Vocal Fold Atrophy in Patients With Alzheimer's Disease and Related Dementias

OBJECTIVES: Alzheimer's disease and related dementias (AD/ADRD) can lead to deterioration in voice and swallowing. Vocal fold atrophy (VFA), seen with aging and neurodegenerative disease, results in thin/bowed vocal folds with incomplete glottic closure during voicing and swallowing, leading to breathy voice from air leakage. Magnitude of VFA in AD/ADRD has not been previously studied. This study compared endoscopic measures of VFA in AD/ADRD patients with age-matched controls. METHODS: Thirteen patients with a diagnosis of AD (n = 3), Lewy body dementia (n = 3), vascular dementia (n = 1), or multiple-etiology dementias (n = 6) presenting to a tertiary laryngology practice were included in this cross-sectional study. Demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), Voice Handicap Index-10, and stroboscopic still images were obtained. Images were analyzed for bowing index (BI), normalized glottal gap area (NGGA), and normalized mucosal wave amplitude (NMWA). Two age-matched controls were selected for each patient, yielding 13 AD/ADRD patients and 26 controls (1:2 ratio). RESULTS: Mean age for patients was 80 ± 10 years. AD/ADRD patients demonstrated higher BI scores compared with controls (4.51; 95% CI [1.39, 7.63]; p = 0.008). AD/ADRD patients displayed significantly lower NMWA values (-8.2; 95% CI [-9.8, -6.6]; p < 0.0001). No significant difference seen in NGGA between groups (0.26; 95% CI [-1.69, 2.43]; p = 0.7). CONCLUSION: This is the first study to quantify VFA in AD/ADRD patients. Endoscopic measures revealed significant atrophic differences compared with age-matched controls. These measures may serve as potential laryngeal indicators of neurodegenerative involvement in ADRD, though larger studies are needed to establish clinical utility.