Effect of tongue strength on clinical outcomes of patients: A systematic review.

OBJECTIVES: Whether decreased tongue strength is associated with poor clinical outcomes is unclear. This systematic review investigated the effect of decreased tongue strength on the clinical outcomes of adults requiring medical treatment. DESIGN: Systematic review. SETTING AND PARTICIPANTS: Systematic reviews, randomized control trials, intervention studies, and longitudinal observational studies involving patients with decreased tongue strength requiring medical treatment were included. METHODS: Articles published between January 2000 and June 2021 were retrieved from MEDLINE, CINAHL, Ichushi-web (in Japanese), Web of Science, ClinicalTrials.gov, UMIN, the Cochrane Library, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The study protocol was pre-registered in XXX. RESULTS: After screening 3040 articles and excluding duplicates, 74 articles were retrieved; after full-text evaluation of the 74 articles, seven articles (with 787 patients) were found to meet the inclusion criteria. The cut-off values for determining decreased tongue strength ranged from 13.8 to 21.6 kPa. Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy than those with high tongue strength. However, tongue strength in older patients with decreased tongue strength increased when they performed physical exercise interventions and followed strict nutritional management plans. CONCLUSIONS: Decreased tongue strength was related to poor clinical outcomes in in- and outpatients. Oral frailty in older patients should be given increased attention in hospitals, and further research is needed to improve the clinical outcomes for older people with reduced tongue strength.

Impact of malnutrition on post-stroke cognitive impairment in convalescent rehabilitation ward inpatients.

PURPOSE: To investigate the relationship between malnutrition risk on admission and improvement in post-stroke cognitive impairment (PSCI). METHODS: This retrospective cohort study included 90 patients with PSCI with a Mini-Mental State Examination (MMSE) score ≤ 23, who were admitted to a rehabilitation hospital between July 2013 and December 2015. We assessed the malnutrition risk using the Mini Nutritional Assessment-Short Form (MNA-SF) and cognitive improvement using the Functional Independence Measure cognitive subscale (cognitive FIM) gain. Participants were classified into the malnourished (MNA-SF score ≤ 7) and adequately nourished groups (≥ 8). The patients' age, modified Rankin Scale score, time to hospitalization, and length of stay were recorded. The relationship between nutritional status and cognitive FIM was determined using a multivariate regression model. RESULTS: The study included 47 men and 43 women, with a mean age of 75.0 (standard deviation: 8.7) years. The number of patients in the malnourished and adequately nourished groups were 68 (75.6%) and 22 (24.4%), respectively. The median MMSE score was 19 (interquartile range 15-22), and the median cognitive FIM score at admission was 17 (interquartile range 11-21.8). Univariate analysis showed no significant difference in cognitive FIM gain between the malnourished and adequately nourished groups (P = 0.781). Multivariate regression analysis showed that the MNA-SF score (beta = 0.84, P = 0.009) and cognitive FIM at admission (beta = - 0.347, P < 0.001) were independently related to cognitive FIM gain. CONCLUSION: Most patients with PSCI were malnourished; malnutrition on admission for rehabilitation was associated with poor improvement after PSCI.

[Examination of Criterion Validity about the Standard Language Test of Aphasia].

The Standard Language Test of Aphasia (SLTA) is the most frequently used comprehensive aphasia rating scale in Japan. Although the SLTA has been verified for reliability, verification for validity is inadequate. The purpose of this study was to examine criterion-related validity of the SLTA. The SLTA was performed on patients who had passed 3months or more after onset of the aphasia-causing disease such as stroke, and the Japanese version of the Western Aphasia Battery (WAB) was subsequently performed. We investigated age, gender, disease, and calculated Spearman's rank correlation coefficient for total score and each item of the SLTA and the WAB. There were 20participants (14males, 6females), with a mean age of 68.5±12.5years. Correlations of the SLTA and the WAB were as follows: SLTA total index score and WAB aphasia quotient; r=0.870 (P<0.001), SLTA Writing factor and WAB (VI) Writing; r=0.852 (P<0.001), SLTA writing instructions and WAB writing instructions; r=0.807 (P<0.001). Many of the correlations of Z-scores between sub-tests were r≥0.7. The SLTA has criteria-related validity and now the aphasia test that has been tested for reliability and validity. (Received July 22, 2019; Accepted March 4, 2020; Published July 1, 2020).