Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes

Coexistence of low body mass index and poor oral health negatively affects activities of daily living, swallowing, and cognition after stroke

AIM

Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients.

METHODS

A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest.

RESULTS

The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone.

CONCLUSIONS

The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 00: 000-000. Geriatr Gerontol Int 2024; ••: ••-••.

CAR, mGPS and hs-mGPS: What is among them the best gero-biomarker for age-related diseases? And for what clinical application?

The identification of biomarkers linked to the onset, progression, and prevention of age-related diseases (ARD), in the era of personalized medicine, represents the best goal of geroscience. Geroscience has the fundamental role of exploring and identifying the biological mechanisms of aging to suggest interventions capable of stopping/delaying the many pathological conditions and disabilities related to age. Therefore, it has become its key priority, as well as that of clinical practice and research, based on identifying and validating a range of biomarkers, geromarkers, which can be used to diagnostic, prognostic, or predictive clinical purposes. Indeed, geromarkers have, the potential to predict ARD trajectories and facilitate targeted interventions to slow down the related disabilities. Here our attention is paid to the inflammatory indexes (CAR, mGPS, hs-mGPS) linked to the relationship between the plasma levels of two inflammatory analytes, the typical positive protein of the acute phase, and the negative one, i.e. c-reactive protein (CRP) and albumin, respectively. These indexes allow us to understand the magnitude of the two main mechanisms predicted to influence the aging process, including inflammation and immunosenescence, as well as the degree of ARD severity. Evidence on their relationship with ARD is widely reported and discussed, to understand which can represent the best ARD geromarker, and its clinical application.

Association between sarcopenia at discharge and functional outcomes 1 month and 6 months after discharge in patients in convalescent rehabilitation wards

AIM

This retrospective cohort study investigated the relationship between sarcopenia and Activities of Daily Living capacity after discharge from convalescent rehabilitation wards.

METHODS

We included consecutive patients discharged from three convalescent rehabilitation wards in a hospital in Japan between December 2018 and October 2020. Sarcopenia was diagnosed based on the criteria of the 2019 Asian Working Group for Sarcopenia, utilizing skeletal muscle mass index and handgrip strength. Statistical analyses were carried out separately for men and women. The primary outcome was a higher motor domain (motor Functional Independence Measure [mFIM]) and a higher cognitive domain (cognitive Functional Independence Measure [cFIM]) of the FIM score 1 month after discharge. The secondary outcomes were higher mFIM and cFIM scores 6 months after discharge, analyzed using binary logistic regression.

RESULTS

Among 305 participants (mean age 70.0 years, 148 men), 93 were identified as having sarcopenia. The prevalence of sarcopenia was 16% for outpatient rehabilitation services, 59% for home-visit rehabilitation services and 50% for older adult day care. Logistic regression analyses showed that sarcopenia at discharge was not an independent variable for mFIM at 1 month (odds ratio [OR] 20, 95% confidence interval [CI] 0.31-1300 for men, OR 0.51, 95% CI 0.11-2.4 for women) and cFIM (OR 0.63, 95% CI 0.10-3.8 for men, OR 5.3, 95% CI 0.81-34 for women). At 6 months, sarcopenia at discharge was not an independent variable for mFIM (OR 0.30, 95% CI 0.02-3.6 for men, OR 0.40, 95% CI 0.06-2.5 for women) and cFIM (OR 0.16, 95% CI 0.01-2.4 for men, OR 0.00, 95% CI 0.00-1.1 for women).

CONCLUSIONS

Sarcopenia at the time of discharge from convalescent rehabilitation wards does not independently predict FIM 1 month or 6 months after discharge. Geriatr Gerontol Int 2024; 24: 715-721.

Low hemoglobin levels are associated with compromised muscle health: Insights from a post-stroke rehabilitation cohort

AIM

There is limited evidence concerning the association between anemia and alterations in muscle health among hospitalized older patients. We aimed to evaluate the associations between baseline hemoglobin (Hb) levels and changes in muscle function in patients undergoing rehabilitation after stroke.

METHODS

This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. The main outcomes were discharge score for the skeletal muscle mass index (SMI) obtained through bioimpedance analysis and the corresponding change in SMI during hospitalization. Other outcomes were handgrip strength (HGS) at discharge and the alteration in HGS during hospitalization. Multivariate linear regression analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders.

RESULTS

Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median Hb level at admission was 13.3 [11.9, 14.5] g/dL. After fully adjusting for confounding factors, the baseline Hb level was significantly and positively associated with SMI at discharge (β = 0.046, P = 0.039) and with SMI gain (β = 0.010, P = 0.039). Further, the baseline Hb level was independently and positively associated with HGS at discharge (β = 0.058, P = 0.014) and with its change from baseline (β = 0.100, P = 0.014).

CONCLUSION

Diminished baseline Hb levels were demonstrated be correlated with compromised muscle health in patients after stroke. Evaluating anemia at the outset serves as a crucial prognostic indicator. Geriatr Gerontol Int 2024; 24: 305-311.

Negative impact of computed tomography-based low skeletal muscle mass on swallowing recovery in patients with post-stroke dysphagia

OBJECTIVES

Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index（cm2/height2（m2））, calculated by the psoas muscle area at the L3 level via abdominal computed tomography （CT）, can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery.

METHODS

A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study（VFSS）. Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale （FOIS） from the time of VFSS to discharge（observational period: ObPd）. The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively.

RESULTS

There were 53 subjects （36 male, median age 73.9）. The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass （β - 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029） was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS.

CONCLUSION

CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.

Trajectories of the Prevalence of Sarcopenia in the Pre- and Post-Stroke Periods: A Systematic Review

Interventions for stroke-related sarcopenia in patients with stroke are needed, but the details of the target population are unclear. This systematic review aimed to identify trajectories of the prevalence of sarcopenia in the pre- and post-stroke periods and to determine the diagnostic criteria used in patients with stroke. We searched for literature in six databases: MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and Ichushi-web (in Japanese). We included 1627 studies in the primary screening, and 35 studies were finally included. Of the 35 studies, 32 (91.4%) included Asian patients, and the criteria of the Asian Working Group for Sarcopenia was mainly used as the diagnostic criteria. Nineteen studies used muscle strength and muscle mass to diagnose sarcopenia, whereas a full assessment, including physical performance, was performed in five studies. The estimated prevalences of sarcopenia in pre-stroke, within 10 days of stroke, and from 10 days to 1 month after stroke were 15.8%, 29.5%, and 51.6%, respectively. Sarcopenia increased by approximately 15% from pre-stroke to 10 days, and increased by approximately 20% from 10 days to 1 month. Healthcare providers should note that the prevalence of sarcopenia increases during the acute phase in patients with stroke.

Prevalence of sarcopenic obesity based on newly proposed diagnostic criteria and functional outcomes in older adults undergoing rehabilitation

In 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) working group proposed uniform diagnostic criteria for sarcopenic obesity. However, no study has adapted these criteria to an Asian population or examined sarcopenic obesity prevalence diagnosed using these criteria or its association with functional outcomes. This retrospective cohort study investigated sarcopenic obesity prevalence diagnosed based on the ESPEN and EASO criteria, and its association with functional outcomes in 1080 older Japanese patients (mean age 79.5 years, 43.5 % male) undergoing rehabilitation. Based on the mentioned criteria, sarcopenic obesity is defined as a BMI ≥ 25 kg/m², increased percent body fat (PBF), reduced skeletal muscle mass (SMM), and low handgrip strength. Sarcopenic obesity prevalence was investigated using various ESPEN- and EASO-proposed definitions of increased PBF and reduced SMM. Functional outcomes were evaluated based on whether patients improved in the minimal clinically important difference (MCID) of the Functional Independence Measure (FIM). The prevalence was 4.3-5.3 %. Sarcopenic obesity was not independently related to FIM MCID achievement. Sarcopenic obesity prevalence-based on the ESPEN and EASO criteria-in older Japanese patients undergoing rehabilitation was low and was not associated with poor functional outcomes.

Association between premorbid sarcopenia and neurological deterioration in patients with acute ischemic stroke

OBJECTIVE

Sarcopenia is associated with poor outcomes in patients with stroke. This study aimed to investigate the association between premorbid sarcopenia and neurological deterioration (ND) in patients with acute ischemic stroke. To the best of our knowledge, there have been no studies on this topic.

METHODS

In this prospective longitudinal study, we assessed premorbid sarcopenia using the SARC-F questionnaire, and the incidence of ND was defined by an increase of ≥ 1 point on the National Institutes of Health Stroke Scale (NIHSS) or the occurrence of any new neurological symptoms/signs. Logistic regression analysis was used to investigate the relationship between premorbid sarcopenia and ND.

RESULTS

Of the 290 patients enrolled, 46 and 244 patients experienced and did not experience ND 1 week after admission (ND and non-ND groups, respectively). The prevalence of sarcopenia was significantly higher in the ND group than in the non-ND group (39% vs. 17%). In the adjusted model, premorbid sarcopenia was significantly associated with ND (adjusted odds ratio: 3.06, 95% confidence interval: 1.11-8.40; p = 0.03).

CONCLUSION

Premorbid sarcopenia is independently associated with ND in patients with acute ischemic stroke. Therefore, it is necessary to detect premorbid sarcopenia to predict ND in these patients.

The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes

Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (β = −0.048, p = 0.031) and FILS at discharge (β = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (β = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (β = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.

Aging after stroke: how to define post-stroke sarcopenia and what are its risk factors?

BACKGROUND

Sarcopenia, generally described as "aging-related loss of skeletal muscle mass and function", can occur secondary to a systemic disease.

AIM

This project aimed to study the prevalence of sarcopenia in chronic ambulatory stroke survivors and its associated risk factors using the two most recent diagnostic criteria.

DESIGN

A cross-sectional observational study.

SETTING

A scientific laboratory.

POPULATION

Chronic stroke.

METHODS

Twenty-eight ambulatory chronic stroke survivors (12 females; mean age=57.8±11.8 years; time after stroke=76±45 months), hand-grip strength, gait speed, and appendicular skeletal muscle mass (ASM) were measured to define sarcopenia. Risk factors, including motor impairment and spasticity, were identified using regression analysis.

RESULTS

The prevalence of sarcopenia varied between 18% and 25% depending on the diagnostic criteria used. A significant difference was seen in the prevalence of low hand grip strength on the affected side (96%) when compared to the contralateral side (25%). The prevalence of slow gait speed was 86% while low ASM was present in 89% of the subjects. Low ASM was marginally negatively correlated with time since stroke and gait speed, but no correlation was observed with age, motor impairment, or spasticity. ASM loss, bone loss and fat deposition were significantly greater in the affected upper limb than in the affected lower limb. Regression analyses showed that time since stroke was a factor associated with bone and muscle loss in the affected upper limb, spasticity had a protective role for muscle loss in the affected lower limb, and walking had a protective role for bone loss in the lower limb.

CONCLUSIONS

The prevalence of sarcopenia in stroke survivors is high and is a multifactorial process that is not age-related. Different risk factors contribute to muscle loss in the upper and lower limbs after stroke.

CLINICAL REHABILITATION IMPACT

Clinicians need to be aware of high prevalence of sarcopenia in chronic stroke survivors. Sarcopenia is more evident in the upper than lower limbs. Clinicians also need to understand potential protective roles of some factors, such as spasticity and walking for the muscles in the lower limb.

Sarcopenia and Chronic Complications of Type 2 Diabetes Mellitus

Sarcopenia, defined as the loss of skeletal muscle mass and strength and/or a decrease in physical performance, is classically related to aging. However, chronic disease, including type 2 diabetes mellitus (T2DM), may accelerate the development of sarcopenia. Previous studies found strong association between T2DM and sarcopenia. Insulin resistance that exists in T2DM is thought to be the key mediator for impaired physical function and mobility which may lead to sarcopenia. T2DM may cause sarcopenia through the mediation of insulin resistance, inflammation, accumulation of advanced glycation end-products, and oxidative stress that may affect muscle mass and strength, protein metabolism, and vascular and mitochondrial dysfunction. On the other hand, loss of muscle in sarcopenia may play a role in the development of T2DM through the decreased production of myokines that play a role in glucose and fat metabolism. This review highlights the findings of existing literature on the relationship between T2DM and sarcopenia which emphasize the pathophysiology, chronic vascular complications, and the course of macrovascular and microvascular complications in T2DM.

Sarcopenia affects Functional Independence Measure motor scores in elderly patients with stroke

OBJECTIVES

There is no unified view of the relationship between sarcopenia and the activities of daily living (ADL) in stroke patients. This study aimed to determine whether sarcopenia affects the ADL in elderly patients with stroke.

MATERIALS AND METHODS

This case-control study included 472 stroke patients aged ≥ 65 years who were admitted to the convalescent rehabilitation ward. Sarcopenia was defined as a decrease in both the skeletal muscle mass index and handgrip strength, based on the Asian Working Group for Sarcopenia 2019 criteria cut-off, which was assessed on admission. ADL was assessed using the Functional Independence Measure-motor (FIM-m) score at discharge. The Charlson comorbidity index, Mini Nutritional Assessment-Short Form, Brunnstrom recovery stage of the upper limb, Brunnstrom recovery stage of the lower limb and total amount of rehabilitation during hospitalization were evaluated as confounding factors. To clarify whether sarcopenia affects the ADL in patients with stroke, we conducted a multiple regression analysis with the presence of sarcopenia as the independent variable and FIM-m at discharge as the objective variable.

RESULTS

The final analysis included 283 patients; among them, 163 (57.6%) patients had sarcopenia at the time of admission to the convalescent rehabilitation ward. In the multiple regression analysis, sarcopenia was independently associated with FIM-m at hospital discharge, even after adjusting for confounders (β = -0.100, p = 0.034).

CONCLUSIONS

Sarcopenia at admission in elderly patients with stroke affected the FIM-m at discharge, even after adjusting for multiple confounders.

Possible Sarcopenia and Its Association with Nutritional Status, Dietary Intakes, Physical Activity and Health-Related Quality of Life among Older Stroke Survivors

Background

Screening for sarcopenia in the stroke population is an emerging concept in research and clinical practice. Therefore, this cross-sectional study aimed to assess the prevalence of possible sarcopenia and its associated factors among older stroke survivors who visited the neurology and rehabilitation departments of three public hospitals in Malaysia.

Methods

We acquired data on sociodemographic characteristics, clinical profiles, malnutrition risk, dietary intake, physical activity level, and health-related quality of life. Possible sarcopenia was diagnosed in individuals with decreased calf circumference and low handgrip strength, as proposed by the Asia Working Group for Sarcopenia (2019). Finally, we performed descriptive analysis and binary logistic regression.

Results

Among 196 older adults with stroke (mean± standard deviation of age: 67.60 ± 5.70 years), 42.3% had possible sarcopenia, with a higher prevalence in the more advanced age group (≥70 years). In univariable analysis, possible sarcopenia was significantly associated with anthropometric indices, malnutrition risk, nutrient intake, physical activity level, and health-related quality of life. In multivariable analysis, body mass index (adjusted odds ratio [AOR]=0.57; 95% confidence interval [CI], 0.43–0.75) was the only factor associated with possible sarcopenia among individuals aged ≥70 years. Recurrent stroke (AOR=3.48; 95% CI, 1.02–11.92), body mass index (AOR=0.64; 95% CI, 0.54–0.76), and EQ-5D index (AOR=0.15; 95% CI, 0.03–0.78) were significantly associated with possible sarcopenia in the 60–69-year age group.

Conclusion

The prevalence of possible sarcopenia among community-dwelling older stroke survivors was high. Therefore, we recommend routine screening for possible sarcopenia to ensure early nutritional and exercise intervention.

Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes

Background Evidence is scarce regarding polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine. Aim To investigate the prevalence of polypharmacy and PIMs and their association with outcomes in stroke rehabilitation. Method A retrospective cohort study was conducted with 849 older inpatients post-stroke. Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included functional independence measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay, and the rate of home discharge. To consider the effect of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes. Results After enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed in 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = - 0.062, P = 0.049), FIM-cognitive score (β = - 0.076, P = 0.014), energy intake (β = - 0.143, P = 0.005), and home discharge (OR: 0.458; 95% CI: 0.248, 0.847; P = 0.013). PIMs were negatively associated with home discharge (OR: 0.375; 95% CI: 0.195, 0.718; P = 0.003). Conclusion Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy was negatively associated with activities of daily living (ADL) but not with PIMs and ADLs, and both were associated with home discharge.

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson's syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

The Effect of Branched Chain Amino Acid Supplementation on Stroke-Related Sarcopenia

Background

Stroke-related sarcopenia is caused by various factors, such as brain damage, systemic catabolic state, skeletal muscle imbalance, and malnutrition. In the long-term care plan after stroke, appropriate rehabilitation strategies to achieve maximum functional improvement and prevent the development of sarcopenia are important. This study has investigated the effect of branched-chain amino acid (BCAA) supplementation on sarcopenia after stroke. We also evaluated the effect of BCAA on functional improvement during the intensive rehabilitation period.

Methods

Patients with subacute stroke with stroke-related disabilities were enrolled and given dietary supplement powder containing BCAAs for 1 month. These BCAAs were supplied through the nutrition team during feeding time. Patients whose age, sex, and stroke lesions were similar to those of the study group were enrolled in the control group through medical record review. Both groups received personalized intensive inpatient rehabilitation therapy in a single-unit rehabilitation center. All patients' target calories were calculated regularly by the nutritional support team in our institution. Sarcopenia status was evaluated using grip strength and the skeletal muscle index (SMI), which was assessed by dual-energy X-ray absorptiometry (DEXA). The functional status associated with stroke was evaluated every month, including activities of daily living, balance, gait, and swallowing.

Results

A total of 54 patients were enrolled, with 27 patients in each of the two groups. The study group showed significantly greater improvement in SMI after intervention than the control group. Both groups improved functionally over time, but the improvement in the study group was significantly greater than that in the control group. Univariate analysis revealed that patients with better functional status had a greater SMI with a combination of BCAA supplementation and intensive rehabilitation therapy.

Conclusion

Our results showed a positive effect of BCAA supplementation on sarcopenia after stroke. We also found that nutritional support helps functional improvement during neurological recovery. These results suggest that comprehensive rehabilitation intervention combined with BCAA supplementation could be a helpful option during the critical period of post-stroke neurological recovery.

Chair-Stand Exercise Improves Sarcopenia in Rehabilitation Patients after Stroke

Currently, there is a lack of evidence to show that exercise therapy improves sarcopenia in older patients in clinical practice. We therefore conducted a retrospective cohort study to clarify the effects of chair-stand exercise on improving sarcopenia among patients diagnosed with sarcopenia undergoing convalescent rehabilitation after stroke. According to the latest Asian criteria, sarcopenia was diagnosed when both skeletal muscle mass index (SMI) and handgrip strength (HGS) were low. Patients were asked to perform a repeated chair-stand exercise as whole-body resistance training, in addition to the rehabilitation program. Outcomes included sarcopenia rates, SMI, HGS, and physical function at hospital discharge. Multivariate analyses were used to examine whether the frequency of daily chair-stand exercise was independently associated with the outcomes after adjustment for potential confounders. After enrollment, 302 patients with sarcopenia (mean age: 78.6 years; 46.4% male) were analyzed. Overall, sarcopenia prevalence decreased by 21.9%, from 100% at admission to 78.1% at discharge. Multivariate analyses showed that the frequency of the exercise was significantly associated with the presence of sarcopenia (odds ratio: 0.986, p = 0.010), SMI (β = 0.181, p < 0.001), and HGS (β = 0.101, p = 0.032) at discharge, respectively. The chair-standing exercise was effective in improving sarcopenia in these patients.

Association between BIA-derived Phase Angle and Sarcopenia and Improvement in Activities of Daily Living and Dysphagia in Patients undergoing Post-Stroke Rehabilitation

OBJECTIVES

To investigate the predictive value of the BIA-derived phase angle with respect to the functional prognosis and baseline sarcopenia in patients undergoing post-stroke rehabilitation.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Overall, 577 Japanese patients admitted to a post-acute care hospital from 2016 to 2020 were recruited.

MEASUREMENTS

Body composition analysis, which included BIA-derived phase angle and skeletal muscle mass, was performed using bioelectrical impedance analysis (BIA). Study outcomes included physical function assessed using the Functional Independence Measure (FIM-motor) and the level of dysphagia assessed using the Food Intake LEVEL Scale (FILS). Sarcopenia was defined as the loss of skeletal muscle mass and decreased muscle strength. Receiver operating characteristic curves were used to calculate the optimal cutoff value of BIA-derived phase angle to diagnose sarcopenia. Multivariate analyses were used to determine whether the BIA-derived phase angle at admission was associated with outcomes at discharge and baseline sarcopenia.

RESULTS

After enrollment, 499 patients (mean age: 74.0 ± 13.1 years; 52.0% men) were examined. The median FIM-motor and FILS scores at admission were 47 (20-69) and 8 (7-10), respectively. Sarcopenia was observed in 43.2% of patients. After adjusting for potential confounders, BIA-derived phase angle was positively associated with FIM-motor scores at discharge (β = 0.134, P < 0.001), FIM-motor score gain (β = 2.504, P < 0.001), and FILS scores at discharge (β = 0.120, P = 0.039). BIA-derived phase angle was negatively associated with the sarcopenia diagnosis at baseline (odds ratio = -0.409, P < 0.001); its cutoff value was 4.76° (sensitivity 0.800, specificity 0.790, P < 0.001) for sarcopenia diagnosis in men and 4.11° (sensitivity 0.735, specificity 0.829, P < 0.001) in women.

CONCLUSION

BIA-derived phase angle was positively associated with the recovery of physical function and dysphagia level and negatively associated with baseline sarcopenia in patients undergoing post-stroke rehabilitation. The BIA-derived phase angle cutoff for sarcopenia diagnosis was 4.76° for men and 4.11° for women.

Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia

OBJECTIVES

This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia.

DESIGN

A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database.

SETTING

The database was constructed using data from 19 hospitals and one home visiting rehabilitation team.

PARTICIPANTS

Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included.

MEASUREMENTS

Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function.

RESULTS

A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up.

CONCLUSIONS

Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.

A Combined Assessment Method of Phase Angle and Skeletal Muscle Index to Better Predict Functional Recovery after Acute Stroke

OBJECTIVES

We aimed to investigate whether combination assessment of phase angle (PhA) and skeletal muscle index (SMI), was a possible predictor of physical function at discharge from the hospital in patients with acute stroke.

RESEARCH METHODS AND PROCEDURES

In this retrospective cohort study that was conducted from May 2020 and July 2021, we determined PhA and SMI using bioimpedance analysis (BIA) in patients with acute stroke. Patients were classified as normal, low PhA + SMI group, pre-sarcopenia (low SMI only), and dynapenia (low PhA only) using cut-off points (men: SMI < 7.0 kg/m2, PhA < 4.05 degrees; women: SMI < 5.7 kg/m2, PhA < 3.55 degrees). The main outcome was physical function based on functional independence measure motor (FIM-motor) score at discharge. Multiple regression analysis was used to determine the association between low PhA + SMI and FIM-motor score.

RESULTS

We included 244 patients (161 men; mean age, 73.9 years). low PhA + SMI was found in 21 (8.6%) patients. Multiple regression analysis showed that low PhA + SMI was independently associated with the FIM-motor score at discharge (β= -0.099, 95%CI: -0.193,-0.005, p = 0.039). The PhA cutoff values for determining good functional results using receiver operating characteristic (ROC) curves were 5.36 for men (sensitivity = 0.769, specificity = 0.586, area under the curve [AUC] = 0.682), and 3.85 for women (sensitivity = It was 0.881, specificity = 0.481, AUC). Further, pearson correlation coefficient showed that PhA was significantly related to FIM-motor score in patients with mild or moderately severe stroke (mild: r = 0.472, p < 0.001; moderate: r = 0.524, p < 0.001).

CONCLUSIONS

Combination of low PhA and SMI values at baseline, was an independent predictor of physical function at discharge in patients with acute stroke. The findings highlighted the importance of measuring PhA and SMI using BIA in patients with acute stroke.

Sarcopenia is associated with incontinence and recovery of independence in urination and defecation in post-acute rehabilitation patients

OBJECTIVE

The aim of this study was to examine the association between sarcopenia and recovery of independence in urination and defecation in patients undergoing convalescent rehabilitation.

METHODS

This single-center, retrospective cohort study included post-acute rehabilitation patients. Sarcopenia was diagnosed using the muscle mass index and handgrip strength according to the updated criteria of the Asian Working Group for Sarcopenia 2019. Study outcomes and the recovery of independence in urination and defecation were evaluated using the sphincter control items of the Functional Independence Measure (FIM) at discharge: urination (FIM-Bladder) and defecation (FIM-Bowel), respectively. Multivariate regression analyses were used to determine whether sarcopenia at baseline was associated with the study outcomes. Statistical significance was set at P < 0.05.

RESULTS

After enrollment, 917 patients (mean age 74.7 ± 13.5 y; 58% women) were included in the final analyses. Sarcopenia was present in 451 patients (49.2%). The median FIM-Bladder and FIM-Bowel scores at admission were 5 [2-7] and 5 [3-7], respectively. Multivariate analyses showed that the presence of sarcopenia at admission was independently and negatively associated with FIM-Bladder and FIM-Bowel at discharge (all P < 0.001), respectively, after adjusting for potential confounders including baseline outcome variables, FIM, and disease.

CONCLUSIONS

Sarcopenia was negatively associated with the recovery of independence in urination and defecation in a post-acute rehabilitation setting. This relationship was independent of physical and cognitive level and disease. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented to predict and maximize improvement in toileting independence in this population.

Unresolved inflammation during hospitalization is associated with post-discharge institutionalization and mortality in geriatric rehabilitation inpatients: The RESORT cohort

BACKGROUND

Inflammation contributes to adverse health outcomes in community-dwelling populations. Little is known about inflammation in hospitalized older adults and its association with adverse outcomes. This study aimed to evaluate the association of the inflammatory markers C-reactive protein (CRP) and albumin measured during acute and geriatric rehabilitation hospitalization with institutionalization and mortality in geriatric rehabilitation inpatients.

METHODS

Within the REStORing health of acutely unwell adulTs (RESORT) cohort, CRP and albumin were measured as part of usual care during acute and geriatric rehabilitation hospitalization. Inflammatory markers are presented as median, peak (CRP: maximum; albumin: minimum), variation (interquartile range) and direction of change (increased CRP or decreased albumin: positive or negative difference between last measurement and median of preceding measurements). Logistic regression was used to determine the associations between inflammatory markers and institutionalization at three-month and all-cause mortality at three- and twelve-month post-discharge.

RESULTS

Geriatric rehabilitation inpatients (n = 1846) with a median age of 83.3 years (interquartile range 77.6-88.3) and 56.6% of female were included. Increased CRP during geriatric rehabilitation was associated with institutionalization. Higher median, peak and increased levels of CRP during geriatric rehabilitation but not during acute hospitalization were associated with higher mortality. Lower CRP variation during acute hospitalization but higher CRP variation during geriatric rehabilitation was associated with higher mortality. Lower median level of albumin during both hospitalizations were associated with higher mortality.

CONCLUSIONS

Inflammation characterized by lower albumin during acute hospitalization and, higher CRP and lower albumin during geriatric rehabilitation was associated with mortality in geriatric rehabilitation inpatients. Increased CRP during geriatric rehabilitation was associated with institutionalization. Unresolved inflammation in geriatric rehabilitation might indicate ongoing disease activity leading to adverse outcomes.

Role of systemic inflammation in functional recovery, dysphagia, and 1-y mortality in heart failure: A prospective cohort study

OBJECTIVES

This study evaluated the relationship between systemic inflammation and clinical outcomes in people hospitalized with acute heart failure (AHF).

METHODS

We prospectively enrolled people newly hospitalized with AHF after excluding those with concomitant infectious or inflammatory diseases. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS) at hospitalization, and participants were classified into low-grade and high-grade inflammation groups (mGPS 0-1 and 2, respectively). The primary outcome measure was functional recovery, evaluated using the Barthel Index gain. Secondary outcome measures were dysphagia at discharge and all-cause 1-y mortality after discharge. Multivariable analyses and Kaplan-Meier estimates were used to determine the association between systemic inflammation and study outcomes.

RESULTS

A total of 184 participants (mean age, 79.1 y; 48.4% female, 51.6% male) were included; 148 (80.4%) and 36 (19.6%), respectively, had low-grade and high-grade inflammation. Participants with high-grade inflammation were significantly older, had lower body mass index and muscle strength, and had lower nutrient intake, swallowing status, and Barthel Index than those with low-grade inflammation. In multivariable analyses, mGPS was significantly associated with Barthel Index gain (β = -0.229, P = 0.004) and Food Intake Level Scale (odds ratio = 5.067, P = 0.034) at discharge; mGPS was associated with 1-y mortality after discharge (P = 0.003).

CONCLUSIONS

Baseline systemic inflammation was negatively associated with improvements in physical function and dysphagia and with 1-y survival in people with AHF. These findings highlight the importance of focusing on the assessment of systemic inflammation to accurately predict the functional prognosis of people with AHF.

Improvement in Oral Health Enhances the Recovery of Activities of Daily Living and Dysphagia after Stroke

OBJECTIVE

Oral problems affect rehabilitation outcomes. This study aimed to examine the association between improvement in oral health and functional outcomes in patients after stroke.

MATERIALS AND METHODS

This retrospective cohort study included post-acute rehabilitation patients who presented with oral problems at admission. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). The ROAG score change during hospitalization was calculated by subtracting the score at admission from the score at discharge; oral problems were defined as "improved", when the score change value was lower than the median value. Study outcomes were the activities of daily living assessed by the motor domain of the Functional Independence Measure (FIM-motor) scores and dysphagia as assessed by the Food Intake Level Scale (FILS). Multivariate regression analyses were used to determine whether improved oral problems were associated with study outcomes. P-values of <0.05 were considered statistically significant.

RESULTS

This study included 300 patients (mean age, 72.0 years; 51.7% men). The median [IQR] baseline ROAG score and its change value during hospitalization were 11 [10, 14] and -1[-3, 0] points, respectively. Multivariate analyses showed that improved oral problems was independently associated with FIM-motor score (β = 0.144, p = 0.001) and FILS score (β = 0.227, p < 0.001) at discharge, after adjusting for potential confounders.

CONCLUSIONS

Improvement in oral health was positively associated with recovery of the ADL and dysphagia after stroke. Early detection of oral problems and oral treatment should be implemented in these patients to maximize functional recovery.

Impact of Phase Angle on Physical Function in Patients with Acute Stroke

OBJECTIVE

Phase angle, an assessment of muscle quality, might be a possible predictor of physical function in patients with an acute stroke; however, the evidence for the same is limited. Therefore, this study aimed to investigate whether phase angle is associated with improved physical function at discharge.

METHODS

In this observational cohort study, we determined the phase angle in patients with an acute stroke using a portable, noninvasive multifrequency bio-impedance device. The primary objective was the assessment of physical function using the Functional Independence Measure motor (FIM-motor) at discharge in the acute phase. The secondary outcome was home discharge. Multiple regression analysis was used to determine the association between phase angle, FIM-motor score, and home discharge.

RESULTS

The study included 129 patients (78 men; mean age 75.2 years). Multiple linear regression analysis showed that the phase angle was independently associated with FIM-motor score at discharge in all models (Model 1: β= 0.27, p < 0.001; Model 2: β = 0.234, p < 0.001; Model 3: β = 0.201, p = 0.017). However, multiple logistic regression analysis showed that the phase angle was not associated with home discharge (p = 0.464).

CONCLUSIONS

The phase angle at the onset of a stroke, is an independent predictor of physical function at discharge in the acute phase. Our findings highlight the importance of determining the phase angle in patients with an acute stroke.

Effect of Improvement in Sarcopenia on Functional and Discharge Outcomes in Stroke Rehabilitation Patients

This cross-sectional study investigated the proportion of patients’ recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709–10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912–7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.

Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients

Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.

Nutrition in the First Week after Stroke Is Associated with Discharge to Home

Malnutrition is associated with poor clinical outcomes in stroke patients. The effect of early nutritional intake after admission on home discharge is unclear. We evaluated the impact of energy intake in the first week of hospitalization of acute stroke patients on home discharge and activities of daily living (ADL). A retrospective cohort study was conducted with 201 stroke patients admitted to an acute care hospital in Japan. The energy and protein intake during the first week were evaluated. Multivariate models were used to estimate variables related to discharge destination and ADL at discharge. The cut-off point of nutritional intake for determining the discharge destination was evaluated using the receiver operating characteristic curve. Out of 163 patients included in the analysis, 89 (54.6%) and 74 (45.4%) were discharged home and elsewhere, respectively. Those discharged home had higher energy and protein intake than those discharged elsewhere. In multiple regression analysis, energy intake was independently associated with ADL at discharge and home discharge (odds ratio 1.146). Those with energy intake >20.7 kcal/kg/day had higher ADL at discharge and more patients discharged home than those with energy intake <20.7 kcal/kg/day. Energy intake during the first week affected home discharge in acute stroke patients.

Are Sarcopenia and Cognitive Dysfunction Comorbid after Stroke in the Context of Brain-Muscle Crosstalk?

Stroke is a leading cause of death and disability and is responsible for a significant economic burden. Sarcopenia and cognitive dysfunction are common consequences of stroke, but there is less awareness of the concurrency of these conditions. In addition, few reviews are available to guide clinicians and researchers on how to approach sarcopenia and cognitive dysfunction as comorbidities after stroke, including how to assess and manage them and implement interventions to improve health outcomes. This review synthesises current knowledge about the relationship between post-stroke sarcopenia and cognitive dysfunction, including the physiological pathways, assessment tools, and interventions involved.

Low handgrip strength is associated with reduced functional recovery and longer hospital stay in patients with osteoporotic vertebral compression fractures: a prospective cohort study

AIM

Despite the growing interest in sarcopenia in clinical medicine, there is little evidence to support the association between muscle strength and functional prognosis in patients with osteoporotic vertebral fractures. The aim of this study was to evaluate the impact of low handgrip strength (HGS) on functional outcomes in older patients with osteoporotic vertebral fractures.

METHODS

A prospective cohort study was performed between 2017 and 2019 on consecutive patients with conservatively treated vertebral compression fractures who were newly admitted for post-acute rehabilitation. HGS was measured on admission. Outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and length of hospital stay. Multivariate linear regression analyses were utilized to determine whether HGS at baseline was significantly associated with these outcomes after adjustment for potential confounders.

RESULTS

Of the 207 patients admitted, 159 patients (mean age 83 years; 78% women) were enrolled in the analysis. The mean (standard deviation: SD) HGS was 15.9 (7.7) kg. Multivariate analysis showed that HGS at admission was independently associated with the FIM-motor score at discharge (β = 0.107, p = 0.006) and length of stay (β = - 0.118, p = 0.030).

CONCLUSION

Low HGS is commonly found and is associated with reduced functional recovery and prolonged hospital stay in older patients with osteoporotic vertebral fractures. Early detection and interventions for low HGS could help achieve improved outcomes. However, further studies are needed to validate our findings.

Association of impaired oral health status with chronic kidney disease in post-acute rehabilitation

BACKGROUND

Despite the growing interest in oral health and chronic disease in geriatric medicine, the evidence of an association between the two variables is limited.

OBJECTIVES

This study sought to examine the association between oral health status and chronic kidney disease (CKD) in this setting.

MATERIALS AND METHODS

This retrospective study included consecutive post-acute patients in a rehabilitation hospital. Oral health status was evaluated using the Revised Oral Assessment Guide (ROAG). Renal function or CKD stage was assessed by measurement of the estimated glomerular filtration rate (eGFR). Multivariate logistic regression analysis was used to determine which subcategories of ROAG were independently associated with advanced CKD stages (vs. early CKD stages). Multiple linear regression analysis was used to clarify whether eGFR on admission was independently associated with ROAG score after adjusting for potential confounders.

RESULTS

A total of 1056 (mean age 70 years; 52% women) were included in the analysis. Slight and moderate-to-severe oral health problems were detected in 57.7% and 15.4% of patients, respectively. Patients with oral problems had a more severe stage of CKD (P = .036) and a lower eGFR (P = .028). Among subitems of ROAG, tongue (OR = 1.40, P = .041), saliva (OR = 1.72, P = .039) and oral cavity mucosa (OR = 1.37, P = .013) status was independently associated with the presence of CKD stages 3, 4 and 5. Furthermore, eGFR was independently associated with ROAG score (β = -0.180, P = .034) after adjusting for possible confounders.

CONCLUSIONS

Impaired oral health status is common and closely associated with CKD in post-acute inpatients.

Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke

OBJECTIVES

Evidence for appropriate nutritional assessment, energy prediction, and adaptation and their effect on outcomes after stroke is scarce. We sought to determine the frequency of individualized dietary prescriptions issued for individuals undergoing rehabilitation after stroke and to analyze the effect of diet-prescription frequency on outcomes after stroke.

METHODS

This single-center prospective cohort study included poststroke patients newly admitted to convalescent rehabilitation wards. The frequency and content of dietary prescriptions issued as part of nutritional assessments were examined. Study outcomes were nutritional status assessed using changes in skeletal muscle mass, physical function assessed using the Functional Independence Measure motor score, dysphagia status assessed using the Food Intake LEVEL Scale (score < 7), and length of hospital stay. Multivariate analyses were performed to determine whether the frequency of dietary prescriptions issued during hospitalization was independently associated with outcomes of interest, after adjusting for potential confounders.

RESULTS

A total of 454 participants (mean age = 71.8 y; 53.1% men, 46.9% women) were included in the final analysis data set. A median of five (range, 2-11) dietary prescriptions were issued per participant during the median 96 d of hospitalization, with the most common items being diet-texture modification for dysphagia and oral energy/protein enhancement. In multivariate analyses, the frequency of dietary prescriptions was independently associated with the change in skeletal muscle mass (β = 0.165, P = 0.028), Functional Independence Measure motor scores at discharge (β = 0.104, P = 0.045), length of stay (β = -0.056, P = 0.019), and presence of dysphagia at discharge (odds ratio = 0.949, P = 0.032).

CONCLUSIONS

Frequent and individualized nutritional support is associated with improved nutritional status, physical function, and dysphagia after stroke. Intensive nutritional support through multidisciplinary discussion plays a central role in the prevention and management of malnutrition to maximize the improvement of patient outcomes. This study is the first to report this association.

Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia

OBJECTIVES

The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke.

METHODS

This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders.

RESULTS

Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (β = 0.114, p = 0.031), and negatively associated with length of stay (β = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (β = 0.267, p = 0.001).

CONCLUSIONS

A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.

Prevalence of stroke-related sarcopenia: A systematic review and meta-analysis

OBJECTIVES

Although the skeletal muscle is the main effector of disability in stroke, evidence on post-stroke skeletal muscle is scarce; especially, the prevalence of stroke-related sarcopenia remains unclear. Thus, we aimed to systematically search the prevalence of sarcopenia in stroke survivors and synthesize pooled estimates of overall prevalence of stroke-related sarcopenia and prevalence stratified by sex, country, time since stroke onset, and diagnostic criteria of sarcopenia.

METHODS

We performed systematic searches in the MEDLINE, CINAHL, Embase, and Cochrane Library databases. English-language searches to identify included studies were completed August 25, 2019. Meta-analysis of data collected from cross-sectional or observational studies which were reported the prevalence of sarcopenia among stroke participants. All statistical analyses were performed using R version 3.5.2.

RESULTS

A total of 855 articles were initially identified. Seven articles were included in this study. Total sample size across all included studies was 1695. Three studies were conducted in Japan, 2 in South Korea, 1 in Taiwan, and 1 in the U.S. Four included studies had a cross-sectional design, and 3 were retrospective cohort studies. Four and 3 studies included participants at <1 month and ≥6 months since stroke onset, respectively. The pooled prevalence estimate was 42% (95% confidence interval: 33%-52%), with a substantial heterogeneity (I²=91%).

CONCLUSIONS AND IMPLICATIONS

Sarcopenia is frequently observed in stroke survivors, and a higher prevalence of sarcopenia is noted during the early phase after stroke. This study would be useful for researchers to design sarcopenia studies in this population. Further prospective longitudinal studies for sarcopenia and their prognostic outcomes in stroke survivors are urgently needed to propose appropriate physical and nutritional strategies in geriatric rehabilitation.