Dementia is a degenerative neurological syndrome, characterized by the presence of cognitive decline and/or behavioral changes that impact the functionality of the individual. The presence of dysphagia, change in swallowing, in the elderly with dementia can cause dehydration, malnutrition and respiratory infections, and can lead to death. This leads to an unfavorable prognosis, increasing the length of hospital stay and health expenses. The literature reports that, through the clinical evaluation of swallowing, it is possible to verify its functionality, classify the severity of dysphagia and collect information that helps in the understanding of the case and prognosis.

To verify the functionality of swallowing in the elderly with severe dementia. It has a secondary objective to describe the sample and its clinical characteristics.

A case series was carried out through consultation of secondary data. The study took place at a Reference Center for Health Care for the Elderly in the Federal District, between September 2017 and December 2019. The following data were collected: age, sex, type of dementia, medical diagnoses, and functional classification of swallowing, which was defined after the patients underwent clinical evaluation. The functionality of swallowing was classified into normal, functional swallowing, mild, moderate, or severe dysphagia.

The participants were five women and three men. The average age was 82.62 ± 6.23. All had a diagnosis of dementia, according to the criteria of the National Institute of Neurological and Communicative Diseases and Stroke - Alzheimer's Disease and Related Disorders Association and a 3-point score in the CDR (Clinical Dementia Rating). Four individuals had a diagnosis of vascular dementia, three (37.5%) Alzheimer's Disease and only one (12.5%) mixed dementia.

Four individuals (50%) had systemic arterial hypertension, three (37.5%) sleep disorders, three (37.5%) history of stroke, two (20%) depression, two (20%) hypothyroidism, two (20%) behavioral disorder, two (20%) dyslipidemia. Other conditions observed: postural instability, sphincter incontinence, asthma, osteoporosis and heart disease. At the time of the clinical evaluation of swallowing, five patients (62.5%) had dysphagia, three of whom were severe, one was moderate and the other mild. Two (20%) had normal swallowing, and one (12.5%) had functional swallowing.

Clinical evaluation was shown to be effective in identifying dysphagia in elderly people with dementia. However, through the objective assessment of swallowing, through imaging exams, it is possible to verify aspects that cannot be observed through clinical evaluation. Therefore, future studies may add objective assessment as a complementary evaluation and assist in the conclusion of the speech-language diagnosis.

There is a need for better management of dysphagia, including its evaluation with a reliable method, avoiding its underdiagnosis. There is a need for action at the three levels of health care. The results of this study can contribute to the construction of these actions.