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Dissertation
To be or not to be dysphagic: the prevalence of dysphagia in newly diagnosed head-and-neck cancer patients.
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Year: 2024 Publisher: Leuven KU Leuven. Faculteit Geneeskunde

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Abstract

Introduction: To our knowledge, no studies have yet been published on the systematic screening for oropharyngeal dysphagia (OD) in all newly diagnosed head-and-neck cancer (HNC) patients irrespective of cancer stage and primary tumor location. This knowledge gap has led to uncertainty regarding the exact prevalence of OD within this population, which is also characterized by aging and comorbid conditions. Moreover, the understanding of the prevalence of OD and its relationship with demographic and oncological characteristics can guide us to more effective screening and management of a patient’s risk profile before cancer treatment. With this in mind, the aims of this prospective cohort study were: (1) to determine the prevalence of the risk of OD in HNC patients within three weeks before treatment; (2) to investigate which demographic and oncological characteristics may predict the risk of OD prior to cancer treatment. It is hypothesized that a significant subset of newly diagnosed HNC patients have a risk of OD and that the risk of OD may be associated with higher age, poor Charlson Comorbidity Index (CCI) grading, primary tumor location, and advanced cancer stage grouping. Materials and Methods: From December 2021 to May 2023, all newly diagnosed HNC patients of the Comprehensive Cancer Center Maastricht underwent screening for the risk of OD (Eating Assessment Tool-10 – EAT-10) and malnutrition (Short Nutritional Assessment Questionnaire – SNAQ and body mass index – BMI). Their comorbid status was assessed using the CCI grade. Demographic and oncological data were retrieved from the Dutch Head and Neck Audit. Multivariable logistic regression analysis was performed. Results: The mean age (N=225) was 66.8 (SD 10.7). Primary tumors of the oral cavity (34.2%) and pharynx (31.1%) were predominant. The prevalence of the risk of OD (EAT-10 ≥3) was 21.3% (proportion 0.213; 95% CI 0.163-0.274). The risk of OD was not significantly associated with age, CCI grade, and primary tumor location. However, a significant association was found between advanced-stage cancer and the risk of OD (EAT-10 ≥3) in the multivariable logistic regression analysis with correction for age, CCI grade, and tumor location. Post hoc additional correction also revealed a significant association between the risk of malnutrition (SNAQ ≥2 or BMI <20 kg/m² if <70 years old or BMI <22 kg/m² if ≥70 years old) and the risk of OD, while advanced-stage cancer remained significantly associated with the EAT-10 score. Conclusion: This study unveiled that approximately one-fifth of newly diagnosed HNC patients have a risk of OD (EAT-10 ≥3) before the start of cancer treatment, with advanced-stage cancer and malnutrition emerging as significant predictors. These findings equip health professionals to prioritize closer monitoring and tailored interventions for patients with a risk of OD and OD-related complications during their cancer treatment trajectory. Future studies should investigate the effects of OD screening on cancer treatment outcomes and survival rates, alongside exploring prophylactic interventions for OD and malnutrition aimed at reducing the prevalence and severity of OD in HNC patients.

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Dissertation
The functional brain network in aphasia: a resting-state EEG study

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Background: About one out of three stroke patients are affected by aphasia, an acquired language disorder which impairs the production and/or comprehension of spoken and/or written language. Traditionally, behavioral tests are used during aphasia assessment. However, due to the lack of objective results, questionable psychometric properties, the influence of confounding factors, and the inability to test too severely impaired patients, objective measures might form promising additional assessment tools. Resting-state electroencephalography (rsEEG) is emerging as a convenient method for this, as it does not require overt task performance or sensory stimulation, is inexpensive, has no contra-indications for use and is already present in most hospitals. The present study aims to contribute to filling the gap in the literature concerning functional connectivity (FC) during rsEEG in people with aphasia (PWA). More specifically, it aims to answer the question whether graph metrics characterizing FC networks as measured during rsEEG can predict aphasia severity. Methods: EEG recordings were carried out in 26 PWA during resting state. The weighted phase lag index was used as a measure of FC between the EEG-signals at scalp level. A global and a local graph measure, average characteristic path length and node strength respectively, were calculated for six frequency bands: delta (1–4 Hz), theta (4.5-7 Hz), alpha (7.5-14.5 Hz), beta (15-30 Hz), low-gamma (30.5-49 Hz) and mid-gamma (50-90 Hz). Node strength was averaged across frontal, temporal, parietal, and occipital scalp regions. Two behavioral measures were used to assess aphasia severity, namely the e-ScreeLing and the Nederlandse Benoem Test (“Dutch Naming Test”). Multiple linear regression and Spearman’s rank correlations were implemented to examine whether the graph measures can predict and/or correlate with aphasia severity. Results: The results show that average path length predicts aphasia severity in the delta and theta bands and negatively correlates with aphasia severity in the delta band. Positive correlations with aphasia severity were found for average delta and theta node strength in all four regions. Moreover, in the gamma bands, average node strength in the frontal and occipital lobes was found to negatively correlate with aphasia severity. No significant predictors or correlations were identified in the alpha and beta bands. Conclusion: Based on the current findings, both global network properties in the delta and theta band and local properties in the delta, theta and gamma bands correlate with aphasia severity. While correlations in the gamma bands seem to reflect compensatory mechanisms, it is less clear if changes in the delta and theta bands reflect compensation of language deficits through the engagement of extra cognitive resources during language processing or rather reflect inefficient language processing through overrecruitment or ineffective inhibition of activity irrelevant to language processing. It remains unclear which specific regions are responsible for these findings due to their low spatial resolution, but as correlations with the local measure were found across all four cortical lobes, it is possible that different parts of the language network were involved and correlate with aphasia. Future research is necessary to gain further insight into rsFC in PWA and to establish whether EEG may be a reliable diagnostic tool in the assessment of aphasia.

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