Dysphagia increases the risk of post-stroke fatigue

Background: Post-stroke dysphagia is known to have a pronounced effect on mortality and quality of life of stroke patients. Here, we investigate whether this extends to post-stroke fatigue, a major contributor to morbidity after ischemic stroke.

Methods: Patients with acute ischemic stroke (recruited consecutively in the STROKE-CARD Registry from 2020 to 2023 at the study center Innsbruck, Austria) were examined for dysphagia via clinical swallowing examination at hospital admission. Post-stroke fatigue was assessed using the Fatigue Severity Scale (FSS) at study specific in person follow-up visits within the first year after ischemic stroke.

Results: Among 882 ischemic stroke patients (mean age 72.4 ± 13.5 years, 36.8% females), dysphagia was present in 22.0% at hospital admission and persisted in 16.2% until hospital discharge. Post-stroke fatigue affected 52.2% of the total cohort during follow-up and was significantly more prevalent among those with dysphagia (68.4% vs. 49.0%, p < 0.001). The prevalence of fatigue increased with the severity of dysphagia, with the highest proportion (86.7%) in those with severe dysphagia. After multivariable adjustment for other factors associated with post-stroke fatigue, including age, sex, pre-stroke disability, cognitive impairment, stroke severity, inability to walk at discharge, and need for antidepressants at discharge, dysphagia remained independently associated with post-stroke fatigue during the first year after stroke (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.22-3.38).

Conclusions: Dysphagia is common after ischemic stroke and increases the risk of post-stroke fatigue. Patient-tailored measures are warranted to reduce fatigue after stroke and therefore enhance quality of life.