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Rationale: Oropharyngeal dysphagia (OD) is a major contributor to malnutrition. Starch-based thickeners improve safety of deglutition but increase residue. We aimed to evaluate the therapeutic effect of a xanthan gum-based thickener, Resource®ThickenUp Clear (RTUC, Nestle Health Science). Methods: We studied 120 patients with OD with videofluoroscopy while swallowing a series of 5 20mL liquid boluses at nectar, thin and extreme spoon-thick (EST) viscosities measured at 50/s 20oC and obtained with a hydrosoluble X-Ray contrast (50/50 vol with water) and RTUC. We assessed prevalence of penetrations and aspirations for impaired safety, oropharyngeal residue for impaired efficacy, bolus velocity, timing of the swallow response, and the nutritional risk (MNASF, NRS 2002). Results: Prevalence of malnutrition or risk of malnutrition was 71% according to MNA-SF and 76% according to NRS 2002. Increasing bolus viscosity: a) improved safety of swallow as 24% of patients with OD presented safe swallow at thin, 55% at nectar (P< 0.001) and 85% at EST (P< 0.001). Prevalence of aspiration was 16% at thin, 9% at nectar (P< 0.01) and 5% at EST (P< 0.01). The score of the penetration-aspiration scale was 3.3±0.2 (thin), 2.2±0.2 (P< 0.001, nectar) and 1.5±0.1 (P< 0.001, EST); b) did not enhance oropharyngeal residue; c) did not affect timing of swallow response; d) reduced bolus velocity from 0.25±0.01m/s at thin to 0.21±0.01m/s at EST (P< 0.05). Conclusion: Prevalence of malnutrition among neurological and older patients with OD is very high. Increasing bolus viscosity with RTUC exerts a strong therapeutic effect by improving the safety of swallow without increasing oropharyngeal residue, an advantage of new generation versus conventional thickening agents. This effect might help to improve the nutritional treatments for these patients. Disclosure of Interest: L. Rofes: None Declared, V. Arreola: None Declared, R. Mukherjee: None Declared, P. Clave Grant/Research Support from: Nestec Ltd

Rationale: To determine the relationship between oropharyngeal dysphagia (OD), nutritional status and clinical outcome in elderly patients with acute diseases admitted to a general hospital. Methods: Prospective observational study of 1662 patients over 70 years of age consecutively hospitalized in an acute geriatric unit (AGU) in a general hospital. Dysphagia was clinically assessed with the volumeviscosity swallow test (V-VST) and nutritional status with the Mini Nutritional Assessment. Other measurements taken during admission were anthropometry and laboratory values, comorbidities (Charlson index), cognitive status (Pfeiffer) and functional capacity (Barthel index). Mortality during admission, referral to nursing homes and mortality at 12 months after discharge were also monitored. Results: Up to 52.6% patients admitted to the AGU presented clinical signs of OD and a) more comorbidities (2.42+1.6 vs 2.02+1.6 p < 0.001), poorer functionality both pre-admission and at discharge (p < 0.001), more geriatric syndromes (93.3% vs 72.5% p < 0.001) and poorer outcome (1 year mortality 48.7 vs 25.1%) (p < 0.001) and b) higher prevalence of malnutrition (MNA< 17 45.3% vs 18%, p < 0.001; BMI 25.5 vs 26.8, p < 0.001) and albumin

Rationale: Recent literature suggests that diabetes is a risk factor for Parkinson’s disease (PD). We investigated the clinical features of idiopathic PD (IPD) patients in whom the onset of diabetes came first. Methods: We designed a case-control study. From the cohort of all new IPD patients free of vascular disease (n = 783) admitted and evaluated at our Institute over a 3-year period (2007 2010) we included all the patients with a diagnosis of diabetes prior to PD onset (n = 89) and a control group (n = 89) matched (1:1) for gender, body mass index (±1 kg/m2) and duration of PD (±1 year). The Unified PD Rating Scale (UPDRS) motor score was the primary endpoint. Results: At study entry, patients with diabetes were similar to controls in terms of most demographic, lifestyle and general medical features with exception of statins (18% vs. 3.4%; P= 0.003). However, diabetes was associated with higher UPDRS motor (22.3±9.0 vs. 19.3±7.9; P= 0.019) and activities of daily living (9.7±5.1 vs. 8.3±4.3; P= 0.049) scores, more severe Hoehn-Yahr staging (P= 0.009) and higher treatment doses of levodopa (mg/day, 448±265 vs. 300±213; P< 0.0001; mg/kg/day, 5.8±4.0 vs. 3.8±2.9; P< 0.0001). Conclusion: Onset of diabetes before the onset of PD appears to be a risk factor for more severe PD symptoms. These findings support the hypothesis that diabetes has a role in the etiopathogenesis of PD. Neurologists should be aware of the potential impact of diabetes on overall PD patient management.