Qiao Jia, Wu Zhi-Min, Ye Qiu-Ping, Dai Yong, Dou Zu-Lin
Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, China.
Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Brain Sci. 2022 Jun 19;12(6):803. doi: 10.3390/brainsci12060803.
Objective: To investigate the relationship between post-stroke cognitive impairment (PSCI) and severe post-stroke dysphagia (PSD) and explore the risk factors related to PSCI combined with severe PSD. Methods: Data from patients were collated from the rehabilitation-specific disease database. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Videofluoroscopy Swallowing Study (VFSS), Penetration-aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used to evaluate cognitive and swallowing functions. Differences between groups were determined by the Pearson chi-square test (χ2) or Fisher exact test. PAS and FOIS data were analyzed with the use of the Wilcoxon rank-sum or Kruskal−Wallis test in the prespecified subgroup analysis. Risk factors were investigated by multivariate logistic regression. Results: A total of 1555 patients were identified with PSCI. The results indicated that patients with PSCI had a higher incidence rate of severe PSD as compared to patients without PSCI (p < 0.001). Patients with severe PSCI were more likely to clinically manifest oral phase dysfunction (p = 0.024), while mild PSCI patients mainly manifested pharyngeal phase dysfunction (p < 0.001). There was a significant difference in FOIS score changes between subgroups during the hospitalization period (severe PSCI vs. moderate PSCI and severe PSCI vs. mild PSCI) (all p < 0.001). In addition, multivariate logistic regression revealed pneumonia (p < 0.001), tracheotomy (p < 0.001), and dysarthria (p = 0.006) were related to PSCI, combined with severe PSD. Conclusion: PSCI may be related to severe PSD. Patients with severe PSCI were more likely to manifest oral phase dysfunction, while mild PSCI manifested pharyngeal phase dysfunction. Pneumonia, tracheotomy, and dysarthria were risk factors related to PSCI combined with severe PSD.
探讨脑卒中后认知障碍（PSCI）与重度脑卒中后吞咽困难（PSD）之间的关系，并探索与PSCI合并重度PSD相关的危险因素。方法：从康复专科疾病数据库整理患者数据。采用简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）、电视荧光吞咽造影检查（VFSS）、渗透-误吸量表（PAS）和功能性经口进食量表（FOIS）评估认知和吞咽功能。组间差异采用Pearson卡方检验（χ2）或Fisher确切概率法检验。在预先设定的亚组分析中，使用Wilcoxon秩和检验或Kruskal-Wallis检验分析PAS和FOIS数据。通过多因素logistic回归研究危险因素。结果：共识别出1555例PSCI患者。结果表明，与无PSCI的患者相比，PSCI患者重度PSD的发生率更高（p<0.001）。重度PSCI患者更易出现口腔期功能障碍（p=0.024），而轻度PSCI患者主要表现为咽期功能障碍（p<0.001）。住院期间各亚组间FOIS评分变化存在显著差异（重度PSCI与中度PSCI、重度PSCI与轻度PSCI）（均p<0.001）。此外，多因素logistic回归显示，肺炎（p<0.001）、气管切开术（p<0.001）和构音障碍（p=0.006）与PSCI合并重度PSD有关。结论：PSCI可能与重度PSD有关。重度PSCI患者更易出现口腔期功能障碍，而轻度PSCI表现为咽期功能障碍。肺炎、气管切开术和构音障碍是与PSCI合并重度PSD相关的危险因素。
