Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke |
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| Institution: | 1. Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan;2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan;3. Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan;4. Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan;5. Biostatistics Center, Krume University, Kurume, Japan;6. Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan;7. Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation Kawasaki University of Medical Welfare, Kurashiki, Japan;8. Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan;9. Department of Rehabilitation, Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan;10. Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Shinagawa, Japan;11. Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan;12. Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan;13. Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan;14. Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan;15. Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Matsumoto, Okinawa, Japan;1. Medical Director, Baltimore, MD, USA;2. Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA;1. Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan;2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan;3. Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan;4. Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan;1. Department of Gerontology and Gerodontology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan;2. Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Koriyama-shi, Fukushima, Japan;3. Hamamatsu City Rehabilitation Hospital, Naka-ku Hamamatsu-shi, Shizuoka, Japan;4. Department of Rehabilitation Medicine, Yokohama City University Medical Center, Minami-ku, Yokohama-shi, Japan;5. Department of Oral Rehabilitation Osaka Dental University Hospital, Chuo-ku, Osaka, Japan;6. Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki-shi, Nagasaki, Japan;7. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Bunkyo-ku, Tokyo, Japan;8. Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;1. Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan;2. Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan;3. Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan;1. Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, 950-3198, Japan;2. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan;3. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan;4. Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8127, Japan;5. Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo, 663-8211, Japan;6. Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan;7. Okinawa Chuzan Clinical Research Center, Chuzan Hospital, 6-2-1, Matsumoto, Okinawa, Okinawa, 904-2151, Japan;8. Biostatistics Center, Kurume University, Asahi Machi, 67, Kurume, Fukuoka, 830-0011, Japan |
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| Abstract: | ObjectiveIn many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke.DesignA multicenter prospective observational cohort study.Setting and ParticipantsParticipants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation.MethodsSwallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia.ResultsDelayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400–13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078–0.986, P = .047).Conclusions and ImplicationsThe development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population. |
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| Keywords: | Stroke sarcopenia sarcopenic dysphagia dysphagia |
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