Association between Dysphagia and Symptoms of Depression and Anxiety after Ischemic Stroke

ABSTRACT BACKGROUND Dysphagia after stroke is associated not only with poor outcome and higher mortality, but also with reduced quality of life and social isolation. We aimed to investigate the potential relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke. METHODS Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study at the study center Innsbruck, Austria from 2020 to 2022 were assessed for presence of dysphagia on hospital admission (clinical swallowing assessment) as well as for persistence until hospital discharge and a 3-month follow-up (SINGER Independency Index). Symptoms of anxiety and depression were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up. RESULTS Of 648 patients (36.6% female), 19.3% had dysphagia at hospital admission which persisted in 14.8% (hospital discharge) and 6.8% (3-month follow-up). With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, discharge or at 3 months), score points (mean±SD) increased in the BDI (7.9±6.7, 12.5±8.7, 13.5±9.0, 16.5±10.2), HADS-D (4.4±3.7, 7.1±4.2, 7.7±4.4, 9.8±4.3) and HADS-A (4.4±3.5, 5.4±3.6, 6.0±3.6, 7.0±3.6). In linear regression analysis adjusting for age, sex and functional disability, BDI and HADS-D but not HADS-A scores were significantly higher in patients with dysphagia when compared to those without dysphagia at baseline or who recovered to discharge and follow-up. Moreover, patients with swallowing impairment were more likely to receive antidepressants, antipsychotics or benzodiazepines at discharge and 3-month follow-up. CONCLUSIONS Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor of depressive symptoms after stroke.