The purpose of this study is to determine whether chin-down posture or use of a thickened
liquid diet is more effective in the prevention of aspiration and aspiration pneumonia in
patients with Parkinson's disease and/or dementia. Liquid aspiration is the most common type
of aspiration in older populations, especially those suffering from debilitation, dementia,
and depression. Pneumonia may develop as a consequence of aspiration and is the fifth
leading cause of death in the US among persons age 65 years and over. Current treatment
involves either use of chin-down position with swallowing or use of thickened liquids in the
diet, without any clear evidence supporting the use of one treatment over the other. This is
a Phase III inpatient and/or outpatient study in which all participants will be randomly
assigned to either the chin-down position or the thickened liquid treatment group based on
swallowing function during a modified barium swallow. This study is scheduled to recruit
patients for a three-year period; participation by each individual patient spans no more
than three months after entry.
- Have dementia or Parkinson's disease and are found to aspirate on thin liquid during
a set of qualifying swallows.
- Have smoked more than a pack of cigarettes per day in the last year.
- Drink more than 3 alcoholic beverages per day on a regular basis.
- Have had any head and neck cancer treatment.
- Have any head and neck anatomic deformities.
- Have a history of 20 years or longer of insulin-dependent diabetes.
- Have other exclusionary neurologic diagnoses.
- Have had pneumonia within 6 weeks of screening.
- Currently have a nasogastric tube.
- Currently have a tracheotomy.
- Are a resident in non-participating nursing home or assisted living environment.
- Live alone.
- Have no regular care provider present at meals.
- Have no Speech-Language Pathologist to provide a 3-month follow-up.