Post-Cerebrovascular Stroke and Early Dysphagia Assessment: A Systematic Review

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Antonino Maniaci
Jerome R Lechien
Emanuele D'amico
Ignazio La Mantia
Francesco Cancemi
Francesco Patti
Claudio Faia
Elio Privitera
Milena Di Luca
Giannicola Iannella
Giuseppe Magliulo
Annalisa Pace
Paola Di Mauro
Christian Calvo-Henriquez
Salvatore Ferlito
Gaetano Motta
Giuditta Mannelli
Mario Zappia
Claudio Vicini
Salvatore Cocuzza


Dysphagia; stroke; FEES; VFFS; BDS


Purpose: We performed a systematic review on the early assessment of swallowing function after cerebrovascular stroke.

Materials and Methods: A systematic review of the English language literature of the past 20 years was performed regarding swallowing function and cerebrovascular stroke. All articles reporting swallowing evaluation through clinical examination validated scores, and diagnostic tools were included in the summary.

Results: The systematic review of the literature identified 1,768 potentially relevant studies with 7 papers retrieved with a total of 589 stroke dysphagic patients. While at the clinical neurological assessment, The National Institutes of Health Stroke Scale was more frequently used as a clinical outcome predictor. The Bedside screening approach was carried out in 6 papers to assess patients with probable swallowing disorders. Among the diagnostic tools, seven studies performed the Flexible Fiberoptic Endoscopic evaluation assessing scoring validated system while two papers reported early swallowing outcomes Videofluoroscopic Swallow Study.

Conclusions: Our systematic review revealed the findings significantly associated with dysphagia in post-cerebrovascular patients. Endoscopic evaluation of swallowing proved to be the most used method in the literature, effective in identifying early predictors of dysphagia.

Given the presence of different assessing scores employed and reduced study samples enrolled, further studies with large courts are necessary for a greater significance.


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1. Umay EK, Yaylaci A, Saylam G, et al. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study. Neurol India. 2017;65(4):734-742. doi:10.4103/neuroindia.NI_377_16
2. Logemann JA. Dysphagia: evaluation and treatment. Folia Phoniatr Logop. 1995;47(3):140-164. doi:10.1159/000266348
3. Ney DM, Weiss JM, Kind A.J., Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24(3):395-413. doi:10.1177/0884533609332005
4. Nishimura N, Hongo M, Yamada M, et al. effect of aging on the esophageal motor functions. J Smooth Muscle Res. 1996;32(2):43-50. doi:10.1540/jsmr.32.43
5. Robson KM, Glick ME. Dysphagia and advancing age: are manometric abnormalities more common in older patients?. Dig Dis Sci. 2003;48(9):1709-1712. doi:10.1023/a:1025430625252
6. Grande L, Lacima G, Ros E, et al. Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects. Am J Gastroenterol. 1999;94(7):1795-1801. doi:10.1111/j.1572-0241.1999.01208.x
7. Suh MK, Kim H, Na DL. Dysphagia in patients with dementia: Alzheimer versus vascular. Alzheimer Dis Assoc Disord. 2009;23(2):178-184. doi:10.1097/WAD.0b013e318192a539
8. Wolters FJ, Ikram MA. Epidemiology of Vascular Dementia. Arterioscler Thromb Vasc Biol. 2019;39(8):1542-1549. doi:10.1161/ATVBAHA.119.311908
9. Kim DY, Park HS, Park SW, Kim JH. The impact of dysphagia on quality of life in stroke patients. Medicine (Baltimore). 2020;99(34):e21795. doi:10.1097/MD.0000000000021795
10. Stach CB. Vascular dementia and dysphagia. Topics in Stroke Rehabilitation. 2000;7 (3):1-10
11. Abubakar SA, Jamoh BY. Dysphagia following acute stroke and its effect on short-term outcome. Niger Postgrad Med J. 2017;24(3):182-186. doi:10.4103/npmj.npmj_96_17
12. Reyes-Torres CA, Castillo-Martínez L, Reyes-Guerrero R, et al. Design and implementation of modified-texture diet in older adults with oropharyngeal dysphagia: a randomized controlled trial. Eur J Clin Nutr. 2019;73(7):989-996. doi:10.1038/s41430-019-0389-x
13. O'Brien JT, Thomas A. Vascular dementia. Lancet. 2015;386(10004):1698-1706. doi:10.1016/S0140-6736(15)00463-8
14. Leys D, Hénon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol. 2005;4(11):752-759. doi:10.1016/S1474-4422(05)70221-0
15. de Lima Alvarenga EH, Dall'Oglio GP, Murano EZ, Abrahão M. Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol. 2018;275(2):443-449. doi:10.1007/s00405-017-4801-7
16. Hoffmann S, Harms H, Ulm L, et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study. J Cereb Blood Flow Metab. 2017;37(12):3671-3682. doi:10.1177/0271678X16671964
17. De Stefano A, Di Giovanni P, Kulamarva G, et al. Oropharyngeal dysphagia in elderly population suffering from mild cognitive impairment and mild dementia: Understanding the link. Am J Otolaryngol. 2020;41(4):102501. doi:10.1016/j.amjoto.2020.102501
18. Chen SY, Chie WC, Lin YN, Chang YC, Wang TG, Lien IN. Can the aspiration detected by videofluoroscopic swallowing studies predict long-term survival in stroke patients with dysphagia?. Disabil Rehabil. 2004;26(23):1347-1353. doi:10.1080/09638280412331270407
19. Warnecke T, Teismann I, Meimann W, et al. assessment of aspiration risk in acute ischaemic stroke--evaluation of the simple swallowing provocation test. J Neurol Neurosurg Psychiatry. 2008;79(3):312-314. doi:10.1136/jnnp.2007.134551
20. Pilz W, Vanbelle S, Kremer B, et al. Observers' Agreement on Measurements in Fiberoptic Endoscopic Evaluation of Swallowing. Dysphagia. 2016;31(2):180-187. doi:10.1007/s00455-015-9673-7
21. Dziewas R, Auf dem Brinke M, Birkmann U, et al. Safety and clinical impact of FEES - results of the FEES-registry. Neurol Res Pract. 2019;1:16. doi:10.1186/s42466-019-0021-5
22. Lees KR, Selim MH, Molina CA, Broderick JP. Early Versus Late Assessment of Stroke Outcome. Stroke. 2016;47(5):1416-1419. doi:10.1161/STROKEAHA.115.011153
23. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews 4 (1):1. doi:10.1186/2046-4053-4-1
24. Whiting PF, Rutjes AW, Westwood ME et al (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8): 529–536
25. Moola S, Munn Z, Tufanaru C et al (2017) Chapter 7: Systematic reviews of etiology and risk. Rev Man Joanna Briggs Inst
26. Dziewas R, Warnecke T, Olenberg S, et al. Towards a basic endoscopic assessment of swallowing in acute stroke - development and evaluation of a simple dysphagia score. Cerebrovasc Dis. 2008;26(1):41-47. doi:10.1159/000135652
27. Umay EK, Unlu E, Saylam GK, Cakci A, Korkmaz H. Evaluation of dysphagia in early stroke patients by bedside, endoscopic, and electrophysiological methods. Dysphagia. 2013;28(3):395-403. doi:10.1007/s00455-013-9447-z
28. Bahcecı K, Umay E, Gundogdu I, Gurcay E, Ozturk E, Alıcura S. The effect of swallowing rehabilitation on quality of life of the dysphagic patients with cortical ischemic stroke. Iran J Neurol. 2017;16(4):178-184.
29. Kim SB, Lee SJ, Lee KW, Lee JH, Kim DW. Usefulness of Early Videofluoroscopic Swallowing Study in Acute Stroke Patients With Dysphagia. Ann Rehabil Med. 2018;42(1):42-51. doi:10.5535/arm.2018.42.1.42
30. https :// -level s-of-evide nce/. Accessed 21 Apr 2020
31. Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis. 2014;23(4):712-716. doi:10.1016/j.jstrokecerebrovasdis.2013.06.030
32. Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35(3):276-281. doi:10.1159/000348683
33. Takeda C, Yoshida M, Nakamori M, et al. Delayed Swallowing Reflex is Overlooked in Swallowing Screening Among Acute Stroke Patients. J Stroke Cerebrovasc Dis. 2020;29(12):105303. doi:10.1016/j.jstrokecerebrovasdis.2020.105303
34. Maeshima S, Osawa A, Takajo F, Kurozumi S, Ota N, Kumakura I. A comparison study of aspiration with clinical manifestions in stroke patients. Brain Nerve. 2007;59(5):521-526.
35. Lim SH, Lieu PK, Phua S.Y., et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia. 2001;16(1):1-6. doi:10.1007/s004550000038
36. Immovilli P, Rota E, Morelli N, et al. Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients. J Stroke Cerebrovasc Dis. 2021;30(2):105470. doi:10.1016/j.jstrokecerebrovasdis.2020.105470
37. Jang S, Yang HE, Yang HS, Kim DH. Lesion Characteristics of Chronic Dysphagia in Patients With Supratentorial Stroke. Ann Rehabil Med. 2017;41(2):225-230. doi:10.5535/arm.2017.41.2.225
38. Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database Syst Rev. 2018;10(10):CD000323. doi:10.1002/14651858.CD000323.pub3
39. Momosaki R, Abo M, Kakuda W, Kobayashi K. Applicability of the two-step thickened water test in patients with poststroke dysphagia: a novel assessment tool for paste food aspiration. J Stroke Cerebrovasc Dis. 2013;22(6):817-821. doi:10.1016/j.jstrokecerebrovasdis.2012.05.011
40. Matsuo T, Matsuyama M. Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography. PLoS One. 2021;16(3):e0248770. doi:10.1371/journal.pone.0248770
41. Ramsey DJ, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34(5):1252-1257. doi:10.1161/01.STR.0000066309.06490.B8
42. Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke. 2016;11(4):399-411. doi:10.1177/1747493016639057
43. Smith Hammond CA, Goldstein LB, Horner RD, et al. Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest. 2009;135(3):769-777. doi:10.1378/chest.08-1122
44. Smithard DG. Dysphagia Management and Stroke Units. Curr Phys Med Rehabil Rep. 2016;4(4):287-294. doi:10.1007/s40141-016-0137-2
45. Ferlito S, Luca MD, Maniaci A et al. Progressive dysphagia in a patient with parapharingeal pulsating mass: A case report and literature's review. Acta Medica Mediterranea 2020
46. Heckert KD, Komaroff E, Adler U, Barrett AM. Postacute reevaluation may prevent Dysphagia-associated morbidity. Stroke. 2009;40(4):1381-1385. doi:10.1161/STROKEAHA.108.533489
47. D'Amico E, Zanghì A, Serra A, et al. Management of dysphagia in multiple sclerosis: current best practice. Expert Rev Gastroenterol Hepatol. 2019;13(1):47-54. doi:10.1080/17474124.2019.1544890

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