Summary Background Cognitive status is important for performing the assessment and treatment of dysphagia. Nonetheless, the cognitive neuropsychological profile of patients with stroke and dysphagia is not studied as deeply enough as it should be. On the one hand, focal and non‐focal brain lesions may lead to dysphagia and cognitive disorders, and on the other hand, the cognitive status possibly affects swallowing. In this study, cognition is supposed to be a mediator between brain lesion and swallowing disorder (dysphagia). The role of cognition and attention as mediators between brain lesion and dysphagia was evaluated via three causal models in which the causal mechanisms of swallowing were explained. Methods Eighty‐eight patients with their first stroke (34 women and 54 men) in the acute phase (mean: 3.5 days after stroke; SD: 2.7) participated in this research. The data of dysphagic and non‐dysphagic patients were entered into structural equation models. Two relationships were estimated: a direct relationship between brain lesion and dysphagia and an indirect association between brain lesion and dysphagia through cognition and attention. Results The goodness‐of‐fit indices confirmed the three models. Our first model proved a good fit [CFI = 1.00; TLI = 1.00]. The second model revealed an appropriate goodness of fit [CFI = 1.00; TLI = 1.00]. Our third model also showed a good fit [CFI = 1.00; TLI = 1.00]. Conclusion It is suggested that in the assessment and treatment of dysphagia, cognition is better to be considered as a mediator along with physical aspects of dysphagia.

Background:Limited data available about the mechanisms of dysphagia and areas involving swallow after brain damage; accordingly it is hard to predict which cases are more likely to develop swallowing dysfunction based on the neuroimaging. The aim of this study was to investigate the relationship between brain lesions and dysphagia in a sample of acute conscious stroke patients.Materials and Methods:In a cross-sectional study, 113 acute conscious stroke patients (69 male mean [standard deviation (SD)] age 64.37 [15.1]), participated in this study. Two neurologists and one radiologist localized brain lesions according to neuroimaging of the patients. Swallowing functions were assessed clinically by an expert speech pathologist with the Mann Assessment of Swallowing Ability (MASA). The association of brain region and swallowing problem was statistically evaluated using Chi-square test.Results:Mean (SD) MASA score for the dysphagic patients was 139.61 (29.77). Swallowing problem was significantly more prevalent in the right primary sensory (P = 0.03), right insula (P = 0.005), and right internal capsule (P = 0.05).Conclusion:It may be concluded from these findings that the right hemisphere lesions associated with occurring dysphagia. Further studies using more advanced diagnostic tools on big samples particularly in a perspective structure are needed.

There is no consensus regarding the association between dysphagia and cognition. The aim of this study was to quantitatively and qualitatively analyze the available evidence on the direction and strength of the association between dysphagia and cognition. PubMed, Scopus, Embase, and Web of Science were searched for studies about the association between dysphagia and cognition. A random effects model was used to determine weighted odds ratios and 95% confidence intervals. Sensitivity analysis was performed to determine the impact of each individual study on the pooled results. A total of 1427 participants showed that some cognitive disorders were significantly associated with dysphagia (odds ratio = 3.23, 95% confidence interval: 2.33–4.48). The association between cognition and swallowing disorders suggests that multiple neuroanatomical systems are involved in these two functions.

Introduction: Many patients who have had strokes suffer from dysphagia which can lead to aspiration pneumonia in 20% to 25% of cases. Early assessment of dysphagia has can reduce the risk of death and the cost of medical care. The present study developed a questionnaire to assess dysphagia in adult patients who have suffered strokes and determined the validity and reliability of the content. Methods: The phases of the study consisted of item generation, analysis of content validity and determination of reliability. To assess the content validity, the primary questionnaire was rated by five experts on swallowing disorders. Items with low scores were removed from the questionnaire. Next, 30 stroke patients were assessed using the final questionnaire and the reliability was assessed by Cronbach's alpha. Results:The average scores of the items ranged from 0.4 to 1. Only two items were omitted because of insufficient content validity. The Cronbach's alpha was 0.71 and the standard error of deviation was 4.96, signifying that the reliability was acceptable. Conclusion: This questionnaire has good content validity and reliability. Although it can be used for clinical assessment of stroke patients who suffer from dysphagia, the concurrent validity should be determined by comparison with to a gold standard such as videofluoroscopy.

Background: Swallowing problems are common in healthy elders. Swallowing difficulties are the cause of medical and psychosocial complications in old age. Thus, to prevent and minimize these complications, diagnosis and proper interventions are important. Objectives: This study aimed to investigate the effects of rehabilitative exercises on swallowing function and quality of life in older adults. Methods: A total of forty healthy elders were randomly assigned to the rehabilitative exercises group (n = 20) and the compensatory group (n = 20). Inclusion criteria in this study were as follows: age 60 - 80; the presence of swallowing problems assessed clinically by a speech therapist; no history of swallowing treatment, pneumonia or head and neck surgery, and other neurological or general disorders that can influence swallowing function. Randomization was undertaken using a block randomization technique. Rehabilitative exercises, including muscle strengthening exercises, were used in 3 sets of 10 per muscle group and three times per week for one month for the rehabilitative exercise group. In order to evaluate the outcomes, the Mann Assessment of Swallowing Ability (MASA) and the P-Dysphagia Handicap Index (P-DHI) were administered. Statistical analysis of data was done by the use of parametric statistical tests such as independent t-test, paired sample t-test, and nonparametric tests such as Mann-Whitney test, and P-value ≤ 0.05 was considered to be statistically significant. Results: There were no significant differences between the two groups regarding demographic and clinical swallowing function before intervention (P ≤ 0.05). There was a significant improvement in the clinical function of swallowing and swallow-related quality of life in the group which received the rehabilitative exercises compared to the group that received only the compensatory methods (P < 0.001). Conclusions: Our research has indicated that swallowing rehabilitative exercises are more effective in improving clinical swallowing function in elderly persons than compensatory exercises.

Background: Dysphagia is commonly seen in patients with severe dementia and increases the risk of mortality. The nature of the swallowing disorders caused by cognitive difficulties differs from post-stroke dysphagia. The relationship between dysphagia and cognitive function is vital for determining the best diagnostic and treatment plan for dementia-associated dysphagia. Objectives: In the current research, we suggest a model to identify the role of cognitive function in the occurrence of dysphagia in dementia patients. Methods: Ninety patients with dementia will be recruited in this experimental research. Dysphagia is screened and confirmed using the albertinen dementia dysphagia screening (ADDS) and the video fluoroscopic swallowing exam (VFSE). Also, cognitive function will be assessed by the mini-mental status examination (MMSE). The information related to dysphagic and non-dysphagic patients will be entered into structural equation models. Finally, the direct and indirect (i.e., via cognition) relationships between brain lesions and dysphagia will be evaluated. Results: The present study will provide evidence regarding the role of cognitive function in dysphagia occurrence in individuals with dementia in a structural equation model. Also, differences in performance (presence or absence of movement disorders) will be assessed in different types of dementia using another model. Conclusions: Moreover, the relative sensitivity of various cognitive domains to dysphagia will be determined in a separate model.