BackgroundThere is some evidence that physical activity delays the onset of dementia in healthy older adults and slows down cognitive decline to prevent the onset of cognitive disability. Studies using animal models suggest that physical activity has the potential to attenuate the pathophysiology of dementia. 'Physical activity' refers to 'usual care plus physical activity'.ObjectivesPrimary: do physical activity programs maintain or improve cognition, function, behaviour, depression, and mortality compared to usual care in older persons with dementia?Secondary: do physical activity programs have an indirect positive impact on family caregivers' health, quality of life, and mortality compared to family caregivers of older persons with dementia who received usual care alone? Do physical activity programs reduce the use of health care services ( e. g., visits to the emergency department) compared to usual care in older persons with dementia and their family caregiver?Search strategyThe trials were identified from searches of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS on 9 September 2007 using the search terms: exercise OR "physical activity" OR cycling OR swim* OR gym* OR walk* OR danc* OR yoga OR "tai chi".Selection criteriaAll relevant, randomized controlled trials in which physical activity programs were compared with usual care for the effect on managing or improving cognition, function, behaviour, depression, and mortality in people with dementia of any type and degree of severity. Secondary outcomes related to the family caregiver(s) included quality of life, mortality, and use of health care services were intended to be examined.Data collection and analysisTwo reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected trials. These were pooled were appropriate.Main resultsFour trials met the inclusion criteria. However, only two trials were included in the analyses because the required data from the other two trials were not made available. Only one meta-analysis was conducted. The results from this review suggest that there is insufficient evidence of the effectiveness of physical activity programs in managing or improving cognition, function, behaviour, depression, and mortality in people with dementia. Few trials have examined these important outcomes. In addition, family caregiver outcomes and use of health care services were not reported in any of the included trials.Authors' conclusionsThere is insufficient evidence to be able to say whether or not physical activity programs are beneficial for people with dementia.

Accidental loss of food or liquids into the airway while eating or drinking is perhaps the most clinically significant consequence of dysphagia. Although videofluoroscopic recording of swallowing is the current gold standard for identifying and determining remediation for aspiration, results are generally described in descriptive terms, thus limiting information and lending to errors of interpretation. We previously published an 8-point scale to quantitate selected aspects of penetration and aspiration conveying depth of airway invasion and whether or not material entering the airway is expelled (Rosenbek et al., 1996, Dysphagia 11:93–98). The present study defines the distribution of the Penetration–Aspiration Scale scores in healthy normal subjects of different genders and ages. The scale was also used with two groups of patients known to have significant dysphagia relative to stroke or head and neck cancer. Significant differences found among groups are discussed.

The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.

The present study had two purposes. The first was to provide variability data on objectively measured durational parameters of swallowing as accomplished by dysphagic patients secondary to stroke. The second was to examine the short-term effects of thermal application on these same durational measures. The study employed a cross-over design with each dysphagic stroke subject swallowing 10 times in both untreated and treated conditions. Two findings emerged: (1) swallowing durations in the 22 dysphagic stroke subjects were highly variable within and across subjects and have distributions that were nonnormal with nonhomogeneous variances; (2) thermal application reduced duration of stage transition (DST) and total swallow duration (TSD). Implications of these findings are discussed.