Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mult Scler Relat Disord. 2024 Jul;87:105640. doi: 10.1016/j.msard.2024.105640. Epub 2024 Apr 21.
Dysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals.
Seventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire.
The frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0-3.5]) and MS patients (2, IQR [0-4]) had a significantly higher median total DYMUS score than control (0, IQR [0-1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status.
The presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.
吞咽困难以前曾被讨论为慢性神经系统疾病（如多发性硬化症（MS）和视神经脊髓炎谱系障碍（NMOSD））导致的潜在危及生命的情况。然而，它对 NMOSD 患者的生活质量（QoL）的影响从未被研究过。本研究旨在确定吞咽困难的频率及其对 NMOSD 患者 QoL 的影响，并与 MS 患者和健康个体进行比较。
本横断面研究纳入了 75 名 MS 和 65 名 NMOSD 患者，其扩展残疾状态量表（EDSS）评分均≥3.5，此外还纳入了 106 名健康对照者。所有参与者都完成了自我报告的 MS 吞咽困难问卷（DYMUS）和 36 项短式健康调查问卷（SF-36）。如果 DYMUS 中的至少一个问题的回答为肯定，则要求他们填写吞咽困难障碍指数（DHI）问卷。
NMOSD、MS 和对照组的吞咽困难发生率分别为 61.54%、72.97%和 27%。与非吞咽困难患者相比，有吞咽问题的患者在不同与吞咽相关的 QoL 领域的评分均降低（p<0.05）。NMOSD（1，IQR [0-3.5]）和 MS 患者（2，IQR [0-4]）的 DYMUS 总分中位数明显高于对照组（0，IQR [0-1]）（p<0.01）。然而，两组患者之间没有明显差异。NMOSD 的总 DHI 评分最高（21.22±21），其次是 MS（15.25±18.94）和对照组（7.08±5.12）。NMOSD 组的 DHI 总分与 SF-36 总分之间存在显著相关性（r=0.62，p<0.05）。DHI 和 SF-36 子量表之间也存在很强的相关性。对照组和 MS 组的整体 SF-36 评分与 DHI 无显著相关性。广义线性模型分析显示，NMOSD 组的年龄（p 值=0.005）、EDSS（p 值<0.001）和 DYMUS 总分（p 值=0.018）显著影响总体健康状况。
吞咽困难的存在显著影响 NMOSD 患者的 QoL，特别是与吞咽相关的方面。这些发现突出表明需要对吞咽困难进行仔细筛查，并强调需要教育护理人员和 NMOSD 患者管理这一具有挑战性的症状。
