June is Alzheimer's & Brain Awareness Month, an opportunity to elevate discussions surrounding one of the most prevalent yet underrecognized complications of Alzheimer's disease and related dementias: dysphagia.

While cognitive decline remains the defining clinical feature of Alzheimer's disease, swallowing dysfunction often emerges as a significant contributor to morbidity, caregiver burden, hospitalization, malnutrition, dehydration, and declining quality of life throughout disease progression.

For Neurologists, GPs, PCPs, Geriatricians, and Speech-Language Pathologists, and Senior Care Providers, dysphagia represents far more than an end-stage complication. Emerging evidence suggests that swallowing impairment may develop earlier than traditionally appreciated and can significantly influence nutritional status, hydration, functional independence, and participation in daily life long before severe aspiration becomes apparent.

As Alzheimer's & Brain Awareness Month encourages broader conversations surrounding brain health, it is equally important to recognize the profound impact neurodegeneration has on one of the brain's most complex and essential sensorimotor functions: swallowing.
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Dysphagia in Alzheimer's Disease Is Common, Progressive, and Frequently Underrecognized

Despite increasing awareness of dementia-related feeding challenges, dysphagia remains underdiagnosed across many care settings. A comprehensive systematic review of dysphagia in Alzheimer's disease reported prevalence estimates ranging from 84% to 93% in moderate to severe stages of disease, highlighting dysphagia as one of the most common clinical manifestations of advanced Alzheimer's disease. Source: Affoo RH, Foley N, Rosenbek J, Shoemaker JK, Martin RE. Dysphagia in Alzheimer's disease: a systematic review.

Importantly, swallowing impairment in Alzheimer's disease is not solely a consequence of generalized aging. Neurodegeneration directly affects cortical and subcortical regions involved in swallowing control, including the insula, anterior cingulate cortex, inferior frontal gyrus, supplementary motor areas, and sensorimotor networks responsible for coordinating safe and efficient oral intake.

As disease progression occurs, individuals may demonstrate:

• prolonged oral transit times
• oral holding
• lingual discoordination
• impaired bolus preparation
• delayed swallow initiation
• reduced airway protection
• feeding apraxia
• impaired self-feeding
• reduced awareness of swallowing difficulties

These deficits often evolve gradually, creating a cumulative burden that may significantly impact nutritional and hydration status before aspiration events become clinically apparent.
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Beyond Aspiration: The Functional Consequences of Dementia-Related Dysphagia

Historically, dysphagia management has focused heavily on aspiration risk and pneumonia prevention. While these outcomes remain critically important, contemporary dementia literature increasingly supports a broader understanding of swallowing dysfunction. Dysphagia in Alzheimer's disease is strongly associated with:

• malnutrition
• dehydration
• frailty
• prolonged mealtimes
• reduced oral intake
• caregiver burden
• increased hospitalization
• institutionalization
• reduced quality of life

The recently updated 2024 ESPEN Guidelines on Nutrition and Hydration in Dementia emphasize that low intake dehydration and malnutrition remain major contributors to adverse outcomes among people living with dementia. Source: ESPEN Guideline on Nutrition and Hydration in Dementia – Update 2024.

Similarly, a 2024 prospective cohort study published in the Journal of the American Medical Directors Association reported dysphagia prevalence rates approaching 86% among hospitalized individuals with Alzheimer's disease and related dementias, underscoring the substantial clinical burden associated with swallowing dysfunction in this population. Source: Oropharyngeal Dysphagia in Hospitalized Older Adults with Dementia: A Prospective Cohort Study.

For many patients, the earliest swallowing-related complications may not be aspiration pneumonia. Instead, clinicians frequently observe:

• declining fluid intake
• weight loss
• medication administration challenges
• prolonged feeding times
• reduced participation in meals
• increasing dependence on caregivers

These outcomes often become major determinants of health status and daily functioning.
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Dysphagia as a Quality-of-Life Issue

One of the most significant shifts occurring within dysphagia management is the growing emphasis on person-centered outcomes. For individuals living with Alzheimer's disease, mealtimes frequently represent more than nutritional events. They remain important opportunities for social engagement, family connection, autonomy, routine, and participation.

As cognitive decline progresses, eating and drinking may become increasingly effortful, frustrating, and dependent upon caregiver assistance. A 2025 conceptual framework published in Alzheimer's & Dementia highlighted the substantial disparities and challenges surrounding eating and swallowing care in persons living with dementia, emphasizing the need to better integrate real-world feeding experiences into clinical decision-making. Source: Loy K, et al. Eating and Swallowing Care Disparities in Persons with Dementia: A Conceptual Framework.

This perspective aligns closely with the broader movement toward person-centered dysphagia care, which recognizes that successful management must consider participation, dignity, hydration, caregiver burden, and quality of life alongside physiologic swallowing outcomes.
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Bridging the Gap Between Clinical Recommendations and Everyday Implementation

One of the most persistent challenges in dementia care is translating clinical recommendations into sustainable daily routines.

Speech-Language Pathologists may recommend modified diets, swallowing strategies, positioning techniques, environmental modifications, and feeding assistance. However, implementation frequently falls to family caregivers, nursing assistants, home health aides, and long-term care staff.

This implementation gap becomes increasingly important as dementia progresses. A 2024 systematic review evaluating dysphagia interventions for persons living with dementia concluded that significant evidence gaps remain regarding optimal treatment approaches, while emphasizing the ongoing need for practical, individualized strategies that support safe and meaningful oral intake. Source: Chan CTW, Wu TY, Cheng I. A Systematic Review on Dysphagia Treatments for Persons Living with Dementia.

The reality is that swallowing management does not occur solely during clinical evaluations. It occurs during breakfast. It occurs during medication administration. It occurs during hydration opportunities throughout the day. It occurs when fatigue, cognitive fluctuations, behavioral symptoms, and caregiver limitations intersect.
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The Role of Assistive Technology in Supporting Hydration and Participation

As dysphagia management continues evolving beyond an aspiration-centric framework, assistive technology may play an increasingly valuable role in supporting functional outcomes. Adaptive intake technologies are widely utilized across mobility, communication, hearing, and activities of daily living. Yet adaptive drinking systems remain relatively underrepresented within dementia care discussions despite the substantial challenges many individuals experience with hydration and self-feeding.

The RoseCup® System represents one example of an adaptive drinking solution designed to support more controlled fluid intake and accessibility during drinking tasks.

For individuals living with Alzheimer's disease who experience tremor, weakness, reduced coordination, impaired motor planning, fatigue, or difficulties managing conventional drinking vessels, the RoseCup® System may help support:

• controlled bolus delivery
• drinking stability
• hydration opportunities
• self-feeding access
• caregiver efficiency
• mealtime participation
• person-centered quality-of-life outcomes

Importantly, adaptive intake technologies are not intended to replace skilled swallowing assessment or intervention. Rather, they may help support accessibility and implementation of clinical recommendations within the environments where individuals actually live, eat, and drink.
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Looking Forward During Alzheimer's & Brain Awareness Month

As Alzheimer's & Brain Awareness Month encourages healthcare professionals to reflect on the broad impacts of neurodegenerative disease, dysphagia deserves greater recognition within the conversation. For many individuals living with Alzheimer's disease, swallowing dysfunction becomes a central driver of nutritional compromise, dehydration risk, caregiver burden, hospitalization, and declining quality of life. Aspiration prevention remains essential.

However, the future of dementia-related dysphagia care will likely require a broader clinical framework that equally values hydration, nutrition, participation, dignity, caregiver support, and functional swallowing outcomes. As evidence continues to evolve, interdisciplinary approaches that integrate medical management, swallowing expertise, caregiver education, and assistive technology may help support more sustainable and person-centered care for individuals living with Alzheimer's disease across the continuum of care.

Jessica Ackerman, MS,CCC-SLP, is a Speech-Language Pathologist and dysphagia specialist with more than 25 years of experience in swallowing disorders, neurological rehabilitation, digital health, and healthcare innovation. As a clinical consultant to Lifemere, she is passionate about advancing person-centered dysphagia care through education, innovation, and practical solutions that support hydration, participation, independence, and quality of life.

Link to relevant articles:
Dysphagia Management Beyond Diet Modification: Reframing Clinical Goals Toward Hydration, Participation, and Quality of Life
Dysphagia Awareness Month 2026: Expanding the Conversation Beyond Aspiration to Functional Living and Assistive Technology
National Nursing Assistants Week: The Overlooked Frontline of Dysphagia Management, Hydration Monitoring, and Functional Swallowing Care