Swallowing disorder in stroke patients with structural equation model: The interaction of cognition and brain lesion location

Background: Cognitive status is important for performing the assessment and treatment of dysphagia. Nonetheless, the cognitive neuropsychological profile of patients with stroke and dysphagia is not studied as deeply enough as it should be. On one hand, focal and non-focal brain lesions may lead to dysphagia and cognitive disorders, and on the other hand, the cognitive status possibly affects swallowing. In this study, cognition is supposed to be a mediator between brain lesion and swallowing disorder (dysphagia). The role of cognition and attention as mediators between brain lesion and dysphagia were evaluated via three causal models in which the causal mechanisms of swallowing were explained.Methods: Eighty-eight patients with their first stroke (34 females and 54 males) in the acute phase (mean: 3.5 days after stroke; SD: 2.7) participated in this research. The data of dysphagic and non-dysphagic patients were entered into structural equation models. Two relationships were estimated: a direct relationship between brain lesion and dysphagia, and an indirect association of brain lesion and dysphagia through cognition and attention.Results: The goodness of fit indices confirmed the three models. Our first model proved a good fit [CFI = 1.00; TLI =1.00]. The second model revealed an appropriate goodness of fit [CFI = 1.00; TLI =1.00]. Our third model also showed a good fit [CFI = 1.00; TLI =1.00].Conclusion: It is suggested that in the assessment and treatment of dysphagia, cognition is better to be considered as a mediator along with physical aspects of dysphagia.