Lifestyle Health and Wellbeing 16 Sep 2019 Dysphagia can lead t ...

Dysphagia can lead to severe depression

DECCAN CHRONICLE. | ARPITA HALDER
Published Sep 16, 2019, 1:35 pm IST
Updated Sep 16, 2019, 2:14 pm IST
It occurs frequently in patients with PD and more so in those who have reached the advanced stage of disease.
Dysphagia in head and neck cancer patients is a common complaint and can exist before, during and after chemo radiotherapy. (Photo: Representational/Pixabay)
 Dysphagia in head and neck cancer patients is a common complaint and can exist before, during and after chemo radiotherapy. (Photo: Representational/Pixabay)

Swallowing affects the physical and mental health of all human beings. 1 in 17 people will develop some form of dysphagia in their lifetime. Dysphagia is an important alarm symptom; however, the epidemiology remains poorly defined. Dysphagia in general population is present from aged >50 years due to which they may need to compromise with their meals or favourite food which shows the impact on their quality of life. Avoiding swallowing specific food, fluids or pills may result in malnutrition and weight loss. Not only does eating provide nutrients, but it also serves as an important role in social interaction. Dr Govathi Nikhila Karpuram, Dysphagiologist – speech pathologist at Medanta – The Medicity talks about how depression is related to dysphagia.

Severity and symptoms of dysphagia defer from condition to condition based on their site and size of lesion/condition. Depression after dysphagia depends on the severity of the condition. Researches say that prevalence rate of Dysphagia in general population is about 11 per cent and 40-70 per cent in stroke patients, 60-80 per cent patients with Neurodegenerative disease and up to 13 per cent of adults aged 65 and older >51 per cent of institutionalised elderly patients. 60-70 per cent of patients who undergo radiotherapy for Head and Neck cancer.  

 

In post-stroke patients, depression is common and affects almost one-third of stroke survivors at any one time after stroke and has a deleterious effect not only on the motivation but also on the cognitive functions, physical abilities, dysphagia, with speech and language issues. It should be logically expected that post-stroke depression has a negative impact on functional recovery due to which it shows the effect on their quality of life. If we see in patients with Parkinson’s disease(PD) it is a Neurodegenerative disease that affects 1.4 per cent of the population over the age of 55 years and 4.3 per cent of population 85 years of age and older. Swallowing disturbances comprise a common complication (up to 95 per cent) of the patient with PD and are considered to be a major cause of death. Dysphagia occurs frequently in patients with PD and more so in those who have reached the advanced stage of the disease which make them compromise with their quality of life and may lead to depression.

Swallowing problem in dementia patients may occur with different factors. Physical illness/metabolic upset may lead to an acute confessional state in cognitively intact older people and those with dementia. Acute confusion can impact on feeding and swallowing due to a decrease in functional skills and conscious level. It is well recognised that decreased in swallowing efficiency and reserve in older people can result in dysphagia when acute illness present which also may lead to depression. So, it is important to recognize and treat the depression in dementia patients or else it may lead to a range of problem including lack of appetite, reduced motivation to eat/ feed oneself, abnormal ideation about food.

Dysphagia in head and neck cancer patients is a common complaint and can exist before, during and after chemoradiotherapy. It leads to nutritional deficiency, weight loss and prolonged un-natural feeding and also has a major potential risk of aspiration which also has a significant negative impact on their quality of life which may lead to depression further. In head and neck cancer patients depression affects up to 20 per cent and anxiety 10 per cent.

Case Study:

A 60 years old man was suffering from Metastatic squamous cell carcinoma and was received Chemo-Radiation therapy. In those days he had severe difficulty in swallowing, though from inside he feels he want to eat everything but his throat was not supporting him for that which made him take liquid diet to survive his day. Due to his low oral intake, he got dehydrated.  All this made his life miserable, depressed and stressed about the same, after achieving many things in his life he could not able spent his good time with his family member with his gold olden days and unable to play with his grand children’s all this were affected his quality of life. One fine bad day was turned out for a good reason. On that particular day, in the morning he had a fall and vomiting, his daughter took him to the hospital through the emergency ward.T here immediate MRI/CT was done and diagnosed with “Lateral Medullary Syndrome (LMS)” at that movement his family was hopeless and the patient fully depressed after knowing it. But, YES! They didn’t know that there is a treatment for that, with which he can overcome easily. Here, the patient received a helpline through doctors for dysphagia Evaluation.On an immediate day, a Detail Bedside Swallow Evaluation was done by Dysphagiaologist in order to check the severity and to plan for the perfect management. Yes! Now, the immediate management plan was done by Dysphagiaologist for intensive Swallow therapy with Vital stim Electrical stimulation and family and the patient was accepted for that and new hope was seen in their faces. After 15 intensive sessions, the patient started eating a soft diet without any aspiration or difficulty in swallowing which turned out his life happy and now, currently he is on a normal diet and spending his golden time with his family, playing with his grandchildren. Enjoying his life happily. The is how the bad day from liquid diet turned out him with a normal diet.

So that I would like to conclude that a well comprehensive and early identification of Dysphagia will help the patients to have a good comprehensive dysphagia management plan which protects them from aspiration and also helps them to overcome with dysphagia by which they can have a good quality of life and also overcome depression.

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