Functional limitations and cognitive impairment predict the outcome of dysphagia in older patients after an acute neurologic event

Abstract

BACKGROUND: Dysphagia prevalence increases with age and a significant contribution is given by stroke survivors; its treatment is mainly based on rehabilitation, but outcome cannot be easily predicted. OBJECTIVE:The aim of this study is to detect possible predictors of the outcome of dysphagia in patients beginning rehabilitation after a major Central Nervous System injury. METHODS: Dysphagia severity was measured in 95 consecutive patients (71 with ischemic or hemorrhagic stroke) upon admission to our neurorehabilitation unit and at discharge, during the year 2017. The initial evaluation included also demographic data, functional and geriatric multidimensional assessment, laboratory test results and comorbidities. Their possible predictive value on the degree of recovery of the swallowing process at discharge has been analyzed. RESULTS: Poor functional conditions and the presence of cognitive impairment on admission appear to be associated with a worse outcome of dysphagia at discharge. A significant correlation exists between scores at functional scales at the beginning of rehabilitation and dysphagia score at discharge. Patients with cognitive impairment at the beginning (n = 60) showed a significantly lower degree of recovery of dysphagia at discharge. CONCLUSION: Other factors, beside the degree of dysphagia itself, are important to predict its outcome. Their knowledge not only allows an initial prognostic assessment; it can also be useful to decide which aspects should receive greater attention when treating patients with dysphagia.

Incidence and Risk Factors for Dysphagia Following Cerebellar Stroke: A Retrospective Cohort Study

“…Male patients were found to have a better recovery than female patients, which was consistent with the nding that female was associated with prolonged dysphagia and increased death [30,50,55]. Besides, increased age was shown to have poorer recovery from dysphagia, which was consistent with the advocate that the elder had reduced cognitive function and decreased ability to compensate for changes in skeletal muscle strength, and these factors could affect the outcome of post-stroke swallowing impairment [29,48,49,[55][56][57][58]. However, the above ndings were not consistent with the result from one previous study that age and sex were not signi cant predictors of persistent dysphagia [59].In addition, patients with ischemic strokes were reported to have poorer recovery than those with hemorrhagic strokes since patients with ischemic strokes were more likely to have a relatively poor overall condition [60].However, our result demonstrated that the cumulative recovery of the ischemic type was better than that of the hemorrhagic and mixed type, which was not consistent with the previous studies [60].…”

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

“…Some researchers have also proposed that poor cognitive function weakens the swallowing ability by affecting the patients’ visual attention and execution ability ( Jo et al, 2017 ). Patients with dementia are also prone to aspiration, with aspiration-induced pneumonia being the most frequent cause of death in these patients ( Castagna et al, 2019 ). In view of these connections between dysphagia and cognitive impairment, related pathological models have indicated that combining cognition and dysphagia as an intermediary of treatment might be beneficial for the treatment of dysphagia ( Ebrahimian Dehaghani et al, 2019 ).…”

Relationship between Post-Stroke Cognitive Impairment and Severe Dysphagia: A Retrospective Cohort Study

“…During a long period after stroke, many patients suffered from both PSCI and PSD in clinical settings. As compared to those only with PSD, patients with both complications were more likely to obtain a worse prognosis [ 26 , 27 ].…”