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      Prognostic Value of Dysphagia for Activities of Daily Living Performance and Cognitive Level after Stroke

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          ABSTRACT

          Objectives:

          The purpose of this study was to examine the association between baseline dysphagia and the improvement of activities of daily living performance and cognitive level among inpatients after stroke.

          Methods:

          This was a retrospective cohort study of patients undergoing convalescent rehabilitation after stroke. Dysphagia was assessed using the Food Intake LEVEL Scale. Outcomes were the motor and cognitive scores of the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to examine the association between dysphagia at admission and these outcomes.

          Results:

          There were 499 participants with a median age of 74 years. A multiple regression analysis was carried out after adjusting for potential confounders including age and sex. Dysphagia at admission was independently and negatively associated with motor (β=−0.157, P<0.001) and cognitive (β=−0.066, P=0.041) FIM scores at discharge.

          Conclusions:

          Baseline dysphagia in patients after stroke was negatively associated with improvement in performance of activities of daily living and cognitive level.

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          Mary Charlson, Peter Pompei, Kathy Ales … (1987)
          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

            Liang-Kung Chen, Jean Woo, Prasert Assantachai … (2020)
            Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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              Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.

              Olivier Bouillanne, Gilles Morineau, Claire Dupont … (2006)
              Patients at risk of malnutrition and related morbidity and mortality can be identified with the Nutritional Risk Index (NRI). However, this index remains limited for elderly patients because of difficulties in establishing their normal weight. Therefore, we replaced the usual weight in this formula by ideal weight according to the Lorentz formula (WLo), creating a new index called the Geriatric Nutritional Risk Index (GNRI). First, a prospective study enrolled 181 hospitalized elderly patients. Nutritional status [albumin, prealbumin, and body mass index (BMI)] and GNRI were assessed. GNRI correlated with a severity score taking into account complications (bedsores or infections) and 6-mo mortality. Second, the GNRI was measured prospectively in 2474 patients admitted to a geriatric rehabilitation care unit over a 3-y period. The severity score correlated with albumin and GNRI but not with BMI or weight:WLo. Risk of mortality (odds ratio) and risk of complications were, respectively, 29 (95% CI: 5.2, 161.4) and 4.4 (95% CI: 1.3, 14.9) for major nutrition-related risk (GNRI: <82), 6.6 (95% CI: 1.3, 33.0), 4.9 (95% CI: 1.9, 12.5) for moderate nutrition-related risk (GNRI: 82 to <92), and 5.6 (95% CI: 1.2, 26.6) and 3.3 (95% CI: 1.4, 8.0) for a low nutrition-related risk (GNRI: 92 to < or =98). Accordingly, 12.2%, 31.4%, 29.4%, and 27.0% of the 2474 patients had major, moderate, low, and no nutrition-related risk, respectively. GNRI is a simple and accurate tool for predicting the risk of morbidity and mortality in hospitalized elderly patients and should be recorded systematically on admission.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Prog Rehabil Med
                Journal ID (iso-abbrev): Prog Rehabil Med
                Journal ID (publisher-id): prm
                Title: Progress in Rehabilitation Medicine
                Publisher: JARM
                ISSN (Electronic): 2432-1354
                Publication date (Electronic): 07 February 2024
                Publication date Collection: 2024
                Volume: 9
                Electronic Location Identifier: 20240005
                Affiliations
                [a ] Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kikuyo, Japan
                [b ] Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kikuyo, Japan
                [c ] Pharmacy Department, Kumamoto Rehabilitation Hospital, Kikuyo, Japan
                [d ] Department of Nutrition Management, Kumamoto Rehabilitation Hospital, Kikuyo, Japan
                [e ] Department of Dental Office, Kumamoto Rehabilitation Hospital, Kikuyo, Kikuchi, Japan
                Author notes
                Correspondence: Yoshihiro Yoshimura, MD, PhD, 760 Magate, Kikuyo, Kumamoto 869-1106, Japan, E-mail: hanley.belfus@ 123456gmail.com
                Article
                Publisher ID: 20240005
                DOI: 10.2490/prm.20240005
                PMC ID: 10844015
                PubMed ID: 38327737
                SO-VID: ea0b2842-7c67-45d9-bc43-bf342e1e52da
                Copyright © 2024 The Japanese Association of Rehabilitation Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.

                History
                Date received : 06 September 2023
                Date accepted : 23 January 2024
                Categories
                Subject: Original Article

                Keywords: cognitive function,convalescent rehabilitation,dysphagia,motor function,stroke
                Data availability:
                Keywords: cognitive function, convalescent rehabilitation, dysphagia, motor function, stroke

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