title: The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke.
abstract: Dysphagia, dysarthria and aphasia occur frequently following stroke. Our purpose was to identify the incidence, co-occurrence, and predictors of these impairments after first-ever ischemic stroke. We used the Registry of the Canadian Stroke Network's database (2003-2008) from one stroke center to identify a random sample of 250 patients with acute ischemic stroke confirmed by MR imaging. We further conducted a retrospective medical chart review. We established reliable data capture and identified the presence of the three impairments. We derived incidence and co-occurrence estimates along with 95% confidence intervals (CI) for dysphagia, dysarthria, and aphasia. We then computed odds ratios (OR) through logistic regression to identify predictors. Twenty-nine patient charts were not available for review. Estimates of the incidence of dysphagia, dysarthria, and aphasia were 44% (95% CI, 38-51), 42% (95% CI, 35-48) and 30% (95% CI, 25-37), respectively. The highest co-occurrence of any two impairments was 28% (95% CI, 23-34) for the presence of both dysphagia and dysarthria. Ten percent of all 221 patients had all three impairments. The highest predictors were non-alert level of consciousness for dysphagia (OR 2.6, CI 1.03-6.5), symptoms of weakness for dysarthria (OR 5.3, CI 2.4-12.0), and right-sided symptoms for aphasia (OR 7.1, CI 3.1-16.6). These findings are a first step toward identifying the incidence and predictors of multiple co-occurring impairments in a homogenous stroke sample.
  
  
  OBJECTIVE
  Learning outcomes: Readers will be able to (1) RECOGNIZE the need for research in stroke, whereby outcomes are reported according to stroke etiology and recurrence patterns, (2) identify the incidence and co-occurrence of dysphagia, dysarthria, and aphasia after a first-ever acute ischemic stroke, and (3) describe clinical precursors of these impairments in the acute stage of stroke.
authors: Department of Speech Language Pathology, University of Toronto, 160-500 University Avenue, Rehabilitation Sciences Building, Toronto, ON M5G 1V7, Canada. heather.flowers@utoronto.ca
authors: Heather L
authors: HL
authors: Flowers
authors: Frank L
authors: FL
authors: Silver
authors: Jiming
authors: J
authors: Fang
authors: Elizabeth
authors: E
authors: Rochon
authors: Rosemary
authors: R
authors: Martino
mesh_terms: D000368:Aged; D001037:Aphasia / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D004401:Dysarthria / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis