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Periventricular White Matter Lesions as a Prognostic Factor of Swallowing Function in Older Patients with Mild Stroke

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Abstract

Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have poor functional prognosis such as cognitive dysfunction, increased propensity for falling, and gait and balance problems. The aim of this study was to determine whether WM lesions exert negative effects on swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 63 patients aged >65 years who had a National Institutes of Health Stroke Scale score ≤5 and who underwent videofluoroscopic swallowing examination after their first stroke. Linear regression analysis showed that oral transit time tended to increase as Fazekas grade increased (p = 0.003). In addition, inadequate mastication was related to the presence of lesions in the left hemisphere (p = 0.039). The presence of penetration could also be predicted by Fazekas grade (p = 0.015). Our findings suggest that WM lesions observed in brain magnetic resonance imaging scans can impact swallowing problems in older patients with mild stroke, regardless of initial stroke severity or other factors associated with lesion location. Accordingly, our data indicate that WM lesions are a predictive factor by which patients can be stratified into favorable or unfavorable outcomes with respect to dysphagia.

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References

  1. Denti L, Scoditti U, Tonelli C, Saccavini M, Caminiti C, Valcavi R, et al. The poor outcome of ischemic stroke in very old people: a cohort study of its determinants. J Am Geriatr Soc. 2010;58(1):12–7.

    Article  PubMed  Google Scholar 

  2. Kammersgaard LP, Jorgensen HS, Reith J, Nakayama H, Pedersen PM, Olsen TS, et al. Short- and long-term prognosis for very old stroke patients. The copenhagen stroke study. Age Ageing. 2004;33(2):149–54.

    Article  PubMed  Google Scholar 

  3. Feigin VL, Barker-Collo S, Parag V, Senior H, Lawes CM, Ratnasabapathy Y, et al. Auckland stroke outcomes study. part 1: gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology. 2010;75(18):1597–607.

    Article  CAS  PubMed  Google Scholar 

  4. Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke. 2012;43(3):645–9.

    Article  PubMed  Google Scholar 

  5. Forti P, Maioli F, Procaccianti G, Nativio V, Lega MV, Coveri M, et al. Independent predictors of ischemic stroke in the elderly: prospective data from a stroke unit. Neurology. 2013;80(1):29–38.

    Article  PubMed  Google Scholar 

  6. Liou LM, Chen CF, Guo YC, Cheng HL, Lee HL, Hsu JS, et al. Cerebral white matter hyperintensities predict functional stroke outcome. Cerebrovasc Dis. 2010;29(1):22–7.

    Article  PubMed  Google Scholar 

  7. Sonohara K, Kozaki K, Akishita M, Nagai K, Hasegawa H, Kuzuya M, et al. White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly. Geriatr Gerontol Int. 2008;8(2):93–100.

    Article  PubMed  Google Scholar 

  8. Srikanth V, Beare R, Blizzard L, Phan T, Stapleton J, Chen J, et al. Cerebral white matter lesions, gait, and the risk of incident falls: a prospective population-based study. Stroke. 2009;40(1):175–80.

    Article  PubMed  Google Scholar 

  9. Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, et al. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. 2009;339:b2477.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Levine R, Robbins JA, Maser A. Periventricular white matter changes and oropharyngeal swallowing in normal individuals. Dysphagia. 1992;7(3):142–7.

    Article  CAS  PubMed  Google Scholar 

  11. Cola MG, Daniels SK, Corey DM, Lemen LC, Romero M, Foundas AL. Relevance of subcortical stroke in dysphagia. Stroke. 2010;41(3):482–6.

    Article  PubMed  Google Scholar 

  12. Fandler S, Gattringer T, Eppinger S, Doppelhofer K, Pinter D, Niederkorn K. Frequency and predictors of dysphagia in patients with recent small subcortical infarcts. Stroke. 2016;48(1):213–5.

    Article  PubMed  Google Scholar 

  13. Shaker R. Principles of deglutition: a multidisciplinary text for swallowing and its disorders. New York: Springer; 2013.

    Book  Google Scholar 

  14. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63.

    Article  PubMed  Google Scholar 

  15. Leslie P, Drinnan MJ, Ford GA, Wilson JA. Swallow respiratory patterns and aging: presbyphagia or dysphagia? J Gerontol A Biol Sci Med Sci. 2005;60(3):391–5.

    Article  PubMed  Google Scholar 

  16. Aviv JE. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med. 1997;103(5A):74S–6S.

    Article  CAS  PubMed  Google Scholar 

  17. Cook IJ, Weltman MD, Wallace K, Shaw DW, McKay E, Smart RC, et al. Influence of aging on oral-pharyngeal bolus transit and clearance during swallowing: scintigraphic study. Am J Physiol. 1994;266(6 Pt 1):G972–7.

    CAS  PubMed  Google Scholar 

  18. Achem SR, Devault KR. Dysphagia in aging. J Clin Gastroenterol. 2005;39(5):357–71.

    Article  PubMed  Google Scholar 

  19. Daggett A, Logemann J, Rademaker A, Pauloski B. Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia. 2006;21(4):270–4.

    Article  PubMed  Google Scholar 

  20. Lee KM, Jang YH, Kim YH, Moon SK, Park JH, Park SW, Yu HJ, Lee SG, Chun MH, Han TR. Reliability and validity of Korean version of national institutes of health stroke scale. J Korean Acad Rehab Med. 2004;28:422–35.

    Google Scholar 

  21. Logemann JA. Swallowing physiology and pathophysiology. Otolaryngol Clin North Am. 1988;21(4):613–23.

    CAS  PubMed  Google Scholar 

  22. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351–6.

    Article  CAS  PubMed  Google Scholar 

  23. Yokoyama M, Mitomi N, Tetsuka K, Tayama N, Niimi S. Role of laryngeal movement and effect of aging on swallowing pressure in the pharynx and upper esophageal sphincter. Laryngoscope. 2000;110(3 Pt 1):434–9.

    Article  CAS  PubMed  Google Scholar 

  24. Rademaker AW, Pauloski BR, Colangelo LA, Logemann JA. Age and volume effects on liquid swallowing function in normal women. J Speech Lang Hear Res. 1998;41(2):275–84.

    Article  CAS  PubMed  Google Scholar 

  25. McKee GJ, Johnston BT, McBride GB, Primrose WJ. Does age or sex affect pharyngeal swallowing? Clin Otolaryngol Allied Sci. 1998;23(2):100–6.

    Article  CAS  PubMed  Google Scholar 

  26. Nilsson H, Ekberg O, Olsson R, Hindfelt B. Quantitative aspects of swallowing in an elderly nondysphagic population. Dysphagia. 1996;11(3):180–4.

    Article  CAS  PubMed  Google Scholar 

  27. Toscano M, Cecconi E, Capiluppi E, Vigano A, Bertora P, Campiglio L, et al. Neuroanatomical, clinical and cognitive correlates of post-stroke dysphagia. Eur Neurol. 2015;74(3–4):171–7.

    Article  CAS  PubMed  Google Scholar 

  28. Murray ME, Vemuri P, Preboske GM, Murphy MC, Schweitzer KJ, Parisi JE, et al. A quantitative postmortem MRI design sensitive to white matter hyperintensity differences and their relationship with underlying pathology. J Neuropathol Exp Neurol. 2012;71(12):1113–22.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol. 2008;105(5):1652–60.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bisschops RH, van der Graaf Y, Mali WP, van der Grond J, group Ss. High total cerebral blood flow is associated with a decrease of white matter lesions. J Neurol. 2004;251(12):1481–5.

    Article  CAS  PubMed  Google Scholar 

  31. Nudo RJ. Postinfarct cortical plasticity and behavioral recovery. Stroke. 2007;38(2 Suppl):840–5.

    Article  PubMed  Google Scholar 

  32. Madden DJ, Bennett IJ, Song AW. Cerebral white matter integrity and cognitive aging: contributions from diffusion tensor imaging. Neuropsychol Rev. 2009;19(4):415–35.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gunning-Dixon FM, Brickman AM, Cheng JC, Alexopoulos GS. Aging of cerebral white matter: a review of MRI findings. Int J Geriatr Psychiatry. 2009;24(2):109–17.

    Article  PubMed  PubMed Central  Google Scholar 

  34. de Groot M, Ikram MA, Akoudad S, Krestin GP, Hofman A, van der Lugt A, et al. Tract-specific white matter degeneration in aging: the Rotterdam Study. Alzheimers Dement. 2015;11(3):321–30.

    Article  PubMed  Google Scholar 

  35. Moon HI, Choi SY, Tae WS, Pyun SB. Effects of age on cortical activation during swallowing: an fMRI study. J Korean Dysphagia Soc. 2016;6(1):26–33.

    Google Scholar 

  36. Martin R, Barr A, MacIntosh B, Smith R, Stevens T, Taves D, et al. Cerebral cortical processing of swallowing in older adults. Exp Brain Res. 2007;176(1):12–22.

    Article  PubMed  Google Scholar 

  37. Humbert IA, Fitzgerald ME, McLaren DG, Johnson S, Porcaro E, Kosmatka K, et al. Neurophysiology of swallowing: effects of age and bolus type. Neuroimage. 2009;44(3):982–91.

    Article  PubMed  Google Scholar 

  38. van den Heuvel DM, ten Dam VH, de Craen AJ, Admiraal-Behloul F, Olofsen H, Bollen EL, et al. Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population. J Neurol Neurosurg Psychiatry. 2006;77(2):149–53.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wright CB, Festa JR, Paik MC, Schmiedigen A, Brown TR, Yoshita M, et al. White matter hyperintensities and subclinical infarction: associations with psychomotor speed and cognitive flexibility. Stroke. 2008;39(3):800–5.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Secil Y, Arici S, Incesu TK, Gurgor N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer’s disease. Neurophysiol Clin. 2016;46(3):171–8.

    Article  PubMed  Google Scholar 

  41. Boccardi V, Ruggiero C, Patriti A, Marano L. Diagnostic assessment and management of dysphagia in patients with Alzheimer’s disease. J Alzheimers Dis. 2016;50(4):947–55.

    Article  PubMed  Google Scholar 

  42. Rosler A, Pfeil S, Lessmann H, Hoder J, Befahr A, von Renteln-Kruse W. Dysphagia in dementia: influence of dementia severity and food texture on the prevalence of aspiration and latency to swallow in hospitalized geriatric patients. J Am Med Dir Assoc. 2015;16(8):697–701.

    Article  PubMed  Google Scholar 

  43. Suh MK, Kim H, Na DL. Dysphagia in patients with dementia: alzheimer versus vascular. Alzheimer Dis Assoc Disord. 2009;23(2):178–84.

    Article  PubMed  Google Scholar 

  44. Lee CK, Kim JA. Pattern of post-stroke swallowing disorder according to the brain lesion. J Korean Acad Rehab Med. 2001;25:193–201.

    Google Scholar 

  45. Steinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40(5):1903–6.

    Article  PubMed  Google Scholar 

  46. Graff-Radford J, Jones DT, Strand EA, Rabinstein AA, Duffy JR, Josephs KA. The neuroanatomy of pure apraxia of speech in stroke. Brain Lang. 2014;129:43–6.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wakasugi Y, Tohara H, Hattori F, Motohashi Y, Nakane A, Goto S, et al. Screening test for silent aspiration at the bedside. Dysphagia. 2008;23(4):364–70.

    Article  PubMed  Google Scholar 

  48. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, et al. The toronto bedside swallowing screening test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40(2):555–61.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180 Beon-gil, Bundang-gu, Seoungnam-si, 13590, Gyeonggi-do, Republic of Korea

    Hyun Im Moon, Je-Shik Nam, Min Jeong Leem & Kee Hoon Kim

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  1. Hyun Im Moon
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Correspondence to Hyun Im Moon.

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Moon, H.I., Nam, JS., Leem, M.J. et al. Periventricular White Matter Lesions as a Prognostic Factor of Swallowing Function in Older Patients with Mild Stroke. Dysphagia 32, 480–486 (2017). https://doi.org/10.1007/s00455-017-9788-0

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