Author Response: Association Between Dysphagia and Symptoms of Depression and Anxiety After Ischemic Stroke

We thank the authors for their thoughtful and insightful comments regarding our recent publication from the STROKE-CARD registry. We fully agree that post-stroke dysphagia remains an under recognized and under researched domain, particularly regarding its longer-term psychosocial impact, and we appreciate the emphasis they have placed on this important issue. It is important to highlight that the cohort reported in our study benefited from a highly structured and comprehensive stroke care pathway. The Tyrolean Stroke Pathway ensures systematic access to both inpatient and fully reimbursed outpatient rehabilitation services, whether at home or within nursing facilities [1]. Additionally, the STROKE-CARD care program—a structured, multidisciplinary post-stroke disease management strategy involving follow-up visits at 3 and 12 months—has been shown to significantly improve patient outcomes, including quality of life and reduction of vascular events [2]. Within this optimized system, we have previously demonstrated that STROKE-CARD care facilitates improved recovery from dysphagia [3]. Nevertheless, even in this setting, persistent dysphagia remains associated with a substantial burden of psychosocial sequelae, including depressive symptoms, anxiety, and fatigue [4, 5]. Thus, the findings from our study likely represent a conservative estimate of the challenges faced by patients with post-stroke dysphagia. We fully concur with the authors that in regions without structured post-stroke care pathways or with limited access to rehabilitation services, the adverse consequences of persistent dysphagia—both physical and psychological—may be even more profound. This underscores the urgent need for interventional studies targeting early and sustained dysphagia management, especially in the post-discharge setting, to optimize recovery and long-term outcomes. Anel Karisik: conceptualization, writing – review and editing, writing – original draft. Lukas Mayer-Suess: conceptualization, writing – original draft, writing – review and editing. Stefan Kiechl: conceptualization, writing – original draft, writing – review and editing, project administration. Michael Knoflach: conceptualization, writing – review and editing, writing – original draft, project administration. Christian Boehme: writing – review and editing, writing – original draft, conceptualization. The authors declare no conflicts of interest. The authors have nothing to report.