Research Article Auditory Verbal Cues Alter the Perceived ...downloads.hindawi.com/journals/bmri/2013/892030.pdf · Analysis . To test the e ects of the presence or absence of auditory

Hindawi Publishing CorporationBioMed Research InternationalVolume 2013 Article ID 892030 10 pageshttpdxdoiorg1011552013892030

Research ArticleAuditory Verbal Cues Alter the Perceived Flavor ofBeverages and Ease of Swallowing A Psychometric andElectrophysiological Analysis

Aya Nakamura and Satoshi Imaizumi

Department of Communication Science and Disorders Faculty of Health and Welfares Prefectural University of Hiroshima1-1 Gakuen Mihara Hiroshima 723-0053 Japan

Correspondence should be addressed to Aya Nakamura a-nakamurapu-hiroshimaacjp

Received 18 April 2013 Revised 17 July 2013 Accepted 17 July 2013

Academic Editor Nader Pouratian

Copyright copy 2013 A Nakamura and S Imaizumi This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

We investigated the possible effects of auditory verbal cues on flavor perception and swallow physiology for younger and elderparticipants Apple juice aojiru (grass) juice and water were ingested with or without auditory verbal cues Flavor perception andease of swallowing were measured using a visual analog scale and swallow physiology by surface electromyography and cervicalauscultation The auditory verbal cues had significant positive effects on flavor and ease of swallowing as well as on swallowphysiology The taste score and the ease of swallowing score significantly increased when the participantrsquos anticipation was primedby accurate auditory verbal cues There was no significant effect of auditory verbal cues on distaste score Regardless of age themaximum suprahyoid muscle activity significantly decreased when a beverage was ingested without auditory verbal cues Theinterval between the onset of swallowing sounds and the peak timing point of the infrahyoidmuscle activity significantly shortenedwhen the anticipation induced by the cuewas contradicted in the elderly participant groupThese results suggest that auditory verbalcues can improve the perceived flavor of beverages and swallow physiology

1 Introduction

Pureed or minced food which is served to patients suf-fering from dysphagia to prevent aspiration is not easilyrecognized based on appearance Individuals with disordersin the anticipatory stage may have difficulties in recognizingeven ordinary foods These difficulties in recognition mayhave a negative influence on flavor perception resulting indecreased appetite Previous reports however have suggestedthat nonverbal as well as verbal information can have signif-icant positive effects on flavor perception For example theperceptual rating score of the flavor of fruit juice increasedwhen pictures of juice were shown during ingestion [1]Potato chipswere perceived as being crisper and fresherwheneither the overall level or the level of the high-frequencycomponents of biting sounds was amplified [2] Swallowingbehavior is initiated more quickly when drinking water whileviewing photographs of food than photographs of common

items [3 4] A significant positive effect of verbal priming onolfactory perception was also reported that is participantsrated the affective value of a tested odor as being morepleasant when labeled ldquocheddar cheeserdquo than when labeledldquobody odorrdquo [5] These reports suggest that nonverbal aswell as verbal information could be utilized to improveflavor perception and to enhance appetite even for pureedor minced foods that have an unfamiliar appearance Thusthe purpose of this study was to investigate whether spokeninformation about food before ingesting has a positive effecton flavor perception and swallowing physiology If so thenthis technique could facilitate dysphagia rehabilitation

2 Materials and Methods

21 Participants Participants were screened for any clinicalsigns of hearing disorders dysgeusia dysosmia dysphagiaand for any medical problems or medications that might

2 BioMed Research International

affect hearing tasting smelling or swallowing Each partici-pant gave hisher informed consent prior to the study Partic-ipants were asked to refrain from drinking and eating for atleast 2 hours before the experimental session Participants inExperiments 1 and 2 were recruited separately

Experiment 1 Participants were 24 people (7 men and 17women) between the ages of 20 and 69 years

Experiment 2 Participants were divided into two groupsbased on age one group of 11 younger people (1 man and 10women) between the ages of 20 and 30 years (mean age of217) and one group of 8 elder people (3 men and 5 women)between the ages of 65 and 75 years (mean age of 684) wereincluded

22 Stimulus Five mL of apple juice aojiru (grass juice)or water was placed on the dorsum of each participantrsquostongue by the examiner using a 10mL syringe (SS-10ESZ30NIPRO) All beverages were presented at room temperature(22-23∘C) The syringe was hidden by plastic tape Thename of the beverage (auditory verbal cue) ldquoRingordquo (applejuice) ldquoAojirurdquo (grass juice) ldquoOmizurdquo (water) or silence waspresented through a speaker (PM-1 Fostex)

We did not use primary taste solution because individu-als with dysphagia usually eat food of complex flavor ratherthan primary taste Stimuli were selected on the grounds thatthese three types of beverages are clearly different in flavor

23 Experimental Conditions There were 2 experimentalconditions the absence condition (3 beverages times 3 times =9 trials) and the presence condition (3 beverages times 3 auditoryverbal cues once each = 9 trials) These conditions includedAccurate auditory verbal cues (the spoken cue correctlyidentified the beverage) Inaccurate (the spoken cue did notcorrectly identify the beverage) and Absence (absence ofspoken cues)

24 Configuration Surface electromyography (sEMG) andcervical auscultation were used The configuration (Fig-ure 1) included a sEMG system (Personal EMG 4CHOisakadenshikiki) AD converter (ML870PowerLab830AD Instruments) contact microphone (ECM-TL1 Sony)microphone amplifier (AT-MA2 Audio-Technica) recorder(CD-2 Roland) personal computer (VPCF12AHJ Sony)control instrument (IS-703 IWATSU) and speaker (PM-1Fostex)

The EMG activity associated with swallowing wasrecorded using bipolar surface electrodes (Arbo H24 Covi-dien Japan) All electrodes were taped to the skin usingdouble-sided adhesive collars Specific electrode positionswere as follows (a) a pair of bipolar surface electrodes wastaped to the skin beneath the chin to record activity inthe suprahyoid muscles and (b) a pair of bipolar surfaceelectrodes was placed on the lower right side of the thyroidcartilage to record activity in the infrahyoidmuscles A singleelectrodewas affixed to the left side of the outer ear as ground

Swallowing sounds were recorded using a contact micro-phone (ECM-TL1 Sony)The contactmicrophonewas placedon the front of sternocleidomastoid muscle The signals fromthe 2 pairs of electrodes and the contact microphone wererecorded using an AD converter (ML870PowerLab830 ADInstruments) with a sampling rate of 2 kHz

25 Experimental Design The experiment was carried out asfollows (Figure 2) during the study participants sat in a chairParticipants were asked to imagine the flavor of a beveragebased on auditory verbal cues (name of the beverage) andthen a beverage was injected into their mouth They wereinstructed to hold the beverage in their mouth for 5ndash7 suntil given direction to swallow They were also instructedto swallow the beverage in a single swallow The participantsrated flavor perception and ease of swallowing using a visualanalog scale (VAS) (Figure 3) Participants rinsed theirmouthwith water after each swallow Every participant completedthe absence trials first followed by the auditory verbal cueconditions

Beverages and auditory verbal cues were presented in arandom order

26 Measurements

261 VAS Scores We used ldquotaste scorerdquo as an indicator ofdelicious tasty nice flavor and ldquodistaste scorerdquo as an indicatorof no good nasty bad flavor ldquoSwallowing easerdquo was used asan indicator of ease of bolus transit pharynx

We used both ldquotaste scorerdquo and ldquodistaste scorerdquo becausewe assumed that distaste score is not an indication in theopposite of the taste scorersquos spectrum Taste score is theindicator of the good or no taste when food intake is possibleand safety On the other hand distaste score is the indicatorof the taste including the judgment of whether or not foodintake is possible

262 Physiological Parameters The parameters for analysisare shown in Figure 4 The original EMG signal was high-pass filtered (over 10Hz) squared and then low-pass filtered(under 10Hz) to calculate the time series of the EMG powerWe then divided the peak of the EMG power by the averagepower during the 5 sec rest period before the first and finaltrials for each muscle to obtain the maximum values ofsuprahyoid muscle activity and infrahyoid muscle activityThe maximum value of muscle activity is the power valueduring swallowing when the power of the rest of the trialis equivalent to 1 Measurements for each swallow wereconducted using the time series of the EMG power andLabchart 7 (AD Instruments)

As swallowing parameters we measured the latency ofthe swallowing sound the latency of suprahyoid muscleactivity the latency of infrahyoid muscle activity the intervalbetween the onset of the swallowing sound and the peaktiming point of infrahyoid muscle activity the maximumvalue of suprahyoid muscle activity and the maximum valueof infrahyoid muscle activity

BioMed Research International 3

Recorder

AD converter

Amplifier

Control instrument

Speakers

Contact microphone

Bipolar surface electrodes

Computer

sEMG system

Figure 1 A schematic diagram of the instrumentation used for the collection of EMG data and swallowing sounds

Auditory verbal clues Ingestion of

drinkDirection of

swallowMeasure

using a VAS

Rinse mouth

1 minute

5ndash7 sec

1 sec After swallow

Figure 2 A schematic diagram of the time course of the task

0 Taste 100

0 Distaste 100

0 Swallowing ease 100

Figure 3 A visual analog scale used to measure the taste scoredistaste score and swallowing ease score

The latency of the swallowing sound was measured as theduration between A (the point at which direction to swallowwas given) and B (the point at which the swallowing sound

started) The latency of suprahyoid muscle activity was theduration between A and C (the peak point of suprahyoidmuscle power) The latency of infrahyoid muscle activitywas the duration between A and D (the peak point ofinfrahyoid muscle power) The interval between the onset ofthe swallowing sound and the peak timing point of infrahyoidmuscle activity was the duration between B and D

It has been noted that infrahyoid muscles are related tolaryngeal decline [6]The activation of the infrahyoidmusclesoccurs after the pharyngeal reflex starts which impliesthat the activity takes place during the pharyngeal phaseof swallowing However the latency of infrahyoid muscleactivity (which is calculated by subtracting the onset of thedirection to swallow from the peak of infrahyoidmuscle EMGpower) includes the duration of the oral phase of swallowingwhich occurs before the pharyngeal reflex beginsThe latencyof the swallowing sound is reportedly affected by age [7ndash9]


swallow

IH (v)

Mic

(v)

SH (v)

IH (v)

A

B

C

D

(1)

(2)

(3) (4)

Mic

(v)

SH (v)

2151050

(5)998400

(6)998400

RestAuditory verbal clues

Direction of

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14(s)

(s)

Figure 4 A schematic illustration of the definitions of the parameters for analysis A the point at which the direction to swallow is given Bthe point at which the swallowing sound starts C the point at the peak of suprahyoid muscle power D the point at the peak of infrahyoidmuscle power (1) The latency of the swallowing sound = B minus A (2) the latency of suprahyoid muscle activity = C minus A (3) the latency ofinfrahyoid muscle activity = D minus A (4) the interval between the onset of the swallowing sound and the peak timing of infrahyoid muscleactivity = D minus B (5) the maximum value of suprahyoid muscle activity = (5)1015840 which is the peak of suprahyoid muscle powerthe averagesuprahyoid muscle power at rest and (6) the maximum value of infrahyoid muscle activity = (6)1015840 which is the peak of infrahyoid musclepowerthe average infrahyoid muscle power at rest SH suprahyoid muscle power IH infrahyoid muscle power

Thus the duration of the oral phase of swallowing is variableTherefore the duration of the oral phase (the latency of theswallowing sound) needs to be subtracted from the latencyof the infrahyoid muscle activity for proper analysis of thelaryngeal phase of swallowing We calculated the intervalbetween the onset of the swallowing sound and the peaktiming point of infrahyoid muscle activity (the peak pointof infrahyoid muscle EMG power minus the onset of theswallowing sound) to estimate the temporal duration fromthe onset of the pharyngeal reflex to the onset of laryngealdecline

27 Statistical Analysis

271 VAS Scores (Experiment 1) Analyses of variances(ANOVA) were performed in Experiment 1 for flavor scores

Analysis 1 To test the effects of the presence or absenceof auditory verbal cues on flavor scores we used a two-way ANOVA with Cue (presence absence) Beverage (applewater aojiru) as independent factors

Analysis 2 To test the effects of accuracy of the auditoryverbal cues on flavor scores we used a two-way ANOVAwith Accuracy (correct incorrect) Beverage (apple wateraojiru) as independent factors Here the ldquoCorrectrdquo cue is acorrect auditory verbal cue inducing appropriate anticipation

for the beverage to be ingested and the ldquoIncorrectrdquo cue is anincorrect auditory verbal cue with respect to the beverage tobe ingested

272 Physiological Parameters (Experiment 2) ANOVAswere performed in Experiment 2 for swallowing parameters

Analysis 3 To test the effects of the presence or absence ofauditory verbal cues on swallowing parameters we used athree-way ANOVA with Cue (presence absence) Beverage(apple water aojiru) and Age (young elderly) as indepen-dent factors

Analysis 4 To test the effects of accuracy of the auditory verbalcues on swallowing parameters we used a three-wayANOVAwith Accuracy (correct incorrect) Beverage (apple wateraojiru) and Age (young elderly) as independent factors

Analysis 5 To clarify the interrelationship between thephysiological parameters of swallowing a repeated-measuresANOVA was applied to the latencies of swallowing soundsand the time points of maximum activity for each musclemeasured from the onset of the instruction to swallow Theinterrelationships between the latencies were analyzed usinga paired 119905-test

Statistical analysis was performed using Stat View 50(Abacus Concepts Cary North Carolina USA) Statisticalsignificance was set at 119875 lt 05


Taste

Apple Water AojiruDrink

0102030405060708090

100

AbsencePresence

lowast

(a)

Distaste


0102030405060708090

100

AbsencePresence

(b)

Swallowing ease


0102030405060708090

100

AbsencePresence

lowast

(c)

Figure 5 Comparisons of the taste score the distaste score and the swallowing ease score after swallowing with or without auditory verbalcues Error bar standard error

3 Results

31 VAS Scores (Experiment 1)

Analysis 1Taste Score In the analysis of the taste score the ANOVArevealed significant main effects of Cue (119865(1426) = 49 119875 lt05) and Beverage (119865(2426) = 260 119875 lt 01) as shown inFigure 5(a) The taste score significantly increased under thepresence condition compared to the absence condition Thetaste score significantly increased in the order of apple waterand aojiru

Distaste Score In the analysis of the distaste score theANOVA revealed significant main effect of Beverage(119865(2426) = 226 119875 lt 01) as shown in Figure 5(b) The

distaste score significantly increased in the order of aojiruwater and apple There was no significant effect of Cue onthe distaste score

Swallowing Ease Score In the analysis of the swallowing easescore the ANOVA revealed significant main effects of Cue(119865(1426) = 51 119875 lt 05) and Beverage (119865(2426) = 632119875 lt 01) as shown in Figure 5(c) The swallowing ease scoresignificantly decreased under the presence condition than theabsence condition The swallowing ease score significantlydecreased for aojiru compared to apple and waterAnalysis 2

Taste Score In the analysis of the taste score the ANOVArevealed significant main effects of Accuracy (119865(1210) = 65119875 lt 05) andBeverage (119865(2210) = 1406119875 lt 01) as shown in


Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)

Figure 6 Comparisons of the taste score the distaste score and the swallowing ease score after swallowingwhen the participantrsquos anticipationwas primed by auditory verbal cues that were accurate versus inaccurate Error bar standard error

Figure 6(a) The taste score significantly increased under theaccuracy condition compared to the inaccuracy conditionThe taste score significantly increased in the order of applewater and aojiru

Distaste Score In the analysis of the distaste score theANOVA revealed significant main effect of Beverage(119865(2210) = 1078 119875 lt 01) as shown in Figure 6(b) Thedistaste score significantly increased in the order of aojiruwater and apple Accuracy did not have significant effects onthe distaste score

Swallowing Ease Score In the analysis of the swallowingease score the ANOVA revealed significant main effects ofAccuracy (119865(1210) = 68 119875 lt 01) and Beverage (119865(2210) =357 119875 lt 01) as shown in Figure 6(c) The swallowing easescore significantly decreased under the inaccurate condition

compared to the accurate condition The swallowing easescore of aojiru significantly decreased compared to apple andwater

32 Physiological Parameters (Experiment 2)

Analysis 3Latency of Swallowing Sound In the analysis of the latencyof the swallowing sound the ANOVA revealed a significantmain effect of Age (119865(1330) = 5 119875 lt 05) as shown inFigure 7(a) In the elder group the latency of the swallowingsound was significantly longer compared to the youngergroup There were no significant effects of Beverage or Cueon the latency of the swallowing sound

Maximum Suprahyoid Muscle Activity In the analysis ofmaximum suprahyoid muscle activity the ANOVA revealed


AbsencePresence

Latency of swallowing sound (s)

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)

Maximum suprahyoid activity

0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)

Figure 7 Comparisons of the latency of the swallowing sound and maximum suprahyoid muscle activity when swallowing with or withoutauditory verbal cues Error bar standard error

a significant main effect of Cue (119865(1330) = 5 119875 lt 05)as shown in Figure 7(b) Maximum suprahyoid muscleactivity significantly increased under the presence conditioncompared to the absence condition regardless of age Therewere no effects of Beverage or Age on maximum suprahyoidmuscles activity

There were no significant effects of Beverage Age orCue on the latency of suprahyoid muscle activity the latencyof infrahyoid muscle activity maximum infrahyoid muscleactivity or the interval between the onset of the swallowingsound and the peak timing point of infrahyoid muscleactivity

Analysis 4Latency of Swallowing Sound In the analysis of the latencyof the swallowing sound the ANOVA revealed a significantmain effect of Age (119865(1159) = 44 119875 lt 05) as shown inFigure 8(a) In the elder group the latency of the swallowingsound was significantly longer compared to the youngergroup There were no effects of Beverage or Accuracy on thelatency of the swallowing sound

Interval Swallowing Sound-Infrahyoid The ANOVA for theinterval between the onset of the swallowing sound and thepeak timing point of infrahyoid muscle activity revealed asignificant main effect of Accuracy (119865(1159) = 42 119875 lt 05)and a significant interaction effect between Accuracy andAge (119865(2159) = 43 119875 lt 05) as shown in Figure 8(b)In the elder group this interval was significantly shorterunder the inaccurate condition than the accurate conditionIn the younger group there was no effect of accuracy on this

interval There were no effects of Beverage or Age on thelength of the interval

There were no effects of Beverage Age or Accuracyon the latency of suprahyoid muscle activity the latencyof infrahyoid muscle activity maximum suprahyoid muscleactivity or maximum infrahyoid muscle activity

Analysis 5 The repeated-measures ANOVA revealed signifi-cant differences between the latency of the swallowing soundand muscle activity for both the younger group (119865(2143) =302 119875 lt 01) and the elder group (119865(2143) = 738 119875 lt 01)as shown in Table 1The latency of suprahyoidmuscle activitywas significantly shorter than that of the swallowing soundin the elder group (119875 lt 01) but not in the younger groupThe latency of the swallowing sound in the elder group wassignificantly longer than that in the younger group (119875 lt 05)

4 Discussion

41 Characteristic Differences between the Beverages Theresults from Experiment 1 are as follows The taste scoreand swallowing ease score were the highest for apple andthe lowest for aojiru The distaste score was the lowestfor apple and the highest for aojiru Water was given anintermediate rating on these scales These results indicatethat the participants felt that apple juice has a good flavorand is easy to swallow water has a neutral flavor and is easyto swallow while aojiru has a bad flavor and is difficult toswallow



0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

Interval swallowing sound-infrahyoid (s)

lowast

(b)

Figure 8 Comparisons of the latency of the swallowing sound and the interval between the onset of the swallowing sound and the peaktiming of infrahyoid muscle activity during swallowing when the participantrsquos anticipation was primed by auditory verbal cues that wereaccurate versus inaccurate Error bar standard error

Table 1 Comparisons of the latencies and swallowing sound for each of the muscles

Young Elderly

Latency of swallowing sound

Latency of suprahyoid activity

Latency of infrahyoid activity lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

119875 lt 05 lowastlowast119875 lt 01

42 Effect of Auditory Verbal Cues on Subjective Index

Taste Score The results of Analysis 1 showed that Cue had asignificant effect on taste score The taste score significantlyincreased when beverages were ingested with auditory verbalcues The results of analysis 2 showed that Accuracy had asignificant effect on taste score The taste score significantlyincreased when correct auditory verbal cues were givenbefore the beverage was ingestedThese results suggested thatflavor perception increased when the participantrsquos anticipa-tion was primed by appropriate auditory verbal cues

Swallowing Ease ScoreThe results of Analyses 1 and 2 showeda significant effect of auditory verbal cues on the swallowingease score The swallowing ease score significantly decreasedwhen inaccurate auditory verbal cues were given before thebeverages were ingested These results suggest that ease ofswallowing decreased when inappropriate anticipation wasinduced by an incorrect auditory verbal cue

Distaste Score Analyses 1 and 2 showed no significant effectof auditory verbal cues on distaste scores Distaste plays avital role in judgment about whether a potential food is


edible Earlier studies have reported that inedible foods arebitter andor sour and connected with unpleasantness (dis-taste) [10] Because this sensation is important for detectingpotentially dangerous foods it is logical that the perceptionof distaste is very sharp and stable This may explain whyauditory verbal cues had no effect on distaste score

43 Effects of Auditory Verbal Cues on Physiological IndexResults obtained from analysis 3 showed that Cue had asignificant effect on maximum suprahyoid muscle activityregardless of age Maximum suprahyoid muscle activitysignificantly increased when beverages were ingested withauditory verbal cues Previous studies have noted that thestrongest activation of suprahyoid muscles is observed at thestart of the pharyngeal reflex Suprahyoidmuscle activation isalso observed before the start of the pharyngeal reflex whenbolus is in the mouth [11]

The proper preparation for oral andor pharyngeal swal-lowing whichwas induced by the auditory verbal cues mighthave been caused by an enhancement of suprahyoid muscleactivity

44 Effect of Age on Physiological Index It has been docu-mented that healthy elderly individuals have slower overalltongue movements during the early portion of swallowing adelay in triggering the pharyngeal component of swallowingand an increased duration of the pharyngeal component ofswallowing [7ndash9] In this study regardless of the presenceor absence of a cue to ingest a beverage the latency of theswallowing sound was significantly longer in the elder groupthan in the younger groupThe swallowing sound is known tostart when the pharyngeal reflex starts [11] The results of thisstudy showed that the pharyngeal reflex is more delayed inelderly individuals These results are in accord with previousstudies [7ndash9]

In contrast this study showed no significant differencein the latency of suprahyoid muscle activity and the latencyof infrahyoid muscle activity between the younger groupand the elder group Earlier studies have suggested that thesuprahyoid muscles can be involved in both the oral andpharyngeal phases of swallowing (particularly in laryngealelevation) [12ndash14]

Analysis 5 showed that in the younger group of partic-ipants the maximum suprahyoid muscle activity occurredconcomitantly with the swallowing sound and occurred priorto the swallowing sound in the elder group The activationof the suprahyoid muscles is known to be the strongest atthe start of the pharyngeal reflex and is also observed duringoral transit [11] In agreement with previous research theactivation of the suprahyoid muscles was the strongest at thestart of the pharyngeal reflex in the younger individuals Onthe other hand in elderly individuals the activation of thesuprahyoid muscles might be stronger during the oral transitof a beverage than during the start of the pharyngeal reflexbecause of a decline in tongue movement associated with agethat does not impact younger individuals [15]

The elder group showed a significant delay in the swal-lowing sound but not in the muscle activities when auditory

verbal cue was incorrect The interval between the onset ofthe swallowing sound and the peak timing point of infrahyoidmuscle activity was significantly shorter for incorrect audi-tory verbal cues than for correct ones in the elder groupbut not in the younger group This shortening found onlyin the elderly may indicate that incorrect verbal cues maycause significant mismatch between the swallowing musclecontrol and actual beverage transition through pharynxand eventually might result in laryngeal penetration andoraspiration

The hypofunction of swallowing [7ndash9 15ndash18] andordecreased taste and smell perception [19ndash24] with whichelderly participants may suffer may accelerate confusionin beverage recognition when inappropriate auditory verbalcues are given thus altering swallowing behavior

The present results suggest that effective verbal commu-nication about food to be ingested is useful for improvingflavor perception and for avoiding abnormal swallowing inyoung and elderly people Individuals who require assistancewith eating such as those with dysphagia as well as thosewith early dementia attentional dysfunction and disorders ofconsciousness may have difficulties recognizing appropriatetimes to eat and identifying food Proper auditory verbal cuesgiven with food to be ingestedmight be important in improv-ing flavor perception and avoiding abnormal swallowing inthese individuals

5 Conclusion

Taste scores were significantly increased when a participantrsquosanticipation was appropriately primed by a correct auditoryverbal cue while the swallowing ease score significantlydecreased when the anticipation was contradicted Therewas no significant effect of auditory verbal cue on the dis-taste score Regardless of age maximum suprahyoid muscleactivity significantly decreased when beverages were ingestedwithout auditory verbal cues The interval between theonset of the swallowing sound and the peak timing pointof infrahyoid muscle activity was significantly shortenedwhen the anticipation induced by the auditory verbal cuewas contradicted in the elderly participants These resultssuggest that flavor perception and swallowing are affected byanticipation induced by auditory verbal cues Disorders thataffect the anticipatory stage of ingestion may cause subjectiveand physiological difficulties in swallowing however thesedifficulties can be abated with the use of adequate auditoryverbal cues

Conflict of Interests

The authors have no conflict of interests to declare

Acknowledgment

The authors sincerely appreciate participation of all theindividuals enrolled in the study


References

[1] N Sakai and S Morikwa ldquoThe pictures of fruits affect flavorperception of fruit juicesrdquo Japanese Journal of Taste and SmellResearch vol 13 pp 463ndash466 2006

[2] M Zampini and C Spence ldquoThe role of auditory cues inmodulating the perceived crispness and staleness of potatochipsrdquo Journal of Sensory Studies vol 19 no 5 pp 347ndash3632004

[3] K Maeda T Ono H Shinagawa E Honda T Kurabayashiand K Ohyama ldquoRole of the anterior cingulate cortex involitional swallowing an electromyographic and functionalmagnetic resonance imaging studyrdquo Journal of Medical andDental Sciences vol 53 no 3 pp 149ndash157 2006

[4] K Maeda T Ono R Otsuka Y Ishiwata T Kuroda and KOhyama ldquoModulation of voluntary swallowing by visual inputsin humansrdquo Dysphagia vol 19 no 1 pp 1ndash6 2004

[5] I E de Araujo E T Rolls M I Velazco C Margot andI Cayeux ldquoCognitive modulation of olfactory processingrdquoNeuron vol 46 no 4 pp 671ndash679 2005

[6] W R Zemlin SpeechampHearing Science Anatomyamp PhysiologyJapanese Translation by T Tatemura Ishiyaku Tokyo Japan2007

[7] M Yoshikawa M Yoshida T Nagasaki et al ldquoAspects ofswallowing in healthy dentate elderly persons older than 80yearsrdquo Journals of Gerontology A vol 60 no 4 pp 506ndash5092005

[8] J Robbins J W Hamilton G L Lof and G B KempsterldquoOropharyngeal swallowing in normal adults of different agesrdquoGastroenterology vol 103 no 3 pp 823ndash829 1992

[9] J F Tracy J A Logemann P J Kahrilas P Jacob M Kobaraand C Krugler ldquoPreliminary observations on the effects of ageon oropharyngeal deglutitionrdquo Dysphagia vol 4 no 2 pp 90ndash94 1989

[10] T Yamamoto ldquoNeurophysiology of taste (Mikaku no sinkei-seiri-gaku written in Japanese)rdquo in Science of Sense and Percep-tion (Koza Kankaku-Chikaku No Kagaku No 4 Taste and SmellWritten in Japanese) M Ohmi Ed pp 21ndash41 Asakura TokyoJapan 2008

[11] T Nakahara H Koga N Murayama Y Hayashida and TIgasaki ldquoDiachronic evaluation of swallowingmdashcomparisonbetween non-invasive measurement and videofluorographymdash IEICE technical reportrdquo ME and Bio Cybernetics vol 105 pp13ndash16 2006

[12] L Reimers-Neils J Logemann andC Larson ldquoViscosity effectson EMGactivity in normal swallowrdquoDysphagia vol 9 no 2 pp101ndash106 1994

[13] J B Palmer N J Rudin G Lara and A W CromptonldquoCoordination of mastication and swallowingrdquo Dysphagia vol7 no 4 pp 187ndash200 1992

[14] R O Dantas and W J Dodds ldquoEffect of bolus volume andconsistency on swallow-induced submental and infrahyoidelectromyographic activityrdquo Brazilian Journal of Medical andBiological Research vol 23 no 1 pp 37ndash44 1990

[15] J Robbins R Levine J Wood E B Roecker and E LuscheildquoAge effects on lingual pressure generation as a risk factor fordysphagiardquo Journals of Gerontology A vol 50 no 5 pp 257ndash262 1995

[16] G J McKee B T Johnston G B McBride and W J PrimroseldquoDoes age or sex affect pharyngeal swallowingrdquo Clinical Oto-laryngology and Allied Sciences vol 23 no 2 pp 100ndash106 1998

[17] S Jaradeh ldquoNeurophysiology of swallowing in the agedrdquo Dys-phagia vol 9 no 4 pp 218ndash220 1994

[18] J A Logemann ldquoEffects of aging on the swallowing mecha-nismrdquo Otolaryngologic Clinics of North America vol 23 no 6pp 1045ndash1055 1990

[19] J M Boyce and G R Shone ldquoEffects of ageing on smell andtasterdquo Postgraduate Medical Journal vol 82 no 966 pp 239ndash241 2006

[20] S S Schiffman ldquoTaste and smell losses in normal aging anddiseaserdquo Journal of the American Medical Association vol 278no 16 pp 1357ndash1362 1997

[21] J C Stevens ldquoDetection of tastes in mixture with other tastesissues of masking and agingrdquo Chemical Senses vol 21 no 2 pp211ndash221 1996

[22] C de Graaf P Polet and W A van Staveren ldquoSensoryperception and pleasantness of food flavors in elderly subjectsrdquoJournals of Gerontology vol 49 no 3 pp P93ndashP99 1994

[23] C Murphy ldquoNutrition and chemosensory perception in theelderlyrdquo Critical Reviews in Food Science and Nutrition vol 33no 1 pp 3ndash15 1993

[24] J MWeiffenbach C A Tylenda and B J Baum ldquoOral sensorychanges in agingrdquo Journals of Gerontology vol 4 pp M121ndashM125 1990

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

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OphthalmologyJournal of


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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


affect hearing tasting smelling or swallowing Each partici-pant gave hisher informed consent prior to the study Partic-ipants were asked to refrain from drinking and eating for atleast 2 hours before the experimental session Participants inExperiments 1 and 2 were recruited separately

Experiment 1 Participants were 24 people (7 men and 17women) between the ages of 20 and 69 years

Experiment 2 Participants were divided into two groupsbased on age one group of 11 younger people (1 man and 10women) between the ages of 20 and 30 years (mean age of217) and one group of 8 elder people (3 men and 5 women)between the ages of 65 and 75 years (mean age of 684) wereincluded

22 Stimulus Five mL of apple juice aojiru (grass juice)or water was placed on the dorsum of each participantrsquostongue by the examiner using a 10mL syringe (SS-10ESZ30NIPRO) All beverages were presented at room temperature(22-23∘C) The syringe was hidden by plastic tape Thename of the beverage (auditory verbal cue) ldquoRingordquo (applejuice) ldquoAojirurdquo (grass juice) ldquoOmizurdquo (water) or silence waspresented through a speaker (PM-1 Fostex)

We did not use primary taste solution because individu-als with dysphagia usually eat food of complex flavor ratherthan primary taste Stimuli were selected on the grounds thatthese three types of beverages are clearly different in flavor

23 Experimental Conditions There were 2 experimentalconditions the absence condition (3 beverages times 3 times =9 trials) and the presence condition (3 beverages times 3 auditoryverbal cues once each = 9 trials) These conditions includedAccurate auditory verbal cues (the spoken cue correctlyidentified the beverage) Inaccurate (the spoken cue did notcorrectly identify the beverage) and Absence (absence ofspoken cues)

24 Configuration Surface electromyography (sEMG) andcervical auscultation were used The configuration (Fig-ure 1) included a sEMG system (Personal EMG 4CHOisakadenshikiki) AD converter (ML870PowerLab830AD Instruments) contact microphone (ECM-TL1 Sony)microphone amplifier (AT-MA2 Audio-Technica) recorder(CD-2 Roland) personal computer (VPCF12AHJ Sony)control instrument (IS-703 IWATSU) and speaker (PM-1Fostex)

The EMG activity associated with swallowing wasrecorded using bipolar surface electrodes (Arbo H24 Covi-dien Japan) All electrodes were taped to the skin usingdouble-sided adhesive collars Specific electrode positionswere as follows (a) a pair of bipolar surface electrodes wastaped to the skin beneath the chin to record activity inthe suprahyoid muscles and (b) a pair of bipolar surfaceelectrodes was placed on the lower right side of the thyroidcartilage to record activity in the infrahyoidmuscles A singleelectrodewas affixed to the left side of the outer ear as ground

Swallowing sounds were recorded using a contact micro-phone (ECM-TL1 Sony)The contactmicrophonewas placedon the front of sternocleidomastoid muscle The signals fromthe 2 pairs of electrodes and the contact microphone wererecorded using an AD converter (ML870PowerLab830 ADInstruments) with a sampling rate of 2 kHz

25 Experimental Design The experiment was carried out asfollows (Figure 2) during the study participants sat in a chairParticipants were asked to imagine the flavor of a beveragebased on auditory verbal cues (name of the beverage) andthen a beverage was injected into their mouth They wereinstructed to hold the beverage in their mouth for 5ndash7 suntil given direction to swallow They were also instructedto swallow the beverage in a single swallow The participantsrated flavor perception and ease of swallowing using a visualanalog scale (VAS) (Figure 3) Participants rinsed theirmouthwith water after each swallow Every participant completedthe absence trials first followed by the auditory verbal cueconditions

Beverages and auditory verbal cues were presented in arandom order

26 Measurements

261 VAS Scores We used ldquotaste scorerdquo as an indicator ofdelicious tasty nice flavor and ldquodistaste scorerdquo as an indicatorof no good nasty bad flavor ldquoSwallowing easerdquo was used asan indicator of ease of bolus transit pharynx

We used both ldquotaste scorerdquo and ldquodistaste scorerdquo becausewe assumed that distaste score is not an indication in theopposite of the taste scorersquos spectrum Taste score is theindicator of the good or no taste when food intake is possibleand safety On the other hand distaste score is the indicatorof the taste including the judgment of whether or not foodintake is possible

262 Physiological Parameters The parameters for analysisare shown in Figure 4 The original EMG signal was high-pass filtered (over 10Hz) squared and then low-pass filtered(under 10Hz) to calculate the time series of the EMG powerWe then divided the peak of the EMG power by the averagepower during the 5 sec rest period before the first and finaltrials for each muscle to obtain the maximum values ofsuprahyoid muscle activity and infrahyoid muscle activityThe maximum value of muscle activity is the power valueduring swallowing when the power of the rest of the trialis equivalent to 1 Measurements for each swallow wereconducted using the time series of the EMG power andLabchart 7 (AD Instruments)

As swallowing parameters we measured the latency ofthe swallowing sound the latency of suprahyoid muscleactivity the latency of infrahyoid muscle activity the intervalbetween the onset of the swallowing sound and the peaktiming point of infrahyoid muscle activity the maximumvalue of suprahyoid muscle activity and the maximum valueof infrahyoid muscle activity


Recorder

AD converter

Amplifier

Control instrument

Speakers

Contact microphone


Computer

sEMG system



drinkDirection of

swallowMeasure

using a VAS

Rinse mouth

1 minute

5ndash7 sec

1 sec After swallow


0 Taste 100

0 Distaste 100







swallow

IH (v)

Mic

(v)

SH (v)

IH (v)

A

B

C

D

(1)

(2)

(3) (4)

Mic

(v)

SH (v)

2151050

(5)998400

(6)998400


Direction of

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14(s)

(s)














Taste


0102030405060708090

100

AbsencePresence

lowast

(a)

Distaste


0102030405060708090

100

AbsencePresence

(b)

Swallowing ease


0102030405060708090

100

AbsencePresence

lowast

(c)


3 Results








Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)










AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Recorder

AD converter

Amplifier

Control instrument

Speakers

Contact microphone


Computer

sEMG system



drinkDirection of

swallowMeasure

using a VAS

Rinse mouth

1 minute

5ndash7 sec

1 sec After swallow


0 Taste 100

0 Distaste 100







swallow

IH (v)

Mic

(v)

SH (v)

IH (v)

A

B

C

D

(1)

(2)

(3) (4)

Mic

(v)

SH (v)

2151050

(5)998400

(6)998400


Direction of

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14(s)

(s)














Taste


0102030405060708090

100

AbsencePresence

lowast

(a)

Distaste


0102030405060708090

100

AbsencePresence

(b)

Swallowing ease


0102030405060708090

100

AbsencePresence

lowast

(c)


3 Results








Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)










AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















swallow

IH (v)

Mic

(v)

SH (v)

IH (v)

A

B

C

D

(1)

(2)

(3) (4)

Mic

(v)

SH (v)

2151050

(5)998400

(6)998400


Direction of

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14(s)

(s)














Taste


0102030405060708090

100

AbsencePresence

lowast

(a)

Distaste


0102030405060708090

100

AbsencePresence

(b)

Swallowing ease


0102030405060708090

100

AbsencePresence

lowast

(c)


3 Results








Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)










AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Taste


0102030405060708090

100

AbsencePresence

lowast

(a)

Distaste


0102030405060708090

100

AbsencePresence

(b)

Swallowing ease


0102030405060708090

100

AbsencePresence

lowast

(c)


3 Results








Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)










AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Taste


0102030405060708090

100

InaccurateAccurate

lowast

(a)

Apple Water Aojiru

Distaste

Drink

0102030405060708090

100

InaccurateAccurate

(b)

Swallowing ease

0102030405060708090

100

InaccurateAccurate


lowastlowast

(c)










AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















AbsencePresence


Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

0

02

04

06

08

1

12

14

16

18

Drink age

lowast lowast

(a)


0

02

04

06

08

1

12

AbsencePresence

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(b)









4 Discussion




0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















0

02

04

06

08

1

12

14

16

18

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age

(a)

0

005

01

015

02

025

03

035

04

InaccurateAccurate

Appl

e el

derly

Appl

e yo

ung

Wat

er e

lder

ly

Wat

er y

oung

Aojir

u el

derly

Aojir

u y

oung

Drink age


lowast

(b)



Young Elderly




lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

lowast

097 plusmn 034

099 plusmn 035

114 plusmn 03

11 plusmn 074

093 plusmn 076

124 plusmn 071

lowast

















5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



























5 Conclusion




Acknowledgment



References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















References






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















Documents

Research Article Auditory Verbal Cues Alter the Perceived ...downloads.hindawi.com/journals/bmri/2013/892030.pdf · Analysis . To test the e ects of the presence or absence of auditory