Dysphagia severity and decision making algorithm after acute stoke in the elderly

• Project/Area Number: 20H04047
• Research Category: Grant-in-Aid for Scientific Research (B)
• Allocation Type: Single-year Grants
• Section: 一般
• Review Section: Basic Section 59010:Rehabilitation science-related
• Research Institution: National Cardiovascular Center Research Institute
• Principal Investigator: Ihara Masafumi 国立研究開発法人国立循環器病研究センター, 病院, 部長 (00372590)
• Co-Investigator(Kenkyū-buntansha): 福間 一樹 国立研究開発法人国立循環器病研究センター, 病院, 医師 (20820674) ; 西村 邦宏 国立研究開発法人国立循環器病研究センター, 研究所, 部長 (70397834)
• Project Period (FY): 2020-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥16,640,000 (Direct Cost: ¥12,800,000、Indirect Cost: ¥3,840,000); Fiscal Year 2022: ¥3,120,000 (Direct Cost: ¥2,400,000、Indirect Cost: ¥720,000); Fiscal Year 2021: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2020: ¥9,230,000 (Direct Cost: ¥7,100,000、Indirect Cost: ¥2,130,000)
• Keywords: 嚥下障害 / サルコペニア / 脳卒中 / 高齢者 / 摂食嚥下障害 / 摂食嚥下機能障害

Outline of Research at the Start

①非侵襲的診断機器を組み合わせたハイブリッド嚥下スクリーニング法の開発、②脳卒中データベース解析による高齢者の脳卒中後嚥下障害急性期の病態解明に基づく包括的な診断・治療アルゴリズムの構築を行う。本邦の脳卒中治療ガイドラインに反映すべく脳卒中後摂食嚥下障害の診療指針の確立を目指す。

Outline of Final Research Achievements

This research project aimed to develop a comprehensive clinical algorithm for assessing dysphagia in acute stroke. We developed a scheme for diagnosing sarcopenia by evaluating calf circumference and handgrip strength in the unaffected limb and appendicular skeletal muscle mass index and screened patients for dysphagia, malnutrition, and sarcopenia on admission to the stroke care unit. The stroke patients with sarcopenia had a higher frequency of dysphagia, lower tongue pressure, and a high risk of Functional Oral Intake Scale (FOIS) score of <5 and aspiration pneumonia during hospitalization.
In addition, the nationwide questionnaire survey revealed that the medical care system for malnutrition and sarcopenia management in stroke patients is insufficient at acute stroke centers.
This research project developed a comprehensive clinical algorithm for dysphagia and showed the significance of implementing it at acute stroke centers.

Academic Significance and Societal Importance of the Research Achievements

これまで報告されていなかった脳卒中急性期における嚥下障害とサルコペニアの関連性、予後への影響を明らかにした。
当センターが実施したアンケート結果で、脳卒中患者の低栄養、特にサルコペニアに対する診療体制が急性期病院では十分でないことを明らかにしていることからも、脳卒中診療施設で広く実装可能である本アルゴリズムの社会的意義は大きい。

Research Products

• [Journal Article] Harboring Cnm‐expressing <i>Streptococcus mutans</i> in the oral cavity relates to both deep and lobar cerebral microbleeds (2023)
  • Author(s): Ikeda Shuhei、Saito Satoshi...
  • Journal Title: European Journal of Neurology Volume: - Issue: 11 Pages: 3487-3496
  • DOI: 10.1111/ene.15720
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Plasma mid‐regional pro‐adrenomedullin: A biomarker of the ischemic penumbra in hyperacute stroke (2023)
  • Author(s): Ishiyama Hiroyuki、Tanaka Tomotaka、Saito Satoshi、Koyama Teruhide、Kitamura Akihiro、Inoue Manabu、Fukushima Naoya、Morita Yoshiaki、Koga Masatoshi、Toyoda Kazunori、Kuriyama Nagato、Urushitani Makoto、Ihara Masafumi
  • Journal Title: Brain Pathology Volume: 33 Issue: 2
  • DOI: 10.1111/bpa.13110
  • Peer Reviewed / Open Access
• [Journal Article] Interictal epileptiform discharges as a predictive biomarker for recurrence of poststroke epilepsy (2022)
  • Author(s): Abe S、Tanaka T、Fukuma M、Matsubara S、Motoyama R、Mizobuchi M、Yoshimura H、Matsuki T、Manabe Y、Suzuki J、Ishiyama H、Tojima M、Kobayashi K、Shimotake A、Nishimura K、Koga M、Toyoda K、Murayama S et al & PROPOSE Study Investigators
  • Journal Title: Brain Communications Volume: 4 Issue: 6 Pages: 312-312
  • DOI: 10.1093/braincomms/fcac312
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Impact of blood flow volume in determining the destination of intracardiac thrombi using computational fluid dynamics (2022)
  • Author(s): Hattori Yorito、Tagawa Naoki、Nakamura Masanori、Ihara Masafumi
  • Journal Title: eNeurologicalSci Volume: 29 Pages: 100437-100437
  • DOI: 10.1016/j.ensci.2022.100437
  • Peer Reviewed
• [Journal Article] Association of Cortical Superficial Siderosis with Post-Stroke Epilepsy (2022)
  • Author(s): Tomotaka Tanaka, Kazuki Fukuma, Soichiro Abe, Soichiro Matsubara, Shuhei Ikeda, Naruhiko Kamogawa, Hiroyuki Ishiyama, Satoshi Hosoki, Katsuya Kobayashi, Akihiro Shimiotake, Yuriko Nakaoku, Soshiro Ogata, Kunihiro Nishimura, Masatoshi Koga, Kazunori Toyoda, Riki Matsumoto, Ryosuke Takahashi, Akio Ikeda, Masafumi Ihara
  • Journal Title: Annals of Neurology Volume: Online ahead of print Issue: 2 Pages: 357-370
  • DOI: 10.1002/ana.26497
  • Peer Reviewed / Open Access
• [Journal Article] Developing an Asymmetry Method for Detecting Postictal Hyperperfusion in Poststroke Epilepsy (2022)
  • Author(s): Kazuki Fukuma, Tomotaka Tanaka, Shigetoshi Takaya, Maya Tojima, Katsuya Kobayashi, Akihiro Shimotake, Yoshiaki Morita, Kunihiro Nishimura, Masatoshi Koga, Kazunori Toyoda, Riki Matsumoto, Ryosuke Takahashi, Akio Ikeda, Masafumi Ihara
  • Journal Title: Frontiers of neurology Volume: eCollection Pages: 877386-877386
  • DOI: 10.3389/fneur.2022.877386
  • Peer Reviewed / Open Access
• [Journal Article] Complement 3 Is a Potential Biomarker for Cerebral Amyloid Angiopathy (2022)
  • Author(s): Saito Satoshi、Yamashiro Takayuki、Yamauchi Miho、Yamamoto Yumi、Noguchi Michio、Tomita Tsutomu、Kawakami Daisuke、Shikata Masamitsu、Tanaka Tomotaka、Ihara Masafumi
  • Journal Title: Journal of Alzheimer's Disease Volume: 89 Issue: 1 Pages: 381-387
  • DOI: 10.3233/jad-220494
  • Peer Reviewed
• [Journal Article] Risk Assessment of Cnm-Positive Streptococcus mutans in Stroke Survivors (RAMESSES): Protocol for a Multicenter Prospective Cohort Study (2022)
  • Author(s): Hosoki Satoshi、Hattori Yorito、Saito Satoshi、Takegami Misa、Tonomura Shuichi、Yamamoto Yumi、Ikeda Shuhei、Hosomi Naohisa、Oishi Naoya、Morita Yoshiaki、Miyamoto Yoshihiro、Nomura Ryota、Nakano Kazuhiko、Ihara Masafumi
  • Journal Title: Frontiers in Neurology Volume: 13 Pages: 816147-816147
  • DOI: 10.3389/fneur.2022.816147
  • Peer Reviewed / Open Access
• [Journal Article] Clinical and imaging features of nonmotor onset seizure in poststroke epilepsy (2022)
  • Author(s): Kazuki Fukuma, Shunhei Ikeda, Tomotaka Tanaka, Naruhiko Kamogawa, Hiroyuki Ishiyama, Soichiro Abe, Maya Tojima, Katsuya Kobayashi, Akihiro Shimotake, Yuriko Nakaoku, Kunihiro Nishimura, Masatoshi Koga, Kazunori Toyoda, Riki Matsumoto, Akio Ikeda, Masafumi Ihara
  • Journal Title: Epilepsia Volume: 63 Issue: 8 Pages: 2068-2080
  • DOI: 10.1111/epi.17308
  • Peer Reviewed / Open Access
• [Journal Article] Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy (2022)
  • Author(s): Yoshimura H、Tanaka T、Fukuma K、Matsubara S、Motoyama R、Mizobuchi M、Matsuki T、Manabe Y、Suzuki J、Kobayashi K、Shimotake A、Nishimura K、Onozuka D、Kawamoto M、Koga M、Toyoda K、Murayama S、Matsumoto R、Takahashi R、Ikeda A、Ihara M、and the PROPOSE Study Investigators
  • Journal Title: Neurology Volume: 99 Issue: 4
  • DOI: 10.1212/wnl.0000000000200609
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Endothelial BACE1: Bridging the Gap Between Hypertension and Alzheimer’s Disease (2022)
  • Author(s): Ihara Masafumi
  • Journal Title: Circulation Research Volume: 130 Issue: 9 Pages: 1342-1344
  • DOI: 10.1161/circresaha.122.321078
  • Peer Reviewed
• [Journal Article] A Nationwide Multi-Center Questionnaire Survey on the Real-World State and Issues Regarding Post-Stroke Complications in Japan. (2021)
  • Author(s): Ikeda S, Washida K, Tanaka T, Kitajima E, Chiba T, Fukuma K, Yoshimoto T, Saito S, Hattori Y, Ihara M.
  • Journal Title: J Stroke Cerebrovasc Dis. Volume: 30(4) Issue: 4 Pages: 105656-105656
  • DOI: 10.1016/j.jstrokecerebrovasdis.2021.105656
  • Peer Reviewed / Open Access
• [Presentation] 脳卒中患者における低栄養・サルコペニア・嚥下障害の診療実態と課題－日本脳卒中学会全国アンケート結果－ (2022)
  • Author(s): 福間 一樹, 猪原 匡史, 山本 壱弥, 鎌田 将星, 父川 拓朗, 馬明 克成, 阿部 宗一郎, 田中 智貴, 横田 千晶, 西岡 心大, 宮井 一郎, 小笠原 邦昭, 飯原 弘二
  • Organizer: 第48回日本脳卒中学会学術集会
• [Presentation] 急性期脳卒中における病前サルコペニアと摂食嚥下予後 (2022)
  • Author(s): 福間一樹, 鎌田 将星, 山本 壱弥, 父川 拓朗, 馬明 克成, 阿部 宗一郎, 田中 智貴, 中奥 由里子, 西村 邦宏, 西岡 心大, 古賀 政利, 横田 千晶, 猪原 匡史
  • Organizer: 第48回日本脳卒中学会学術集会
• [Presentation] 助成研究成果報告講演 急性期脳卒中におけるサルコペニアと摂食嚥下予後 (2022)
  • Author(s): 福間一樹，鎌田将星，山本壱弥，馬明克成，高屋成利， 西岡心大，若林秀隆，藤島一郎，猪原匡史
  • Organizer: 第28回日本摂食嚥下リハビリテーション学会学術集会
  • Invited
• [Presentation] 急性期被殻出血における摂食嚥下予後予測スコア (2021)
  • Author(s): 福間一樹, 田中智貴, 千葉哲矢, 千葉哲矢, 古賀政利, 猪原匡史
  • Organizer: 第39回日本神経治療学会学術集会
• [Presentation] 小脳橋角部腫瘍摘出後の頸静脈孔症候群による嚥下障害を呈した一例 (2021)
  • Author(s): 山路実加, 福間一樹, 横田千晶
  • Organizer: 第27回日本摂食嚥下リハビリテーション学会学術大会
• [Presentation] PROGNOSTIC FACTORS OF SWALLOWING FUNCTION IN PATIENTS WITH PONTINE HEMORRHAGE (2020)
  • Author(s): Luna Kimihira, Kazuki Fukuma, Masafumi Ihara, et al.
  • Organizer: ESO-WSO conference
  • Int'l Joint Research