Neuroanatomical, Clinical and Cognitive Correlates of Post-Stroke Dysphagia

Abstract

Background and Purpose: About half of the dysphagic stroke patients have persistent swallowing dysfunction after 7 days from symptom onset. The aim of the study was to evaluate incidence, prognosis, clinical and neuroradiological correlates of post-stroke dysphagia. Methods: We prospectively examined consecutive patients with acute ischemic or hemorrhagic stroke. Patients' clinical and neuroradiological data were collected. Swallowing function was assessed by the water swallow test upon admission and after 14 days; patients were then classified as persistent dysphagic, non-persistent dysphagic or non-dysphagic. Results: We recruited 275 patients, 121 of whom were dysphagic upon admission and 254 patients attended follow-up at 14 days; 141 never presented dysphagia, 21 had a non-persistent pattern of dysphagia and 92 had a persistent one. Stroke type, leukoaraiosis degree, previous cognitive impairment and stroke severity upon admission independently predicted the occurrence of dysphagia after stroke and its persistence as well. At receiver operating characteristic (ROC) analysis, the National Institutes of Health Stroke Scale (NIHSS) score of 11.5 was the best predictive value of persistent dysphagia, with a specificity of 90.1% and a sensitivity of 72.4%. Conclusion: Stroke severity is an important predictor of a persistent pattern of dysphagia, with a suggested NIHSS cutoff value of ≥12. An independent correlation was observed with leukoaraiosis and with previous cognitive impairment.

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

“…However, not all cases of pneumonia in stroke patients can doubtlessly be referred to dysphagia, and conversely, not all cases of dysphagia lead to a pulmonary infection. Toscano et al [15] calculated a slightly higher cut-off of ≥12 when aiming at predicting persistent dysphagia, lasting for at least 2 weeks after stroke onset. Okubo et al [16] also received a cut-off value of 12 for the same clinical issue.…”

“…A possible explanation is that the authors also included patients with prior strokes and possibly pre-existing dysphagia [18]. Moreover, patients with haemorrhagic strokes were excluded, a group with generally higher NIH-SS scores [18] and higher risk of severe, persistent dysphagia [15]. Jeyaseelan et al [14] used instrumental methods in some of their patients to investigate swallowing function.…”

“…Few studies have addressed the role of the NIH-SS as a predictor for PSD [14][15][16][17][18][19] with inconclusive results due to variability in study design and patient selection, for example, in 1 study dysphagia was only found in supratentorial stroke patients [16]. A further limitation has been that diagnostic criteria for dysphagia in these studies were substantially variable and only few used instrumental assessment, that is, VFS [14].…”

Characteristics of Patients With Aneurysmal Subarachnoid Hemorrhage and Risk Factors Related to Dysphagia

“…The association of cognitive dysfunction regarding the degree and prognosis of dysphagia with a stroke is well known [293031]. In addition, the relationship between cognitive deficits and dysphagia is significant in other central nervous system diseases such as dementia, mild cognitive impairment (MCI), and Parkinson disease.…”

Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo

“…Disfagia secundária ao agravo vascular está presente em mais de 50% dos pacientes com AVC [34]. A utilização de sonda nasogástrica e a imobilidade no leito aumentam de forma importante o risco de aspiração, sendo considerados preditivos da ocorrência de pneumonia, assim como de maior mortalidade [25,26,33] Em geral, a mortalidade entre pacientes com IH varia de 10,9 % a 24,7% [28], e a ocorrência de IH em pacientes pós-AVC pode representar um aumento de até oito vezes no risco de morte [36].…”