Dysphagia in behavioural variant of frontotemporal dementia- a systematic review

Dementia is associated with changes in feeding and swallowing that pose a significant risk to health. This systematic review aimed to examine the diagnosis of dysphagia in behavioral variant of frontotemporal dementia (bvFTD).

Four research databases were systematically searched for studies reporting dysphagia in bvFTD. Selection criteria included human participants with bvFTD, documentation of swallowing function, report of original data, availability in English, and full-text access. Included reports were assessed for quality and risk of bias.

Twenty-two studies met the inclusion criteria. Studies were analyzed and categorized by symptom presence/absence (n = 9), symptom description (n = 12) and swallowing physiology (n = 1). Participants with bvFTD and dysphagia were noted to have a wide range of disease severity and associated symptoms, including motor, cognitive-emotional, and perceptual changes. When specified, assessment methods typically included caregiver questionnaires and brief screening tools. The most frequently reported signs and symptoms of dysphagia were choking, coughing, and chewing difficulties. Hyperphagia and oral packing were noted in 13 studies. Only one study used imaging to assess swallowing, and noted an incongruence between caregiver report and imaging results. The quality of included studies was limited by sampling and sample size.

Although dysphagia has been reported in bvFTD, diagnosis is often through unreported, nonstandardized, observational measures. Limitations to current evidence include small sample sizes, reliance on caregiver reports, and lack of imaging. Further research is warranted to develop standards for assessment of swallowing and dysphagia intervention in bvFTD.