Correlation Between Vascular Territory And Dysphagia /Aspiration Pneumonia In Elderly Patients After Stroke

Objective: Stroke is the most common neurological disease in adults that is associated with deglutition disorders. Our study is to compare the incidence difference between TAI and TPI with dysphagia and aspiration pneumonia in post-stroke elderly individuals.Method: Elderly ischemic post-stroke patients that presented to the Department of Neurology, Xuanwu Hospital of Capital Medical University were gathered between July 2014 and June 2015.criteria were: patients who was over sixty years old and had a ischemic stroke confirmed by MRI, within 7 days after admission.Exclusion criteria included impaired level of consciousness, poor cognitive status,unable to obey instructions, poor control of neck and head, hemorrhagic stroke,abnormal anatomy of oropharynx, transitory ischaemic attack,multiple or bilateral infarct, residual dysphagia after a previous stroke, history of other disorders potentially causing swallowing disorders(e.g. Parkinson’s disease,myasthenia gravis, multiple sclerosis,tumours of the mouth).General information collected include:age,gender, NIHSS score, ADL score, Glasgow Coma Scale,BMI and so on; biochemical indicators include:triglyceride, total Cholesterol, high density lipoprotein, low density lipoprotein 、 apolipoprotein A 、 apolipoprotein B;The presence of dysarthria,masticatory muscles paralysis, facial paralysis,abnormal gag reflex, uvula deviation and tongue deviation were assessed. Swallowing difficulty was assessed using the repetitive saliva swallowing test and the modified water swallowing test.Cerebral infarction patients were fellow up to distinguish patients with aspiraton pneumonia.Result: A total of 212 patients were enrolled in the study and 16 patients were excluded. Of the remaining 196 subjects, 114 patients were categorized with TAI stroke(63% males) and 82 patients with TPI stroke(69% males)(p=0.220).Emographic and baseline characteristics include:Age(p=0.639),Gender(p=0.220),NIHSS score(p=0.003),ADL score(p=0.07),BMI(p=0.437),Triglyceride(p=0.443),total Cholesterol(p=0.117), high density lipoprotein(p=0.082), low density lipoprotein(p=0.427)、 apolipoprotein A(p=0.208)、apolipoprotein B(p=0.726) and the NIHSS score in anterior circulation infarction score is higher than posterior circulation infarction with significant difference; nervous system examination include dysarthria(P = 0.02), masticatory muscle paralysis(p=0.557), facial paralysis(P = 0.01), Abolition of Gag reflex(p=0.069), uvula deviation(p=0.184), tongue deviation(P = 0.045). The TAI group had a greater prevalence of dysarthria(P = 0.02),tongue deviation(P = 0.045) and facial paralysis(P = 0.01) than the TPI group.Dysphagia was more prevalent in the TAI group(P = 0.043), and in individuals between the ages of 75–80. Aspiration pneumonia tended to be more prevalent in the TAI group, but did not show a statistically significant difference. Sputum culture frequency and organism and the number of vascular infarcts did not differ between TAI and TPI.Conclusion: The incidence of dysarthria, tongue deviation and facial paralysis in TAI is greater than TPI in the Evaluation of clinical nerve function of the TAI compared with TPI; The incidence of dysphagia is greater in TAI than TPI in the evaluation Swallowing function of the TAI and TPI;Through subgroup analysis for NIHSS score,in the score group from 0 to 10,the incidence of dysphagia was higher in TAI patients with significant difference;The incidence of aspiration pneumonia is greater in TAI than TPI,but the difference has no significant difference;In the subgroup analysisi of age,age group of patients in 75-80 has the highest incidence of dysphagia in the patients with dysphagia;Patterns of swallowing difficulty may differ according to the vascular territory involved since TAI, rather than TPI, is associated more with dysphagia, dysarthria, tongue deviation and facial paralysis. Sputum bacterial culture does not have significant difference between TAI and TPI.The highest incidence of dysphagia in TAI is temporal parietal lobe infarction,compared with TPI, bulbus medullae.