MD, Medical Director, Complex Continuing Care Program, SCO Health Service, 43 Bruyere St., Ottawa, ON K1N 5C8, Canada. Phone: 613 562 0050. Fax: 613 562 6333. e-mail: jchouina@scohs.on.ca

Abstract: Pseudobulbar dysphagia is a common feature of Alzheimer disease (AD) especially in the late stages. In the majority of cases the clinician can select the most appropriate therapeutic modalities based on a thorough history and bedside assessment. The role of videofluoroscopy in managing the dysphagia of AD has not been established. It is unclear whether the weight loss associated with advanced AD can entirely be prevented by optimizing the management of dysphagia. Pneumonia is a common cause of morbidity and death in patients with AD. The risk of pneumonia is related not only to dysphagia and aspiration but to mobility, nutritional status and host immune response. Prevention of pneumonia through appropriate management of dysphagia is not supported by empirical evidence. The potential role of enteral feeding in patients with advanced AD is small. An evidence-based approach to enteral feeding in AD patients is outlined.

Key words: nutrition, Alzheimer, dysphagia, dementia, pneumonia, elderly, weight loss, enteral feeding, aging