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Schluckstörungen im Alter

Physiologie und Pathophysiologie

Age-related changes in swallowing

Physiology and pathophysiology

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Zusammenfassung

Altersabhängig auftretende Veränderungen des Schluckaktes werden unter dem Begriff der Presbyphagie zusammengefasst. Die primäre Presbyphagie bezeichnet dabei Modifikationen des Schluckaktes, die auf nichtkrankhaften altersphysiologischen Prozessen beruhen. Der primären Presbyphagie kommt kein Krankheitswert zu, sie vermindert allerdings die Kompensationsreserven des Schluckaktes. Unter der sekundären Presbyphagie werden Schluckstörungen verstanden, die sich im höheren Alter krankheitsbedingt, z. B. in Folge eines Schlaganfalls oder einer neurodegenerativen Erkrankung, manifestieren. Altersphysiologische Prozesse haben Auswirkungen auf sämtliche Phasen des Schluckaktes. In der oralen Vorbereitungsphase sind vor allem eine verminderte Geruchs- und Geschmackswahrnehmung sowie die im Alter häufig multifaktoriell verursachte Mundtrockenheit zu nennen. Die altersabhängige Abnahme von Skelettmuskelmasse, -qualität und -stärke, die als Sarkopenie bezeichnet wird, führt insbesondere zu Alterationen der oralen und pharyngealen Phase. Eine verminderte Sensibilität im Mund-Rachen-Raum hat Auswirkungen auf alle Schluckphasen, manifestiert sich aber vor allem mit einer verzögerten Triggerung des Schluckreflexes. Veränderungen des Achsenskeletts und des Bindegewebes führen ebenfalls zu vielfältigen Modifikationen des Bewegungsablaufs.

Summary

The term presbyphagia refers to all changes of swallowing physiology that are manifested with increasing age. Alterations in the pattern of deglutition that are part of healthy aging are called primary presbyphagia. Primary presbyphagia is not an illness in itself but contributes to a more pervasive naturally diminished functional reserve, making older adults more susceptible to dysphagia. If disorders in swallowing occur in the elderly as a comorbidity of a specific disease, for example stroke or neurodegenerative disorders, this is called secondary presbyphagia. Increasing age has an impact on each stage of deglutition. In the oral preparatory phase a diminished input for smell and taste as well as a usually multifactorial cause of dry mouth are the most important influencing factors. Sarcopenia, the degenerative loss of skeletal muscle mass, strength and quality associated with aging, interferes in particular with the oropharyngeal phase. A decreased sensory feedback from the oropharyngeal mucosa leads to a delayed triggering of the swallowing reflex. Finally, a reduction in connective tissue elasticity and changes of the axial skeleton lead to various modifications of the swallowing pattern with advanced age.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Muhle, R. Wirth, J. Glahn und R. Dziewas geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    P. Muhle & R. Dziewas

  2. Klinik für Geriatrie mit Geriatrischer Tagesklinik, St. Marien-Hospital, Borken, Deutschland

    R. Wirth

  3. Klinik für Neurologie, Johannes Wesling Klinikum, Minden, Deutschland

    J. Glahn

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  1. P. Muhle
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  2. R. Wirth
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  3. J. Glahn
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  4. R. Dziewas
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Correspondence to P. Muhle.

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Muhle, P., Wirth, R., Glahn, J. et al. Schluckstörungen im Alter. Nervenarzt 86, 440–451 (2015). https://doi.org/10.1007/s00115-014-4183-7

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