{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T21:33:57Z","timestamp":1768253637989,"version":"3.49.0"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T00:00:00Z","timestamp":1689984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early\u2010stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To identify reliable and clinically measurable indicators of EDS difficulty used in early\u2010stage dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early\u2010stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early\u2010stage dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes &amp; Results<\/jats:title><jats:p>Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full\u2010text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early\u2010stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early\u2010stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non\u2010amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the \u2018candy sucking test\u2019 cannot be recommended because there is an inherent choking risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Implications<\/jats:title><jats:p>EDS difficulty in early\u2010stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early\u2010stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families\u2019 perspectives on potential indicators of EDS difficulty may add to the existing evidence base.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Early identification of EDS difficulty in early\u2010stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds to existing knowledge<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>A comprehensive range of studies related to EDS identification in early\u2010stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early\u2010stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the potential or actual clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This study could help to develop pathways to support the early identification of EDS difficulties for people living with early\u2010stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.12924","type":"journal-article","created":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T12:39:00Z","timestamp":1690029540000},"page":"1994-2007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Identification of eating, drinking and swallowing difficulties for people living with early\u2010stage dementia: A systematic review"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5880-877X","authenticated-orcid":false,"given":"Michelle","family":"O'Neill","sequence":"first","affiliation":[{"name":"Speech and Language Therapy, School of Health Sciences Ulster University Londonderry UK"},{"name":"Institute of Nursing and Health Research Ulster University Londonderry UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3729-7576","authenticated-orcid":false,"given":"Orla","family":"Duffy","sequence":"additional","affiliation":[{"name":"Speech and Language Therapy, School of Health Sciences Ulster University Londonderry UK"},{"name":"Institute of Nursing and Health Research Ulster University Londonderry UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mo","family":"Henderson","sequence":"additional","affiliation":[{"name":"Northern Health and Social Care Trust Antrim UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W George","family":"Kernohan","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Research Ulster University Londonderry UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0196-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12553"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjem.2018.08.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2012.04.011"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab108"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41073-019-0064-8"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.2196\/10017"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7984635"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0404.2002.10062.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta23100"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-282X2010000600005"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afy169"},{"key":"e_1_2_9_14_1","unstructured":"Department of Health Social Services and Public Safety. 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