Relationship Between Cognitive Function and Dysphagia After Stroke
Relationship Between Cognitive Function and Dysphagia After Stroke
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DOI：
10.5535/arm.2017.41.4.564
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发表时间：
2017-08-01
影响因子：
1.3
通讯作者：
Pyun, Sung-Bom
中科院分区：
文献类型：
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作者：
Jo, Soo Yung;Hwang, Jeong-Won;Pyun, Sung-Bom
目的探讨卒中后吞咽障碍患者的认知功能障碍特点，分析幕上卒中患者吞咽障碍严重程度与认知功能障碍的关系。方法对55例首次发病3个月内的幕上病变性卒中患者进行回顾性研究。我们通过临床检查和视频透视吞咽研究(VFSS)，使用吞咽困难严重程度评分(DSS)将吞咽困难分级从0(正常)到4(严重)。受试者分为非吞咽困难(0级)或吞咽困难(1-4级)。我们比较了两组的一般特征、卒中严重程度和功能评分。结果Fugl-Meyer运动评分、Berg平衡量表和改良Barthel指数韩国版在两组间差异有统计学意义。吞咽困难组的认知测试得分显著低于非吞咽困难组。吞咽困难的严重程度与某些认知分测验成绩显著相关：视觉广度倒退(p=0.039)，连线测验A(p=0.042)和B(p=0.002)，以及瑞文递进矩阵(p=0.002)。吞咽困难的出现也与认知子测试显著相关，尤其是视觉注意力和执行注意力(优势比[OR]=1.009；95%可信区间[CI]，1.002-1.016；p=0.017)。早期丢失的参数与相同的分测验也显著相关(OR=1.009；95%CI，1.002~1.016；p=0.017)。结论认知功能与卒中后吞咽困难的存在和严重程度有关。最重要的是，视觉注意和执行功能可能对幕上病变的中风患者吞咽的口腔阶段有重要影响。
Objective To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke.Methods A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase.Results Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002-1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002-1.016; p=0.017).Conclusion Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.