MULTI-INFARCT DEMENTIA: SWALLOWING AND PHYSICAL AND INTELLECTUAL IMPAIRMENT
Swallowing
Following a stroke there may be a period of time when swallowing is difficult. This usually recovers, sometimes with the aid of speech therapists, dieticians, physiotherapists and dentists. With multiple strokes (especially if they occur on both sides of the brain) the problem may develop with the other complications (incontinence, emotional lability, poor mental state etc.) The person may begin to get frequent chest infections or be seen to choke with every mouthful of food. The chestiness shows that some food particles are missing the gullet and going into the lungs because the act of swallowing has been damaged by the strokes. This often recovers as the person gets over the latest stroke, but in the later stages it can become permanent. The problem can be tackled in various ways. Following assessment it may be the case that certain types of food 'go down the right way'; these often include purees and ice-cream type consistencies. Liquids and solids tend to be swallowed only with difficulty. Solids should be mashed to a puree consistency while liquids should be thickened with agents such as Carobel. The position of the head and neck is also important. The best position is sitting upright with the head looking straight ahead (not tipped back). Liquids should fill the cup/glass near to the brim so that on drinking the head does not have to be tipped back. The speech therapist is the best person to give advice on the swallowing difficulties of stroke patients. Some people, however, are unable to swallow anything and then the decision has to be made about passing a tube into the stomach (a nasogastric tube) and feeding the person that way. This may only be a temporary measure as recovery of the swallowing reflex occurs. In some cases the impairment is permanent and most doctors advise that the nasogastric tube be replaced by a more permanent feeding tube direct into the stomach, a gastrostomy. This is a fairly minor procedure and allows the nourishing liquid food to be pumped via the tube direct into the stomach. Once the feed is finished the tube can be disconnected and all that remains until the next feed is a small button-like attachment on the skin of the abdomen.
Physical and intellectual impairment
In any individual the symptoms and signs of their multiple strokes will vary and their degree of disability both mental and physical will differ. Some will have profound physical handicaps in the form of limb weakness and this will dominate their lives, their slight intellectual impairment being fairly irrelevant. For others the degree of physical handicap will be minimal, if present at all, if that part of the stroke has fully recovered. They may however be severely intellectually impaired with very poor memory, no concentrating power and limited learning ability. Speech may be affected (both in the ability to speak and in the ability to understand speech). Writing and reading powers can be damaged as well as the complicated processes of reasoning and decision making. This step-wise decline of both mental and physical powers can be devastating for both sufferer and carer.
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