VASCage-Center on Clinical Stroke Research, Innsbruck, Austria.
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Eur J Neurol. 2024 May;31(5):e16224. doi: 10.1111/ene.16224. Epub 2024 Feb 2.
Dysphagia is associated with poor outcome, higher mortality, reduced quality of life, and social isolation. We investigate the relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke.
Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study from 2020 to 2022 were assessed for dysphagia on hospital admission (clinical swallowing assessment) and for persistence until discharge and 3-month follow-up (SINGER Independency Index). Anxiety and depression symptoms were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up.
Of 648 patients, 19.3% had dysphagia on admission, persisting in 14.8% at discharge and 6.8% at 3-month follow-up. With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, at discharge, at 3 months), score (mean ± SD) increased on the BDI (7.9 ± 6.7, 12.5 ± 8.7, 13.5 ± 9.0, 16.5 ± 10.2), HADS-D (4.4 ± 3.7, 7.1 ± 4.2, 7.7 ± 4.4, 9.8 ± 4.3), and HADS-A (4.4 ± 3.5, 5.4 ± 3.6, 6.0 ± 3.6, 7.0 ± 3.6). In linear regression analysis adjusting for age, sex, diabetes, dementia, and either functional disability or stroke severity, BDI and HADS-D scores were significantly higher in patients with dysphagia across all points in time (admission, discharge, 3-month follow-up). An independent association with HADS-A scores was only evident in patients with persisting dysphagia after 3 months. Patients with dysphagia were more likely to receive antidepressants, antipsychotics, or benzodiazepines at discharge and 3-month follow-up.
Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor for poststroke depressive and, to a lesser extent, anxiety symptoms.
吞咽障碍与不良预后、更高的死亡率、生活质量降低和社会隔离有关。我们研究了缺血性脑卒中后吞咽障碍与焦虑和抑郁症状之间的关系。
连续纳入 2020 年至 2022 年参与前瞻性 STROKE-CARD 登记研究的缺血性脑卒中患者，在入院时（临床吞咽评估）和出院时以及 3 个月随访时（SINGER 独立性指数）评估吞咽障碍。使用贝克抑郁量表（BDI）和医院焦虑抑郁量表（HADS）在 3 个月随访时记录焦虑和抑郁症状。
648 例患者中，入院时吞咽障碍的发生率为 19.3%，出院时为 14.8%，3 个月随访时为 6.8%。随着吞咽障碍的存在或持续时间（无吞咽障碍、基线时有吞咽障碍、出院时有吞咽障碍、3 个月随访时有吞咽障碍），BDI（7.9±6.7、12.5±8.7、13.5±9.0、16.5±10.2）、HADS-D（4.4±3.7、7.1±4.2、7.7±4.4、9.8±4.3）和 HADS-A（4.4±3.5、5.4±3.6、6.0±3.6、7.0±3.6）的评分增加。在调整年龄、性别、糖尿病、痴呆和功能障碍或卒中严重程度的线性回归分析中，吞咽障碍患者在所有时间点（入院、出院、3 个月随访）的 BDI 和 HADS-D 评分均显著升高。只有在 3 个月后持续存在吞咽障碍的患者中，HADS-A 评分与吞咽障碍有独立关联。吞咽障碍患者在出院和 3 个月随访时更有可能接受抗抑郁药、抗精神病药或苯二氮䓬类药物治疗。
卒中后吞咽障碍很常见，严重影响个体的社会心理功能。我们的结果强调吞咽障碍是卒中后抑郁的独立预测因素，对焦虑的影响较小。
