Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Arnold, Marcel; Liesirova, Kai Timo; Broeg-Morvay, Anne; Meisterernst, Julia Anne; Schlager, Markus; Mono, Marie‐Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarıkaya, Hakan

doi:10.1371/journal.pone.0148424

Cited by 300 publications

(284 citation statements)

References 52 publications

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“…In the present study, dementia patients were more likely to have dysphagia. Reportedly, dysphagia was associated with increase in aspiration pneumonia [41] and discharge disposition [13,14] in stroke patients. Thus, the association between dementia and discharge home in the present study can be partly explained by the high proportion of dysphagia in the dementia patients.…”

Section: Discussionmentioning

confidence: 96%

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Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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Background: Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia. Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged ≥60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home. Results: We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67-0.69; P < 0.001). Conclusions: In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.

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Section: Discussionmentioning

confidence: 96%

“…Factors associated with discharge home has been intensively studied in stroke patients [13][14][15]. Dysphagia and cognitive deficit have been reported as risk factors for discharge disposition [13,14].…”

Section: Introductionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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“…Therefore, a variety of neurological conditions -especially stroke -frequently lead to an impairment of swallowing function called dysphagia. The latter is known to be a risk factor for pneumonia, dehydration and malnutrition, and is also associated with poor long-term outcome and increased mortality [2,3]. Evidence-based therapeutic options for dysphagia are still limited [4].…”

Section: Introductionmentioning

confidence: 99%

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

et al. 2018

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Background/Aims: Performing neurophysiological and functional imaging studies in severely affected patients to investigate novel neurostimulation techniques for the treatment of neurogenic dysphagia is difficult. Therefore, basic research needs to be conducted in healthy subjects. Swallowing is a motor function highly dependent on sensory afferent input. Here we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known as a major contributor to dysphagia in neurological disease. Methods: In this randomized crossover study on 11 healthy volunteers, cortical activation during pneumatic pharyngeal stimulation was measured applying magnetoencephalography in two separate sessions, with and without pharyngeal surface anesthesia. Results: Stimulation evoked bilateral event-related desynchronization (ERD) mainly in the caudolateral pericentral cortex. In comparison to the no-anesthesia condition, topical anesthesia led to a reduction of ERD in beta (13-30 Hz) and low gamma (30-60 Hz) frequency ranges (p<0.05) in sensory but also motor cortical areas. Conclusions: Withdrawal of sensory afferent information by topical anesthesia leads to reduced response to pneumatic pharyngeal stimulation in a distributed cortical sensorimotor network in healthy subjects. The proposed paradigm may serve to investigate the effect of neuromodulatory treatments specifically on pharyngeal sensory impairment as relevant cause of neurogenic dysphagia.

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“…The reported proportion of stroke patients who experience swallowing problems varies largely in the literature between 20 and 81% [1, 2]. Numbers depend on the diagnostic criteria, timing, and method used for dysphagia assessment.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

et al. 2018

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Background: Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. Methods: In this prospective register-based study (“Stroke Register of Northwestern Germany”), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. Results: Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2–5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0–3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0–3.2], p < 0.001). The order of magnitude of these end points did not change over time. Conclusion: Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.

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Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Cited by 300 publications

References 52 publications

Association between dementia and discharge status in patients hospitalized with pneumonia

Association between dementia and discharge status in patients hospitalized with pneumonia

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

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