Google Scholar , 14 Feng X. Todd T. Lintzenich C.R. et al. Aging-related geniohyoid muscle atrophy is related to aspiration status in healthy older adults. J Gerontol A Biol Sci Med Sci. 2013; 68: 853-860 Crossref PubMed Scopus (105) Google Scholar Sarcopenic dysphagia, which is a new concept involved in dysphagia, 15 Clave P. Shaker R. Dysphagia: Current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015; 12: 259-270 Crossref PubMed Scopus (255) Google Scholar results in swallowing difficulties through mechanisms that are different from those seen with motor neuron diseases such as stroke, dementia, and Parkinson’s disease. Our assumption was that one possible cause of sarcopenic dysphagia might be aspiration pneumonia among older adults with sarcopenia. We also assumed that sarcopenic dysphagia is not only the result of aspiration pneumonia but is also an important cause of recurrent aspiration pneumonia. However, the measurement and evaluation of the muscle mass and strength of swallowing-related muscles are difficult in clinical settings, and no evidence-based diagnostic criteria have yet been established. As a result of this difficulty, to our knowledge no prior case reports have described the diagnosis and treatment of a patient with sarcopenic dysphagia. We describe a case of sarcopenic dysphagia that improved with comprehensive care, including aggressive nutritional support and rehabilitation.