Yoshimura Yoshihiro, Wakabayashi Hidetaka, Nagano Fumihiko, Matsumoto Ayaka, Shimazu Sayuri, Shiraishi Ai, Kido Yoshifumi, Bise Takahiro, Hamada Takenori, Yoneda Kouki
Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan.
Arch Gerontol Geriatr. 2025 Feb;129:105648. doi: 10.1016/j.archger.2024.105648. Epub 2024 Sep 30.
Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.
A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.
The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.
The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.
肌肉减少症和口腔健康状况不佳在老年患者中很常见，且与不良后果相关。然而，关于它们对中风后康复结局的综合影响的证据有限。本研究旨在调查肌肉减少症和口腔健康受损对中风后患者日常生活活动（ADL）、认知和吞咽结局的综合影响。
对1012例中风后患者（中位年龄75.6岁；54.1%为男性）进行了一项回顾性队列研究。采用2019年亚洲肌肉减少症工作组标准诊断肌肉减少症。使用修订版口腔评估指南（ROAG）评估口腔健康状况不佳，得分≥13表明口腔状况受损。使用功能独立性测量（FIM）评估ADL和认知功能结局，使用食物摄入水平量表（FILS）评估吞咽状况。
肌肉减少症的患病率为45.6%（492/1080），口腔健康受损的患病率为27.5%（297/1080），两种情况并存的患病率为12.0%（130/1080）。与单独存在任何一种情况相比，肌肉减少症和口腔健康受损并存与更差的结局相关。在调整混杂因素后，肌肉减少症和口腔状况受损的组合对出院时的FIM运动（B=-8.666，95%CI -11.484至-5.847）、FIM认知（B=-1.122，95%CI -1.987至-0.256）和FILS（B=-0.785，9%CI -1.055至-0.514）得分显示出最强的负面影响。
肌肉减少症和口腔健康受损的双重负担对中风后患者的功能恢复有显著影响。针对这两种情况的综合评估和干预可能会优化该人群的康复结局。
