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.