Signs of Aspiration in Adults with Down Syndrome: Prevalence as Determined Using A WaterSwallowing Screen and Caregiver Report

Background: Pneumonia and aspiration pneumonia are major causes of mortality in adults with Down syndrome (DS). However, dysphagia and swallowing safety have not been well studied in this population. Our aim was to examine the prevalence of aspiration signs in adults with DS. Methods: Caregiver report of swallowing-related concerns and a water-swallowing screen were used to assess signs of aspiration in 26 community-dwelling adults with DS who were otherwise healthy. Individuals were excluded if they had a pre-existing diagnosis of swallowing dysfunction or an estimated IQ below 25. Signs of aspiration were determined through a caregiver questionnaire and 3 trials of the 3oz waterswallowing test, screening for the following signs: coughing, throat clearing, choking, voice change, or stopping prior to completion. Results: Only 4 of the 26 participants (15.4%) had no signs of increased aspiration risk during testing. Eighteen participants (69.2%) screened positive during trial 1. Caregivers reported a comparable prevalence, providing converging evidence of high aspiration risk. Comparisons of swallow test results with previous reports for patients with stroke or Parkinson disease indicated comparable or slightly higher rates of positive screenings for adults with DS, despite their being otherwise healthy and considerably younger. Conclusion: The prevalence of aspiration signs within this cohort of young, otherwise healthy adults with DS was comparable to that of highrisk patients reported elsewhere. Therefore, results support the hypothesis that swallowing dysfunction and aspiration may contribute to risk for the development of pneumonia in this population.