Age better discriminates early dysphagia than cough function, respiratory muscle strength, or trunk control after mild stroke

This retrospective study aimed to identify factors that best discriminate the presence of early dysphagia after mild stroke. We performed a retrospective analysis of prospectively collected routine-care data from consecutive first-ever subacute stroke patients. We included 140 first-ever subacute stroke patients greater than 18 years or older, within 3 weeks of stroke onset, with hemiparesis and a Mini-Mental State Examination score greater than 24, recruited from an inpatient rehabilitation unit. Dysphagia was assessed using the Volume-Viscosity Swallow Test and videofluoroscopy, with swallowing function evaluated by the Penetration-Aspiration Scale. The outcome measures included maximal inspiratory and expiratory muscle pressures (MIP and MEP) for respiratory muscle strength, peak expiratory cough flow (PECF) for cough function, and the Trunk Control Test for trunk control. We found respiratory muscle weakness and impaired cough function (MIP 55.5 ± 23.4; MEP 84.5 ± 33.9 cmH2O; PECF 244.9 ± 87.5 L/min); however, no deficits in trunk control were observed. Dysphagia was present in 30 patients (26.3%), who were older and had lower PECF (215.0 ± 85.8 vs. 255.6 ± 90.3 L/min; P = 0.02). In multivariable analysis, only age predicted dysphagia [odds ratio 1.09, 95% confidence interval (CI): 1.03-1.16; P = 0.03]; receiver operating characteristic area under the curve was 0.717 (95% CI: 0.613-0.821; P < 0.001) with a cutoff of 64.5 years. In early poststroke patients, dysphagia was primarily associated with older age, whereas respiratory muscle strength, cough function, and trunk control - although frequently impaired - were not independent predictors. An age threshold of ~65 years best discriminated between patients with and without dysphagia.