imidapril and Pneumonia--Aspiration

Dysphagia induces silent aspiration, which is a known risk factor for aspiration pneumonia in the elderly. Dysphagia is associated with impaired substance P secretion. Because nicergoline was recently reported to enhance substance P secretion, it may improve dysphagia by upregulating substance P; however, roles for nicergoline in this process have not been demonstrated. We therefore compared the effects of nicergoline on serum substance P and dysphagia with the effects of imidapril, an angiotensin-converting enzyme (ACE) inhibitor whose efficacy in improving dysphagia and preventing pneumonia has been previously demonstrated.We randomly assigned 60 elderly patients with both dysphagia and a previous history of pneumonia to receive either imidapril (5 mg/d; n = 30) or nicergoline (15 mg/d; n = 30) for 6 months. Primary outcomes were the effects of these drugs on the substance P level and dysphagia 4 weeks after the start of treatment. Secondary outcome was the effect of these drugs on pneumonia recurrence during the 6 months of treatment.Significant elevations of serum substance P were obtained by both medications after 4 weeks of treatment. Patients whose dysphagia was improved showed significantly increased serum levels of substance P. There was no statistically significant difference in the overall proportion of patients who showed improvements in dysphagia and pneumonia recurrence with imidapril or nicergoline treatment. Nicergoline, but not imidapril, seemed to be more effective at improving dysphagia and elevating serum substance P in patients with dementia.In conclusion, nicergoline has a comparable effect to ACE inhibitors for improving dysphagia. Nicergoline might be a novel regimen for the treatment of dysphagia in the elderly who are not treatable with ACE inhibitors.

Topics: Adrenergic alpha-Antagonists; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Chi-Square Distribution; Deglutition; Deglutition Disorders; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Geriatric Assessment; Humans; Imidazolidines; Male; Nicergoline; Pilot Projects; Pneumonia, Aspiration; Prospective Studies; Recovery of Function; Reference Values; Severity of Illness Index; Single-Blind Method; Statistics, Nonparametric; Substance P; Treatment Outcome; Up-Regulation

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Dose-Response Relationship, Drug; Female; Humans; Imidazoles; Imidazolidines; Male; Pneumonia, Aspiration; Stroke; Substance P; Treatment Outcome

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Deglutition Disorders; Female; Humans; Hypertension; Imidazoles; Imidazolidines; Losartan; Male; Pneumonia, Aspiration; Stroke; Substance P

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cross-Over Studies; Deglutition; Double-Blind Method; Humans; Imidazoles; Imidazolidines; Pneumonia, Aspiration; Reflex

Symptomless dysphagia and swallowing disorders play a very important role in the pathogenesis of aspiration pneumonia. A videofluoroscopic examination and a simple two-step swallowing provocation test (STS-SPT) could be useful for detection of swallowing disorders in elderly patients with stroke, however, there is no report on such a test for detection of symptomless dysphagia. We administered 1 ml Technetium Tin Colloid (99mTC) to the patient during sleep via a nasal catheter placed in the mouth. At 09:00 h the next day, symptomless dysphagia was checked for by imaging. Improvement of the symptomless dysphagia was observed, and thus we could prevent the occurrence of aspiration pneumonia. The 99mTC test was particularly useful in detecting symptomless dysphagia in elderly patients with stroke.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cerebral Infarction; Colloids; Deglutition Disorders; Female; Humans; Imidazoles; Imidazolidines; Lung; Pneumonia, Aspiration; Radiography; Technetium Compounds; Tin Compounds