Abstract
Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.
Highlights
Stroke is one of the most prevalent causes of death in Europe and the most important cause of morbidity and disability, and its presence significantly increases healthcare utilization and costs [1].Post-stroke oropharyngeal dysphagia (PS-OD) is an important and frequent complication identified in up to 45% of patients by means of the volume-viscosity swallowing test (V-VST), remaining in 66%of discharged patients [2]
The main result of this study is that PS-OD is a dynamic condition with some spontaneous recovery during the chronic post-stroke stage, and with the appearance of new impairments in swallowing function in some vulnerable patients who did not have PS-OD on admission
Our results suggest that systematic and regular PS-OD monitoring is needed in this phase to identify those post-stroke patients with high risk of nutritional and respiratory complications
Summary
Stroke is one of the most prevalent causes of death in Europe and the most important cause of morbidity and disability, and its presence significantly increases healthcare utilization and costs [1].Post-stroke oropharyngeal dysphagia (PS-OD) is an important and frequent complication identified in up to 45% of patients by means of the volume-viscosity swallowing test (V-VST), remaining in 66%of discharged patients [2]. Patients who do not recover from PS-OD remain with severe impaired biomechanics of the swallow response; prevalent impairments include disrupted integration of pharyngeal sensory inputs and reduced cortical excitability of the efferent pathways without physiologic hemispheric dominance (lack of increased motor representation in the contralesional motor cortex) [8]. These patients continue to have swallowing dysfunctions with associated complications that include malnutrition, dehydration, and aspiration pneumonia, with high mortality rates and poor quality of life [2]
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