An 80-year-old man comes to the office for evaluation of persistent dry mouth and difficulty chewing food. He has had no dry eyes or joint pains. The patient has no chronic medical conditions and takes no medications. On examination, there is decreased saliva production but no tenderness or swelling of the salivary glands. Extensive dental caries are present. Laboratory results show negative anti-Ro/SSA and anti-La/SSB antibodies. Which of the following age-related changes is most likely responsible for this patient's symptoms?

Question

An 80-year-old man comes to the office for evaluation of persistent dry mouth and difficulty chewing food.  He has had no dry eyes or joint pains.  The patient has no chronic medical conditions and takes no medications.  On examination, there is decreased saliva production but no tenderness or swelling of the salivary glands.  Extensive dental caries are present.  Laboratory results show negative anti-Ro/SSA and anti-La/SSB antibodies.  Which of the following age-related changes is most likely responsible for this patient's symptoms?

Quizplus · Accepted Answer

11ec160b_3cbe_c88d_9249_dda205012597_MD0001_00 Elderly patients are at increased risk of dysphagia due to age-related physiologic changes in the upper aerodigestive tract. Acinar atrophy and fatty infiltration affecting the parotid salivary glands result in a dramatic reduction (~50%) in saliva production, which frequently leads to xerostomia. This decrease in saliva is often accompanied by age-related mucosal atrophy, which manifests as receding gums with increased exposure of tooth roots; these changes increase the risk of tooth decay in elderly patients. Elderly patients also commonly have a decrease in muscle mass and loss of connective tissue elasticity, which can impact the muscles of mastication, intrinsic and extrinsic tongue muscles, and pharyngeal constrictors. These alterations can lead to difficulty forming food into a bolus and propelling food from the oral cavity into the oropharynx and then into the esophagus. In addition, elderly patients have a decreased sense of taste and smell and impaired airway protective reflexes. They also are more likely to have comorbid neurologic diseases (eg, stroke, Parkinson disease) that further increase the risk of dysphagia. Dysphagia can lead to malnutrition and aspiration, both of which cause significant morbidity and mortality in the elderly. (Choice B) Involvement of the salivary glands by systemic amyloidosis is common, but amyloid deposition significant enough to lead to dysphagia is very rare; normal age-related physiologic changes are much more likely in this patient. (Choice C) Fibrosis and focal lymphocytic infiltration into the salivary glands are seen in Sjögren syndrome, an autoimmune disease impacting exocrine glands (eg, salivary, lacrimal, vaginal). Although patients often have dry mouth, they also typically have dry eyes and positive anti-Ro/SSA and/or anti-La/SSB antibodies. (Choice D) Granulomatous inflammation of the salivary glands is seen in uveoparotid fever (ie, Heerfordt syndrome), an uncommon manifestation of sarcoidosis characterized by acute fever, parotitis, and anterior uveitis. (Choice E) Elderly patients with xerostomia are at risk of acute sialadenitis, an infection of the salivary glands caused by retrograde seeding of bacteria from the oral cavity. Patients have acute, typically unilateral salivary gland swelling, exquisite pain, and fever. Educational objective: Elderly patients have decreased saliva production due to acinar atrophy and fatty infiltration of the salivary glands. Other age-related changes include oral mucosal atrophy; weakening of the muscles of mastication, tongue muscles, and pharyngeal constrictors; and a decreased sense of taste and smell. As a result, elderly patients are at increased risk of dysphagia, malnutrition, and pneumonia.

An 80-Year-Old Man Comes to the Office for Evaluation of Persistent