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. Level of Evidence 3.