How Does Cognition Affect Swallowing

Cognition can impact many facets of life including swallowing.

Patients may be confused  enough that they don’t “recognize” food in their mouth and effectively may not know what to do with that food.

For example, when I was working in the acute care hospital, I evaluated a patient in the ICU that had sodium levels outside of normal parameters.  This person had difficulty recognizing solids in their mouth and would just sit with the solid sitting on the tongue.   This patient had increased confusion and agitation.   They were able to swallow pureeds and thin liquids.    Once their sodium levels returned to a number within normal limits, their swallowing function also returned to normal.

So, what parts of cognition can affect swallowing?

Leder, Suiter and Warner looked at the patient’s ability to answer orientation questions and to follow single-step commands.

They looked at patients with altered mental status related stroke, TBI, degenerative neurological impairment, dementia and alcohol/drug abuse.   4053 patients were used in the study.

Orientation questions consisted of  1.  What is your name?  2.  Where are you right now?  3.  What year is it?

Single step directions were:  1.   Open your mouth.  2.  Stick out your tongue?  3.  Smile.

The authors found that:

Liquid aspiration was 31% greater for patients not oriented to person , place and time.

Liquid aspiration was 57% greater, puree aspiration was 48% greater and being deemed unsafe for any oral intake was 69% greater in patient unable to follow single step verbal commands.

A FEES protocol was used with each patient to determine swallowing function.

“Use of simple orientation questions and single-step verbal command-following to ascertain potential increased odds of both aspiration and safe oral intake prior to dysphagia testing allows for a more precise dysphagia evaluation, e.g., by limiting bolus volume, starting with puree versus thin-liquid consistency, and knowing that thickened liquids may be needed.”


Leder, S. B., Suiter, D. M., & Warner, H. L. (2009). Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia24(3), 290.

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