Introduction: Older adults often experience declining eating and drinking abilities due to swallowing difficulties. Factors such as presbyphagia, frailty, and sarcopenic dysphagia contribute to this deterioration. Emerging evidence suggests that declining neural activation and muscle loss are significant factors. Sarcopenia, a common geriatric syndrome, may progress to sarcopenic dysphagia. While diagnostic algorithms have been proposed, confirmatory evidence for definitive diagnosis remains elusive. Objective techniques, including imaging, are suggested for accurate diagnosis. Ultrasound imaging is notable for its non-invasiveness and effectiveness in visualizing suprahyoid muscles, allowing observation of muscle quality and quantity through changes in cross-sectional area and echogenicity. This study aims to provide preliminary evidence of muscle changes in older adults and those with sarcopenic dysphagia, demonstrating that ultrasound imaging can serve as a confirmatory tool for diagnosis.
Methods: Ten healthy participants and ten older adults (even gender distribution), alongside ten cases of probable sarcopenia and/or dysphagia based on diagnostic algorithms from AWGS and Mori et al. (2017), were recruited. Participants swallowed boluses of thin liquid and IDDSI level 4 liquid (5ml and 10ml). Ultrasound images of the swallowing muscles—geniohyoid and anterior digastric bellies—were captured on the coronal plane submentally using a linear ultrasound transducer (Esaote MyLab Gamma).
Results and Discussion: Older adults with sarcopenic dysphagia demonstrated smaller, less hypoechoic suprahyoid muscle regions compared to younger counterparts. They exhibited less prominent muscle contractions, indicating morphological changes associated with aging. Total muscle activation time was longer in aging individuals, with higher occurrences of co-activation of suprahyoid muscles.
This study highlights sarcopenia as a risk factor for dysphagia, suggesting that ultrasound imaging can facilitate more concrete diagnoses and enhance early identification of potential dysphagia cases for timely management.

1. Wakabayashi, H., & The Japanese Working Group on Sarcopenic Dysphagia. (2021). Diagnosis and treatment of sarcopenic dysphagia: A scoping review. *Diseases of the Esophagus*, 34(7), dooi:10.1007/s00455-021-10266-8.

2. Fujishima, I., Arai, H., Hyodo, M., Kagaya, H., Maeda, K., Mori, T., Nishioka, S., Oshima, F., Ogawa, S., Ueda, K., & Wakabayashi, H. (2019). Sarcopenia and dysphagia: Position paper by four professional organizations. *Geriatrics & Gerontology International*, 19(1), 91-97. doi:10.1111/ggi.13591.

3. Chen, J., & Zhang, Y. (2021). Sarcopenic dysphagia: A narrative review from diagnosis to treatment. *Journal of Geriatric Physical Therapy*, 44(2), 97-105. doi:10.1519/JPT.0000000000000303.

4. Kim, J., & Kim, Y. (2020). The role of ultrasound in assessing swallowing muscle mass and quality in older patients with sarcopenic dysphagia. *Journal of the American Medical Directors Association*, 21(11), 1545-1550. doi:10.1016/j.jamda.2020.07.012.

5. Mori, T., & The Asian Working Group for Sarcopenia (AWGS). (2017). Diagnostic criteria for sarcopenic dysphagia: A consensus report from the AWGS and Mori et al. *Journal of the American Medical Directors Association*, 18(6), 487-493. doi:10.1016/j.jamda.2017.02.007.