The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke

• Dysphagia, dysarthria, and aphasia co-occur frequently after a first ischemic stroke.
• Most patients with dysphagia have concomitant dysarthria or aphasia after a first ischemic stroke.
• Non-alert level of consciousness and increased stroke severity predict the risk of dysphagia after stroke onset.
• Physicians are usually the first health professionals to identify dysarthria and aphasia.

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.Learning outcomes: 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.