Subscribe to RSS
DOI: 10.1055/s-0042-1759612
Cognitive Profile in Patients Admitted to Intensive Rehabilitation after Stroke Is Associated with the Recovery of Dysphagia: Preliminary Results from the RIPS (Intensive Post-Stroke Rehabilitation) Study
FUNDING For this study we received funding from the Italian Ministry of Health current research funds.Abstract
Dysphagia represents one of the most frequent symptoms in the post–acute stroke population. Swallowing impairment and cognitive deficits can often co-occur. This study aims to investigate the relationship between cognitive impairment and the recovery of dysphagia in patients attending specific rehabilitation. Patients admitted to intensive rehabilitation units were administered the Functional Oral Intake Scale (FOIS) and Montreal Cognitive Screening Test (MoCA); when screening positive for dysphagia, they entered a rehabilitation program. Their FOIS score at discharge was the primary outcome measure. In the multivariate analysis, younger age (B = − 0.077, p = 0.017), higher MoCA (B = 0.191, p = 0.002), and higher FOIS (B = 1.251, p = 0.032) at admission were associated with higher FOIS at discharge. When executive function (EF) replaced the MoCA total score in the model, younger age (B = − 0.134, p = 0.001), higher admission EF (B = 1.451, p < 0.001), and FOIS (B = 1.348, p = 0.035) were associated with higher FOIS at discharge. Our results confirm the hypothesis that a better cognitive profile upon admission is associated with a higher probability of dysphagia recovery at discharge. EF seems to have a crucial role in dysphagia recovery. These results highlight the importance of considering the cognitive profile when assessing and treating dysphagia after stroke and of using screening tests that include executive functions.
Publication History
Article published online:
17 January 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36 (12) 2756-2763
- 2 Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30 (04) 744-748
- 3 Lakshminarayan K, Tsai AW, Tong X. et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke 2010; 41 (12) 2849-2854
- 4 McCarty EB, Chao TN. Dysphagia and swallowing disorders. Med Clin North Am 2021; 105 (05) 939-954
- 5 Dubin PH, Boehme AK, Siegler JE. et al. New model for predicting surgical feeding tube placement in patients with an acute stroke event. Stroke 2013; 44 (11) 3232-3234
- 6 Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother 2014; 60 (01) 61
- 7 Jeyaseelan RD, Vargo MM, Chae J. National Institutes of Health Stroke Scale (NIHSS) as an Early Predictor of Poststroke Dysphagia. American Academy of Physical Medicine and Rehabilitation; 2015
- 8 Kumar S, Doughty C, Doros G. et al. Recovery of swallowing after dysphagic stroke: an analysis of prognostic factors. J Stroke Cerebrovasc Dis 2014; 23 (01) 56-62
- 9 Barros AFF. Correlacao entre os achados clinicos da degluticao e os achados da tomografia computadorizada de cranio em pacientes com accidente vascular isquemico na fase aguda da doenca. Arq Neuro-Psiquiatric 2006;64(04)
- 10 Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke 2013; 8 (01) 38-45
- 11 Rhie SH, Choi JW, Jeon SJ, Kang SD, Joo MC, Kim MS. Characteristics of patients with aneurysmal subarachnoid hemorrhage and risk factors related to dysphagia. Ann Rehabil Med 2016; 40 (06) 1024-1032
- 12 Dehaghani SE, Doosti A, Zare M. Association between swallowing disorders and cognitive disorders in adults: a systematic review and meta-analysis. Psychogeriatrics 2021; 21 (04) 668-674
- 13 Moon HI, Pyun SB, Kwon HK. Correlation between location brain lesion and cognitive function and findings of videofluoroscopic swallowing study. Ann Rehabil Med 2012; 36 (03) 347-355
- 14 Mourão AM, Vicente LCC, Abreu MNS. et al. Swallowing progression during the acute phase of cortical and subcortical ischemic stroke and its association with the extension of brain damage and cognitive impairment. Top Stroke Rehabil 2019; 26 (07) 523-527
- 15 Castagna A, Ferrara L, Asnaghi E, Rega V, Fiorini G. Functional limitations and cognitive impairment predict the outcome of dysphagia in older patients after an acute neurologic event. NeuroRehabilitation 2019; 44 (03) 413-418
- 16 Ikenaga Y, Nakayama S, Taniguchi H. et al. Factors predicting recovery of oral intake in stroke survivors with dysphagia in a convalescent rehabilitation ward. J Stroke Cerebrovasc Dis 2017; 26 (05) 1013-1019
- 17 Kidd D, Stewart G, Baldry J. et al. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil 1995; 17 (01) 10-14
- 18 Burns A, Brayne C, Folstein M. Key papers in geriatric psychiatry: mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1998; 13 (05) 285-294
- 19 Nasreddine ZS, Phillips NA, Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53 (04) 695-699
- 20 Jo SY, Hwang JW, Pyun SB. Relationship between cognitive function and dysphagia after stroke. Ann Rehabil Med 2017; 41 (04) 564-572
- 21 Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005; 86 (08) 1516-1520
- 22 Hakiki B, Paperini A, Castagnoli C. et al. Predictors of function, activity, and participation of stroke patients undergoing intensive rehabilitation: a multicenter prospective observational study protocol. Front Neurol 2021; 12: 632672
- 23 Wilmskoetter J, Bonilha L, Martin-Harris B, Elm J, Horn J, Bonilha H. Factors influencing oral intake improvement and feeding tube dependency in patients with poststroke dysphagia. J Stroke Cerebrovasc Dis 2019; 8 (06) 1421-1430
- 24 Aiello EN, Gramegna C, Esposito A. et al. The Montreal Cognitive Assessment (MoCA); updated norms and psychometric insight into adaptive testing from healthy individuals in Northern Italy. Aging Clin Exp Res 2022; 34 (02) 375-382
- 25 Quinn TJ, Dawson J, Walters MR, Lees KR. Functional outcome measures in contemporary stroke trials. Int J Stroke 2009; 4 (03) 200-205
- 26 Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry 1990; 53 (07) 576-579
- 27 Dziewas R, Michou E, Trapl-Grundschober M. et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6 (03) LXXXIX-CXV
- 28 Akaike H. Information theory as an extension of the maximum likelihood principle. In: Petrov BN, Csaki F. eds. Second International Symposium on Information Theory. Budapest: Akademiai Kiado; 1973: 267-281
- 29 Armitage P, Colton T. eds. Encyclopaedia of Biostatistics. Chichester, England: Wiley; 1998
- 30 Burnham KP, Anderson DR. Model Selection and Multimodel Inference: A Practical Information-Theoretic Approach. 2nd ed.. New York: Springer; 2002
- 31 Malandraki GA, Johnson S, Robbins J. Functional MRI of swallowing: from neurophysiology to neuroplasticity. Head Neck 2011; 33 (Suppl. 01) S14-S20
- 32 Teismann IK, Suntrup S, Warnecke T. et al. Cortical swallowing processing in early subacute stroke. BMC Neurol 2011; 11: 34
- 33 Cho Y-S, Oh DH, Paik YR, Lee JH, Park JS. Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study. J Phys Ther Sci 2017; 29 (10) 1815-1816
- 34 Salvadori E, Papi G, Insalata G. et al. Comparison between ischemic and hemorrhagic strokes in functional outcome at discharge from an intensive rehabilitation hospital. Diagnostics 2021; 11 (01) 38
- 35 Perna R, Temple J. Rehabilitation outcomes: ischemic versus hemorrhagic strokes. Behav Neurol 2015; 2015: 891651
- 36 Alghadir AH, Zafar H, Al-Eisa ES, Iqbal ZA. Effect of posture on swallowing. Afr Health Sci 2017; 17 (01) 133-137