Abstract
Objectives: The purposes of this study are to determine whether there is a correlation between the Mann Assessment of Swallowing Ability (MASA) and modified MASA (mMASA) according to various cognitive status and to investigate whether the cognitive status of patients with brain damage affects the prediction of aspiration using the MASA.Methods: We retrospectively assessed 146 dysphagic patients with brain lesion due to various causes. Dysphagia was assessed using the MASA and mMASA. According to the videofluoroscopic swallowing study results, patients were divided into two groups: aspirators and non-aspirators. Patients were classified into four groups according to cognitive function according to the Korean version of Mini-mental State Examination scores: normal (>24), mild (21–24), moderate (10–20), and severe (<10) cognitive impairment. The correlation between the MASA and mMASA scores according to cognitive function were analyzed. The sensitivity, specificity, and positive and negative predictive values of the MASA scores for predicting aspiration were assessed.Results: The MASA and mMASA scores showed a significant positive correlation in all cognition groups. In patients with more severe cognitive impairment MASA scores had high sensitivity and low specificity for prediction of aspiration. On the other hand, the MASA scores had low sensitivity and high specificity for prediction of aspiration in the normal and mild cognitive impairment groups.Conclusions: The MASA and mMASA scores correlated with each other in patients with various levels of cognitive function. Interestingly, this study results demonstrated that patients with good cognitive function may have false negative results of MASA screening due to low sensitivity. Thus, when interpreting the MASA results, the impact of cognitive status should be taken into consideration.
Highlights
Dysphagia is a disorder of the swallowing pathway resulting in impairment of the safety, efficiency, or quality of eating and drinking [1]
Inclusion criteria were as follows: [1] a brain injury confirmed by a neurologist using computed tomography or magnetic resonance imaging, [2] aged ≥18 years, [3] available dysphagia evaluation results from the videofluoroscopic swallowing study (VFSS), Mann Assessment of Swallowing Ability (MASA), and modified MASA (mMASA) those had been conducted within a week, and [4] available cognitive assessment results from the Korean version of the Mini-mental State Examination (K-MMSE), of which evaluation date did not differ with swallowing evaluations by more than a week
This finding suggests that the mMASA, which has a similar tendency with the MASA, might be used instead of the MASA for brain-injured patients with various degrees of Cognitive status (K-MMSE)
Summary
Dysphagia is a disorder of the swallowing pathway resulting in impairment of the safety, efficiency, or quality of eating and drinking [1] It is one of the common and important complications of brain-injured patients, and its prevalence ranges from 30 to 67% in patients with stroke, traumatic brain injury (TBI), and brain tumors [2,3,4,5]. In a clinical swallow assessment at 6 months post-stroke, 11% of patients had dysphagia, whereas in the videofluoroscopic swallowing study (VFSS), 50% of the patients had dysphagia [7, 8]. Dysphagia causes complications, such as dehydration, malnutrition, asphyxia, and aspiration pneumonia, which may delay medical recovery and extend hospital stay [9]. As early screening of dysphagia and proper dietary control are emphasized for improving the rehabilitation outcome in braininjured patients [11,12,13], screening tools are routinely used to assess the risk of dysphagia and aspiration
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