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Karisik A, Bader V, Moelgg K, Buergi L, Dejakum B, Komarek S, Eller MT, Toell T, Mayer-Suess L, Pechlaner R, Granna J, Sollereder S, Rossi S, Schoenherr G, Willeit J, Willeit P, Lang W, Kiechl S, Knoflach M, Boehme C. Comorbidities associated with dysphagia after acute ischemic stroke. BMC Neurol 2024; 24:358. [PMID: 39342159 PMCID: PMC11438413 DOI: 10.1186/s12883-024-03863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Pre-existing comorbidities increase the likelihood of post-stroke dysphagia. This study investigates comorbidity prevalence in patients with dysphagia after ischemic stroke. METHODS The data of patients with acute ischemic stroke from two large representative cohorts (STROKE-CARD trial 2014-2019 and STROKE-CARD registry 2020-2022 - both study center Innsbruck, Austria) were analyzed for the presence of dysphagia at hospital admission (clinical swallowing examination). Comorbidities were assessed using the Charlson Comorbidity Index (CCI). RESULTS Of 2054 patients with ischemic stroke, 17.2% showed dysphagia at hospital admission. Patients with dysphagia were older (77.8 ± 11.9 vs. 73.6 ± 14.3 years, p < 0.001), had more severe strokes (NIHSS 7(4-12) vs. 2(1-4), p < 0.001) and had higher CCI scores (4.7 ± 2.1 vs. 3.8 ± 2.0, p < 0.001) than those without swallowing impairment. Dysphagia correlated with hypertension (p = 0.034), atrial fibrillation (p < 0.001), diabetes (p = 0.002), non-smoking status (p = 0.014), myocardial infarction (p = 0.002), heart failure (p = 0.002), peripheral arterial disease (p < 0.001), severe chronic liver disease (p = 0.002) and kidney disease (p = 0.010). After adjusting for relevant factors, the associations with dysphagia remained significant for diabetes (p = 0.005), peripheral arterial disease (p = 0.007), kidney disease (p = 0.014), liver disease (p = 0.003) and overall CCI (p < 0.001). CONCLUSIONS Patients with multiple comorbidities have a higher risk of developing post-stroke dysphagia. Therefore, early and thorough screening for swallowing impairment after acute ischemic stroke is crucial especially in those with multiple concomitant diseases. TRIAL REGISTRATION Stroke Card Registry (NCT04582825), Stroke Card Trial (NCT02156778).
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Affiliation(s)
- Anel Karisik
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Vincent Bader
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Kurt Moelgg
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Lucie Buergi
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Michael Thomas Eller
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Julian Granna
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
| | - Simon Sollereder
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
| | - Sonja Rossi
- ICONE - Innsbruck Cognitive Neuroscience, Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Peter Willeit
- Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, The Old Schools, Trinity Ln, Cambridge, UK
| | - Wilfried Lang
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Medical Faculty, Sigmund Freud Private University, Freudplatz 1, Vienna, Austria
| | - Stefan Kiechl
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Michael Knoflach
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
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Horn J, Simpson KN, Simpson AN, Bonilha LF, Bonilha HS. The Relationship Between Poststroke Dysphagia and Poststroke Depression and Its Risk Factors. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2487-2499. [PMID: 39088240 PMCID: PMC11427738 DOI: 10.1044/2024_ajslp-23-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/03/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE A diagnosis of dysphagia and/or depression after stroke can impact the physical, psychological, and social welfare of stroke survivors. Although poststroke depression (PSD) and poststroke dysphagia are known to occur concurrently, there is a paucity of research that has specifically investigated their association. Therefore, we aimed to study the relationship between PSD and poststroke dysphagia during acute inpatient hospitalization and within 90 days after discharge. Furthermore, we aimed to evaluate the odds and hazard of being diagnosed with depression after stroke and estimate the time to depression diagnosis from the initial stroke diagnosis in patients with and without a diagnosis of dysphagia. METHOD Using the acute inpatient hospital data set from our previous work, we pulled additional postdischarge administrative claims data from the 2017 Medicare 5% Limited Data Set and conducted a retrospective, cross-sectional study of patients diagnosed with poststroke dysphagia and PSD. RESULTS Patients diagnosed with poststroke dysphagia had 2.7 higher odds of being diagnosed with PSD and had an approximately 1.75-fold higher hazard for PSD diagnosis in the 90 days after discharge compared to patients not diagnosed with dysphagia. Risk factors for PSD included having dysphagia, being female, and having dual eligibility. CONCLUSIONS Our results demonstrated a significant association between PSD and poststroke dysphagia. Additional research should further explore the impact of PSD on poststroke dysphagia.
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Affiliation(s)
- Janet Horn
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - Kit N. Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston
| | - Annie N. Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston
| | - Leonardo F. Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston
- Department of Neurology, School of Medicine, University of South Carolina, Columbia
| | - Heather S. Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
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Karisik A, Dejakum B, Moelgg K, Komarek S, Toell T, Mayer‐Suess L, Pechlaner R, Kostner S, Sollereder S, Kiechl S, Rossi S, Schoenherr G, Lang W, Kiechl S, Knoflach M, Boehme C. Association between dysphagia and symptoms of depression and anxiety after ischemic stroke. Eur J Neurol 2024; 31:e16224. [PMID: 38308469 PMCID: PMC11235684 DOI: 10.1111/ene.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND PURPOSE Dysphagia is associated with poor outcome, higher mortality, reduced quality of life, and social isolation. We investigate the relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke. METHODS Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study from 2020 to 2022 were assessed for dysphagia on hospital admission (clinical swallowing assessment) and for persistence until discharge and 3-month follow-up (SINGER Independency Index). Anxiety and depression symptoms were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up. RESULTS Of 648 patients, 19.3% had dysphagia on admission, persisting in 14.8% at discharge and 6.8% at 3-month follow-up. With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, at discharge, at 3 months), score (mean ± SD) increased on the BDI (7.9 ± 6.7, 12.5 ± 8.7, 13.5 ± 9.0, 16.5 ± 10.2), HADS-D (4.4 ± 3.7, 7.1 ± 4.2, 7.7 ± 4.4, 9.8 ± 4.3), and HADS-A (4.4 ± 3.5, 5.4 ± 3.6, 6.0 ± 3.6, 7.0 ± 3.6). In linear regression analysis adjusting for age, sex, diabetes, dementia, and either functional disability or stroke severity, BDI and HADS-D scores were significantly higher in patients with dysphagia across all points in time (admission, discharge, 3-month follow-up). An independent association with HADS-A scores was only evident in patients with persisting dysphagia after 3 months. Patients with dysphagia were more likely to receive antidepressants, antipsychotics, or benzodiazepines at discharge and 3-month follow-up. CONCLUSIONS Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor for poststroke depressive and, to a lesser extent, anxiety symptoms.
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Affiliation(s)
- Anel Karisik
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Benjamin Dejakum
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Kurt Moelgg
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Silvia Komarek
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Thomas Toell
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Lukas Mayer‐Suess
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Raimund Pechlaner
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Stefanie Kostner
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Sophia Kiechl
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of Neurology, Hochzirl HospitalHochzirlAustria
| | - Sonja Rossi
- ICONE—Innsbruck Cognitive Neuroscience, Department for Hearing, Speech, and Voice DisordersMedical University of InnsbruckInnsbruckAustria
| | - Gudrun Schoenherr
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Wilfried Lang
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Medical FacultySigmund Freud Private UniversityViennaAustria
| | - Stefan Kiechl
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Michael Knoflach
- VASCage—Center on Clinical Stroke ResearchInnsbruckAustria
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Christian Boehme
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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