Journal of Speech, Language, and Hearing Research Vol.51 173-183 February 2008. doi:10.1044/1092-4388(2008/013)
© American Speech-Language-Hearing Association
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A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson's Disease

Jeri A. Logemann
Northwestern University, Evanston, IL

Gary Gensler
The EMMES Corporation, Rockville, MD

JoAnne Robbins
University of Wisconsin, Madison, WI

Anne S. Lindblad
Diane Brandt
The EMMES Corporation, Rockville, MD

Jacqueline A. Hind
William S. Middleton VA Medical Center, Madison, WI

Steven Kosek
Minneapolis VA Medical Center, Minneapolis, MN

Karen Dikeman
Marta Kazandjian
New York Hospital Medical Center – Queens, Flushing, NY

Gary D. Gramigna
VA Boston Healthcare System, Roxbury, MA

Donna Lundy
University of Miami Medical Center, Miami, FL

Susan McGarvey-Toler
Richard L. Roudebush VA Medical Center, Indianapolis, IN

Patricia J. Miller Gardner
Communication Sciences and Disorders Clinical Trials Research Group, American Speech-Language-Hearing Association, Rockville, MD

Contact author: Jeri A. Logemann, Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, #3-358, Evanston, IL 60208. E-mail: j-logemann{at}northwestern.edu.

Purpose: This study was designed to identify which of 3 treatments for aspiration on thin liquids—chin-down posture, nectar-thickened liquids, or honey-thickened liquids—results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease.

Method: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study.

Results: Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids.

Conclusion: To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson's disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient's management plan. The longer-term impact of short-term prevention of aspiration requires further study.

KEY WORDS: dementia, Parkinson's disease, aspiration, thickened liquids, posture


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