PROJECT SUMMARY
Dysphagia frequently develops in persons with AD/ADRD and leads to serious health consequences, including
increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Targeted,
efficacious rehabilitative interventions for dysphagia have been developed in other neurodegenerative
populations, but there are currently no effective treatments for dysphagia in AD/ADRD that have lasting effects
on swallowing physiology. Prior to developing interventions to prevent dysphagia-related adverse
sequelae in patients with AD/ADRD, in-depth understanding of factors contributing to dysphagia risk
and trajectories of swallowing change across disease progression is urgently needed, especially in early
stages when interventions can be most effective and impactful. Small, cross-sectional studies in AD/ADRD
have suggested changes in swallowing beginning early in disease progression. However, these prior studies
examining dysphagia in AD/ADRD lack the comprehensive and longitudinal characterization of swallowing
function across the dementia continuum necessary to improve clinical management. Additionally, while novel,
multi-modality swallowing assessments have enabled detection of subclinical swallowing impairments in other
neurogenerative populations, the nature of subclinical changes in AD/ADRD remains unknown. To address these
critical knowledge gaps, we propose a prospective cohort study of persons with AD/ADRD stratified by disease
stage (very mild to moderate) and their care partners. Participants will undergo comprehensive dementia
characterization, including neuropsychological testing and plasma-based biomarkers, as well as multi-modal
swallowing assessments at baseline and every six months. We will also collect a variety of clinical factors (e.g.,
demographics, comorbidities) and measures of oral function (e.g., saliva production, oral health, lingual
pressures), respiratory pressures, sarcopenia, and nutritional status at baseline. The overarching goal of this
research is to inform development of intervention strategies for persons with AD/ADRD through enhanced clinical
and epidemiologic understandings of the onset, nature, and progression of swallowing deficits. Our
multidisciplinary team of experts will achieve this objective via the following specific aims: 1. Define swallowing
changes from very mild to moderate AD/ADRD to: 1a) characterize subclinical dysphagia features; and 1b)
identify clinical factors and swallowing measures that contribute to symptom reporting; 2. Identify risk factors for
swallowing dysfunction from very mild to moderate AD/ADRD; and 3. Determine trajectories of change in
swallowing function in persons with AD/ADRD and association with risk factors. The proposed work represents
the first longitudinal, comprehensive study of swallowing function in a well-characterized cohort of persons with
AD/ADRD. Improved understanding of swallowing function across disease progression will inform development
of targeted interventions to address identification, prevention, and rehabilitation of dysphagia in AD/ADRD.