Changes in Sensitivity, Taste and Smell in Stroke Patients

Study Overview
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Brief Summary
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This study evaluates changes in swallowing using endoscopic swallowing studies and measuring of pharyngeal sensitivity, taste and smell in stroke patients. Younger (<60 years) and older (>60 years) volunteers will serve as control.

Detailed Description
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Stroke is the second leading cause of death. At least 50% of stroke patients develop dysphagia, leading to aspiration pneumonia, which is the main cause of death in stroke [2]. It is assumed that normal sensitivity is vital for aspiration-free swallowing and for the triggering of the swallowing reflex. Ali et al. demonstrated aspiration-free swallowing in healthy volunteers who underwent local anaesthesia of oral and pharyngeal structures [1]. Power et al. showed a reduced sensitivity of pharyngeal structures in stroke patients prone to aspiration [3]. By combining measuring sensitivity and flexible endoscopic swallowing studies, this study further investigates the role of sensitivity in swallowing Neuropsychological deficits of swallowing, such as swallowing apraxia or buccal hemineglect, is assessed by neuropsychological testing. Additionally, there is no systematic research investigating the change in smell and taste in correlation with changes in stroke patients

Official Title
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Changes in Sensitivity of Swallowing-relevant Structures, Taste and Smell in Stroke Patients

Conditions
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Stroke, Dysphagia

Intervention / Treatment
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* Diagnostic Test: FEES (flexible endoscopic evaluation of swallowing)
* Other: Sensitivity threshold
* Diagnostic Test: Taste-/smell-test
* Diagnostic Test: Neuropsychological testing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Volunteers: informed consent Stroke patients: informed consent new supratentorial stroke (<72 hours old) confirmed by CT (computed tomography) or MRI (magnetic resonance imaging) Exclusion Criteria: pre-existing stroke oder dysphagia extensive white matter lesions in CT- or MRI-scan allergies to odorous substances or flavoring contraindications for FEES (flexible endoscopic evaluation of swallowing), CT or MRI (stroke patients only)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Volunteers <60 years<br>Volunteers, who are able to consent to participation in the study, as control. | Other: Sensitivity threshold<br>* Determining sensitivity threshold using a pudendal electrode<br>Diagnostic Test: Taste-/smell-test<br>* Taste-/smell-test<br>|
| Volunteers >60 years<br>Volunteers, who are able to consent to participation in the study, as control. | Other: Sensitivity threshold<br>* Determining sensitivity threshold using a pudendal electrode<br>Diagnostic Test: Taste-/smell-test<br>* Taste-/smell-test<br>|
| Stroke patients<br>Stroke patients with supratentorial stroke, who are able to consent to participation in the study. | Diagnostic Test: FEES (flexible endoscopic evaluation of swallowing)<br>* Endoscopical swallowing study in stroke patients only<br>Other: Sensitivity threshold<br>* Determining sensitivity threshold using a pudendal electrode<br>Diagnostic Test: Taste-/smell-test<br>* Taste-/smell-test<br>Diagnostic Test: Neuropsychological testing<br>* Neuropsychological testing for neglect, agnosia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dysphagia | Changes found in endoscopic swallowing study : Presence and severity of dysphagia (measured with Rosenbek's Penetration/Aspiration-scale) | 96 hours after initial symptoms | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neuropsychological deficits | Agnosia, neglect | 96 hours after initial symptoms | 
| Lesion site | Side, vascular territory, swallowing relevant structures | 96 hours after initial symptoms | 
| Sensitivity | Sensitivity of faucial pillar region | 96 hours after initial symptoms | 
| Taste/Smell | Smell-/Taste-score | 96 hours after initial symptoms |