A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease

TLDR

The long‑term effects of short‑term aspiration prevention in dementia or Parkinson’s patients remain unclear and warrant further study. This randomized trial aimed to determine which of three interventions—chin‑down posture, nectar‑thickened liquids, or honey‑thickened liquids—most effectively eliminates thin‑liquid aspiration immediately during videofluorographic swallow studies in patients with dementia or Parkinson’s disease, while also assessing patient preference. A total of 711 patients aged 50–95 who aspirated on thin liquids underwent all three interventions in a randomly assigned order during videofluorographic swallow studies, allowing comparison of immediate aspiration elimination rates. Honey‑thickened liquids achieved the highest immediate elimination of aspiration across diagnostic categories, but patients with severe dementia showed the least effectiveness overall, and patient preference favored chin‑down.

Abstract

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.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.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.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.