Analysis of chewing efficiency in dementia patients using two-color chewing gum test and the viewgum software

Abstract

The purpose of this study was to analyze the relationship between chewing efficacy and severity level of cognitive impairment in dementia patients using a smartphone with ViewGum software for chewing efficiency analysis. Participants (n=70) from the Dementia Clinic, King Chulalongkorn Memorial Hospital, included 38 dementia patients (76.1±9.0 years) and 32 patients (71.8±9.9Years) with mild cognitive impairment (MCI), diagnosed by the medical specialists. The cognitive impairment was assessed by the TMSE (Thai Mental State Examination), and then scored. Participants were assessed for chewing efficacy using the mixing ability test of the two-color chewing gum, followed by an analysis using the ViewGum software. The data analysis revealed the variance of hue (VOH) as the measure of the two-color mixture. Inadequate mixing of the two colors presents with VOH larger than the complete mixture. The images of mixing colors in the gum were taken by the smartphone, and then compared to the scanner by intraclass correlation coefficients (ICCs). The analysis demonstrated ICCs of 0.97 indicating the excellent reliability (0.96; p<0.001;95%CI 0.955-0.982) of the two methods. The chewing efficacy, analyzed from the images taken by the smartphone (P=0.01) and the scanner (P=0.02), of dementia patients was significantly different from patients with MCI shown by Independent t-test analysis. The simple linear regression analysis revealed a significant association between VOH and TMSE score analyzed from the images taken by the smartphone (F(1,53)=6.566, P=0.013, R2= 0.110), and the scanner (F(1,53)=6.437, P=0.014, R2=0.108). This study suggested that the chewing efficacy can be simply analyzed with the two-color chewing gum test and a smartphone image capture for ViewGum software analysis. Within the limitation of this study, the participants demonstrated a significant association between chewing efficacy and the severity level of cognitive impairment. Further studies are necessary to determine whether chewing efficacy can support a prediction of the cognitive impairment in patients with early signs of dementia.