Association of Oral Diadochokinesis, Physical Function and Swallowing Function in Community-Dwelling Elderly People

Objective: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty. In this study, we investigate the relationship between physical function, swallowing function, nutritional evaluation, and each syllable of ODK. Methods: The subjects are 26 elderly people living in an area where they can walk. ODK, tongue pressure, modified water swallowing test, EAT-10, grip strength, MNA-SF, skeletal muscle index, height, weight, and BMI were evaluated. For statistical analysis based on ODK values, the subjects were divided into two groups on the basis of the number of times the syllables /pa/, /ta/, and /ka/ were repeated: 1) The first group with >6 repetitions exceeded six; 2) the second group with ≤5 repetitions. Both groups were compared using the Mann-Whitney U test (Model 1). In addition, the syllables /pa/, /ta/, and /ka/ were also divided among the groups and a comparison was performed (Model 2). Results: In Model 1, the tongue pressure value was significantly higher in the good group (p < 0.01). In Model 2, the good group showed significantly higher values for the syllables /pa/ (p < 0.01) and /ta/ (p < 0.05). There was no significant difference in the values for the syllable /ka/. Conclusion: In community-dwelling elderly people, tongue pressure was positively associated with ODK values for the syllables /pa/ and /ta/, suggesting that tongue pressure may be associated with strength of the lip and tongue tip muscles. Furthermore, it was suggested that the ODK values may even be lower than normal values in the elderly who maintain skeletal muscle mass and thus have adequate tongue pressure;therefore, these indicators may be used as a guideline to assess oral frailty.

Capacity of the Pectoralis Major Muscle May Be a Prognostic Factor for Aspiration Pneumonia

Objective: Aspiration pneumonia is thought to be caused by a decline in respiratory and swallowing function. We aimed to clarify whether the pectoralis major muscle and the rectus abdominis muscles are prognostic factors for aspiration pneumonia and to investigate the relationships between these muscles and nutritional status, swallowing function and sarcopenia, Methods: Medical records of 139 Japanese patients hospitalized for aspiration pneumonia between December 2010 and December 2014 were reviewed retrospectively. The volume and thickness of the pectoralis major muscle, the crosssectional area and thickness of the rectus abdominis muscles, and cross-sectional area of the psoas major muscle were measured using computed tomography. Swallowing function, nutritional status, activities of daily living, and prognosis also were evaluated. Results: The volume [Median: (left) 4713.2 mm3 vs. 4232.6 mm3 (right) 4981.7 mm3 vs. 4362.6 mm3 p < 0.05] and thickness [Median: (left) 6.9 mm vs. 4.6 mm (right) 7.3 mm vs. 5.7 mm p < 0.01] of the pectoralis major muscle and thickness of the right rectus abdominis muscles [Median: 7.3 mm vs. 5.8 mm p < 0.05] were significantly larger, while Mini-Nutritional Assessment Short Form (MNA-SF) [Median: 6.0 vs. 4.0 p < 0.01] and Functional Oral Intake Scale (FOIS) [Median: 3 vs. 1 p < 0.01] scores were significantly higher in patients who survived. The volume [Median: (left) 5789.1 mm3 vs. 3706.5 mm3 (right) 5650.3 mm3 vs. 4003.7 mm3 p < 0.01] and thickness [Median: (left) 7.1 mm vs. 5.9 mm p < 0.05] of the pectoralis major muscle and cross-sectional area of the psoas major muscle (left and right) [Median: (left) 500.1 mm2 vs. 432.0 mm2 (right) 563.5 mm2 vs. 446.3 mm2 p < 0.01] were significantly larger, while albumin levels [Median: 3.8 g/dl vs. 3.4g/dl p < 0.01] and MNA-SF [Median: 6.0 vs. 5.0 p < 0.01] and FOIS [Median: 4 vs. 1 p < 0.01] scores were significantly higher in patients with coexisting diseases. Conclusion: The capacity of the pectoralis major muscle may be an independent factor in the prognosis of elderly patients with aspiration pneumonia as a primary disease.