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1 210-3.,* /,**.,**/,* /1/ -2, / ,0 1/ +, +++ Cl, X +,, X 32* 2/1/. + TELFAX *,, , takae_ Montreal@hotmail.com

2 J. Japan Association on Odor Environment Vol. -3 No..,** / -*.* / / +/ mm P P -1./ -2 P P insular region -, - CT

3 212-3.,* P., 0 0 GERD : Gastroesophageal Reflux Disease,. 1 0*+* 0* /, 2* /, + +* P 2*.. GERD 1* GERD Non-Erosive Reflux Disease NERD 0*. 0 predictor NERD GERD ADL : Activities of Daily Living Los Angels GERD / insula Grade A +, 0 A B

4 J. Japan Association on Odor Environment Vol. -3 No..,** GER stridor +-,. ph ph. ALS : Amyotrophic Lateral Sclerosis +. GER ALS.- +/ +-., vs /..- ADL,* 0..- ALS +0,./ Hoehn- Yahr P +2 / - MSA : Multi- -1/. log mgml ple System Atrophy +3

5 214-3.,* + WST : Water Swallowing Test RSST : The Repetitive Saliva Swallowing Test Swallowing Provocation Test VF : Videofluorography + CT MRI - 1 / 1 P - : P MRSA Methicillin-Resistant Staphy- ACE lococcus Aureus : ACE 1 MRSA,*,

6 J. Japan Association on Odor Environment Vol. -3 No..,**2 215 SD *42-1,2 +*,. *4/- ADL SD -. +/ -/ +0 *41* SD -3,, +1 +, *4*+ SD /+ -0-1,, *4*. SD +/++. +*2*0 +* *4*/ MRSA n n, ACE P n-/ n-- Unpaired t test Chi-square test +0. *4*+ +/ / *4*-,+ GERD, P,, *.* +-, -* 0*,- 0, 0 Transient Receptor Potential TRP ; TRPV+ TRPV, TRPV- TRPV. TRPM2 TRPA+, TRPV+.- TRPV, + 01 /, --, -3.,1-/ 2,1,.. TRPV TRPV TRPM,/,2 TRPA TRPV+ TRPV, TRPM2 TRPA+ +*.* + - TRP + - +* -,/ P,0 TRPV+ + TRPV+ TRPV+,2

7 216-3.,* -*.* p *.*/ * Menthol A B 2 TRPV+ TRPV, TRPM2. -, 3 +* +* +* M + -* +* A,3 3, + - P +* B

8 J. Japan Association on Odor Environment Vol. -3 No..,** ,. ADL ADL +- 0/ -, +0 + Kanie /** ml / g P *. +,, -+ -, ++ A B Substance P C + D

9 218-3.,* +, Black pepper +- Drug Delivery System +3-1 : P TRP + Teramoto, S. et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients : a multicenter, prospective study in Japan, J. Am.Geriatr. Soc., /0, /113, (,**2)., Kikuchi, R., Watabe, N., Konno, T. et al : High incidence of silent aspiration in elderly patients with community-acquired pneumonia, Am J Respir Crit Care Med, +/*,,/+,/-, ( +33. ). - Yamaya M., et al : Interventions to prevent pneumonia among older adults, J. Am. Geriatr.Soc.,.3, 2/ 3*,

10 J. Japan Association on Odor Environment Vol. -3 No..,**2 219 (,**+). +2 Ebihara, S.et al : Impaired E$ cacy of cough in pa-. Zald, D.H. et al : The functional neuroanatomy of tients with Parkinson disease, Chest, +,., +**3 +*+/, voluntary swallowing, Ann Neurol.,.0,,2+,20, ( +333 ). (,**-). / Okamura, N. et al : Aspiration pneumonia and insular +3 Nakazawa, H. et al. : Risk of aspiration in the elderly, hypoperfusion in patients with cerebrovascular dis- Chest, +*-, , ( +33-). ease, J. Am. Geriatr. Soc., /,, 0./ 0.0, (,**.).,* Kanda, A. et al : A combinatorial therapy for pneu- 0 Nakagawa, T. et al : High incidence of pneumonia in monia in elderly people, J. Am. Geriatr. Soc., /,, , elderly patients with basal ganglia infarction, Arch. (,**.). Intern. Med., +/1, -,+ -,., ( +331 ).,+ Ebihara, T. et al. : Theophylline-improved swallow- 1 Nakagawa, T. et al, Sasaki, H. : Silent cerebral infarc- ing reflex in elderly nursing home patients, J. Am. tion : a potential risk for pneumonia in the elderly, J Geriatr. Soc., /,, , (,**.). Intern Med,,.1,,// /3, (,***).,, He, M. et al : Mosapride citrate prolongs survival in 2 Wada, H. et al : Risk factors of aspiration pneumonia stroke patients with gastrostomy., J. Am. Geriatr Soc., in Alzheimer s disease patients, Gerontology,.1,,1+,10, //, +.,., (,**1). (,**+),- Matsui,T. et al : Sitting position to prevent aspiration 3 Matui, T. et al. : Plasma homocysteine and risk of in bed-bound patients, Gerontology,.2, +3. /, (,**,). co-existing silent brain infarction in Alzheimer s dis-,. Yoneyama, T. et al : Oral care and pneumonia, Lancet, ease, Neurodegenerative disease,,,,33-*., (,**/). -/., /+/, ( +333). +* Furukawa, N. et al. : Proportion of reflux esophagitis,/ Yoshino, A. et al : Daily oral care and risk factors for in 0*+* Japanese adults : prospective evaluation by en- pneumonia among elderly nursing home patients., doscopy, J gastroenterol, -.,..+, ( +333 ). JAMA.,,20,,,-/,,-0, (,**+). ++ Mishima, I. et al : Prevalence of endoscopically nega-,0 Watando, A.et al : Daily oral care and cough reflex tive and positive gastroesophageal reflux disease in the sensitivity in elderly nursing home patients, Chest, +,0, Japanese, Scand J Gastroenterol,.*, +**/, (,**/). +*00 +*1*, (,**.). +, Lasch, N. et al. : Evidence for diminished visceral,1 Watando, A. et al : E# ect of temperature on swallowpain with aging : studies using graded intraesophageal ing reflex in elderly patients with aspiration pneumoballon distension., Am J Physiol,,1,, G +, ( +331 ). nia., J. Am. Geriatr. Soc., /.,,+.-,+.., (,**.). +- Ebihara, S. et al. : Contribution of gastric acid in,2 Ebihara, T. et al : Capsaicin and swallowing reflex, elderly nursing home patients with cough reflex hyper- Lancet, -.+,.-,, ( +33-). sensitivity, J. Am. Geriatr. Soc., //, , (,**1).,3 Ebihara, T. et al : Capsaicin troche for swallowing +. Ebihara, T. et al : Acid and swallowing reflex, Geriatr. dysfunction in older people, J. Am. Geriatr. Soc., /-, 2,. Gerontol. Int., 1, 3. 3/, (,**1). 2,2,(,**/). +/ Nakajoh, K. et al : Relation between incidence of -* Ebihara, T. et al : E# ects of menthol on the triggering pneumonia and protective reflexes in post-stroke paagia, of the swallowing reflex in elderly patients with dysph- tients with oral or tube feeding, J Intern Med,,.1, -3, Br. J. Clin.Pharmacol, 0,, , (,**0). (,***). -+ Ebihara, T. et al : A randomized trial of olfactory +0 McClave, S.A, et al : Poor validity of residual volume stimulation using black pepper oil in older people with as a marker for risk of aspiration, Crit Care Med,,3, swallowing dysfunction, J. Am. Geriatr. Soc., /., +.*+ +.3/,(,**+). +.*0,(,**0). +1 Dennis, M.S. et al. : E# ect of timing and method of -, Kanie, J. et al : Prevention of gastroesophageal reflux enteral tube feeding for dysphagic stroke patients using application of half-solid nutrients in patients (FOOD) : a multicentre randomized controlled trial, with percutaneous endoscopic gastrostomy feeding, J. Lancet, -0/, ,, (,**/). Am. Geriatr. Soc., /,,.00.13, (,**.).

11 220-3.,* Olfactory Stimulation and Dysphagia in the Elderly Takae EBIHARA MD.PhD., Satoru EBIHARA MD.PhD. and Hiroyuki ARAI MD.PhD. Department of Geriatrics and Gerontology, Institute of Development, Aging, Cancer Research, Tohoku University,. +, Seiryo-machi, Aoba-ku, Sendai, 32* 2/1/, Japan Abstract Aspiration frequently occurs in the elderly. Most aspiration in the elderly does not contribute to neuro-,or muscle-degeneration of the pharynx and larynx but the sensory and transmission impairment of neurons in the brain. Not only medical approaches but also caring/nursing approaches on neurons related to aspiration are important in medication for pneumonia or prevention of aspiration. In particular, olfactory stimulation with black pepper oil improves the swallowing reflexible movement in the elderly with dysphagia. The integrated approach with medication such as an angiotensin-converting enzyme or a dopaminergic agent, oral care, meal temperature, spice with capsaicin and menthol, and olfactory stimulation with black pepper oil can prevent aspiration or aspiration pneumonia in the elderly. (The number of words : ++-) Key words : swallowing disorder, aspiration pneumonia, doparminergic-substance P neurons, transient receptor potential (TRP), olfactory stimulation