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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications.Stroke. 2005; 36: 2756-2763
- Diagnosis and management of oropharyngeal dysphagia among older persons, state of the art.J Am Med Dir Assoc. 2017; 18: 576-582
- Post-stroke dysphagia: A review and design considerations for future trials.Int J Stroke. 2016; 11: 399-411
- Cough reflex attenuation and swallowing dysfunction in sub-acute post-stroke patients: Prevalence, risk factors, and clinical outcome.Neurogastroenterol Motil. 2017; 29
- Dysphagia after stroke: An overview.Curr Phys Med Rehabil Rep. 2013; 1: 187-196
- The natural history of dysphagia following a stroke.Dysphagia. 1997; 12: 188-193
- Sarcopenia and dysphagia: Position paper by four professional organizations.Geriatr Gerontol Int. 2019; 19: 91-97
- Sarcopenia is an independent risk factor of dysphagia in hospitalized older people.Geriatr Gerontol Int. 2016; 16: 515-521
- Decreased skeletal muscle mass and risk factors of sarcopenic dysphagia: A prospective observational cohort study.J Gerontol A Biol Sci Med Sci. 2017; 72: 1290-1294
- Association of sarcopenic dysphagia with underlying sarcopenia following hip fracture surgery in older women.Nutrients. 2020; 12: 1365
- Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia.JCSM Clin Rep. 2017; 2: 1-10
- Development and predictors of sarcopenic dysphagia during hospitalization of older adults.Nutrients. 2019; 12: 70
- The effects of sarcopenic dysphagia on the dynamics of swallowing organs observed on videofluoroscopic swallowing studies.J Oral Rehabil. 2020; 47: 584-590
- Sarcopenia in stroke-facts and numbers on muscle loss accounting for disability after stroke.J Cachexia Sarcopenia Muscle. 2011; 2: 5-8
- Stroke-related sarcopenia: Specific characteristics.J Am Med Dir Assoc. 2015; 16: 272-276
- Atrophy of swallowing muscles is associated with severity of dysphagia and age in patients with acute stroke.J Am Med Dir Assoc. 2017; 18: 635.e1-635.e7
- Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients.Arch Phys Med Rehabil. 2005; 86: 1516-1520
- Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly.Dysphagia. 2015; 30: 80-87
- Development and validation of a prognostic model of swallowing recovery and enteral tube feeding after ischemic stroke.JAMA Neurol. 2019; 76: 561-570
- Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.J Am Med Dir Assoc. 2020; 21: 300-307.e2
- Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan.Arch Gerontol Geriatr. 2012; 55: e9-e13
- Association between muscle mass and disability in performing instrumental activities of daily living (IADL) in community-dwelling elderly in Japan.Arch Gerontol Geriatr. 2012; 54: e230-e233
- Clinical interpretation and use of stroke scales.Lancet Neurol. 2006; 5: 603-612
- A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair.Surg Endosc. 2017; 31: 2509-2519
- Predicting postoperative outcomes in brain tumor patients with a 5-factor modified frailty index.Neurosurgery. 2020; 88: 147-154
- Validation of the Mini Nutritional Assessment short-form (MNA-SF): A practical tool for identification of nutritional status.J Nutr Health Aging. 2009; 13: 782-788
- The Functional Independence Measure: A comparative validity and reliability study.Disabil Rehabil. 1995; 17: 10-14
- Calf circumference value for sarcopenia screening among older adults with stroke.Arch Gerontol Geriatr. 2021; 93: 104290
- The global leadership initiative on malnutrition-defined malnutrition predicts prognosis in persons with stroke-related dysphagia.J Am Med Dir Assoc. 2019; 20: 1628-1633
- Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia.Nutrition. 2021; 90: 111295
- The relationship between tongue pressure and oral dysphagia in stroke patients.Ann Rehabil Med. 2016; 40: 620-628
- Sarcopenic dysphagia with low tongue pressure is associated with worsening of swallowing, nutritional status, and activities of daily living.J Nutr Health Aging. 2021; 25: 883-888
- Relationship between tongue pressure and dysphagia diet in patients with acute stroke.PLoS One. 2021; 16: e0252837
- The prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation.J Nutr Health Aging. 2019; 23: 84-88
- Sarcopenia is associated with worse recovery of physical function and dysphagia and a lower rate of home discharge in Japanese hospitalized adults undergoing convalescent rehabilitation.Nutrition. 2019; 61: 111-118
- Oropharyngeal dysphagia after stroke: Incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit.J Stroke Cerebrovasc Dis. 2009; 18: 329-335
Published online: August 10, 2021
This study was supported by grants-in-aid of The Nakatani Suzuyo Memorial Fund for Nutrition and Dietetics, Tokyo, Japan (KMaeda) and of the Japan Society for the Promotion of Science, Japan (Grant number: 21H03390 to KMaeda).
The authors declare that they have no conflict of interest.
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.