Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke

Akio Shimizu; Ichiro Fujishima; Keisuke Maeda; Kenta Murotani; Tomohisa Ohno; Akiko Nomoto; Shinsuke Nagami; Ayano Nagano; Keisuke Sato; Junko Ueshima; Tatsuro Inoue; Midori Shimizu; Yuria Ishida; Jun Kayashita; Masaki Suenaga; Naoharu Mori

doi:10.1016/j.jamda.2021.07.013

Delayed Dysphagia May Be Sarcopenic Dysphagia in Patients After Stroke

J Am Med Dir Assoc. 2021 Dec;22(12):2527-2533.e1. doi: 10.1016/j.jamda.2021.07.013. Epub 2021 Aug 11.

Authors

Akio Shimizu¹, Ichiro Fujishima², Keisuke Maeda³, Kenta Murotani⁴, Tomohisa Ohno⁵, Akiko Nomoto⁵, Shinsuke Nagami⁶, Ayano Nagano⁷, Keisuke Sato⁸, Junko Ueshima⁹, Tatsuro Inoue¹⁰, Midori Shimizu¹¹, Yuria Ishida¹², Jun Kayashita¹³, Masaki Suenaga¹⁴, Naoharu Mori¹⁵

Affiliations

¹ Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.
² Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan.
³ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan. Electronic address: kskmaeda1701@gmail.com.
⁴ Biostatistics Center, Krume University, Kurume, Japan.
⁵ Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan.
⁶ Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation Kawasaki University of Medical Welfare, Kurashiki, Japan.
⁷ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
⁸ Department of Rehabilitation, Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan.
⁹ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Shinagawa, Japan.
¹⁰ Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan.
¹¹ Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan.
¹² Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan.
¹³ Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
¹⁴ Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Matsumoto, Okinawa, Japan.
¹⁵ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.

PMID: 34389335
DOI: 10.1016/j.jamda.2021.07.013

Abstract

Objective: In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke.

Design: A multicenter prospective observational cohort study.

Setting and participants: Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation.

Methods: Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia.

Results: Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400-13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078-0.986, P = .047).

Conclusions and implications: The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population.

Keywords: Stroke; dysphagia; sarcopenia; sarcopenic dysphagia.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Deglutition
Deglutition Disorders* / etiology
Female
Humans
Male
Prospective Studies
Sarcopenia*
Stroke Rehabilitation*