Neurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy.
Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Eur J Neurol. 2023 Aug;30(8):2324-2337. doi: 10.1111/ene.15846. Epub 2023 May 23.
Post-stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia.
Ischaemic stroke patients underwent clinical, cognitive and pre-morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale.
In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05), pre-event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09-1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49-2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82-19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05-2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85-0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95% CI 1.04-1.56), admission NIHSS (OR 1.88, 95% CI 1.56-2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44-32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95-7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83-0.96) and thrombolysis (OR 0.77, 95% CI 0.23-0.95) had a protective role. The 6-point "NOTTEM" (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk.
Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.
卒中后吞咽困难影响预后。在急性卒中患者中，本研究旨在评估与吞咽困难相关的临床、认知和神经影像学特征，并制定吞咽困难预测评分。
缺血性卒中患者接受临床、认知和发病前功能评估。采用功能性口腔摄入量表（FOIS）在入院和出院时对吞咽困难进行回顾性评分。
共纳入 228 例患者（平均年龄 75.8 岁，52%为男性）。入院时，126 例（55%）存在吞咽困难（FOIS 评分≤6）。年龄（比值比[OR] 1.03，95%置信区间[CI] 1.00-1.05）、发病前改良Rankin 量表（mRS）评分（OR 1.41，95%CI 1.09-1.84）、国立卫生研究院卒中量表（NIHSS）评分（OR 1.79，95%CI 1.49-2.14）、额部运动皮质损害（OR 8.53，95%CI 3.82-19.06）和牛津郡全前循环梗死（TACI）（OR 1.47，95%CI 1.05-2.04）与入院时的吞咽困难独立相关。教育（OR 0.91，95%CI 0.85-0.98）具有保护作用。出院时，82 例（36%）存在吞咽困难。发病前 mRS（OR 1.28，95%CI 1.04-1.56）、入院 NIHSS（OR 1.88，95%CI 1.56-2.26）、额部运动皮质损害（OR 15.53，95%CI 7.44-32.43）和牛津郡分类 TACI（OR 3.82，95%CI 1.95-7.50）与出院时的吞咽困难独立相关。教育（OR 0.89，95%CI 0.83-0.96）和溶栓治疗（OR 0.77，95%CI 0.23-0.95）具有保护作用。6 分“NOTTEM”评分（NIHSS、运动皮质损害、TACI、溶栓治疗、教育、mRS）可较好地预测出院时的吞咽困难。认知评分与吞咽困难风险无关。
确定了吞咽困难的预测因素，并制定了评分以评估卒中单元住院期间的吞咽困难风险。在此情况下，认知障碍不是吞咽困难的预测因素。早期吞咽困难评估有助于制定未来的康复和营养策略。
