Prevalence, recognition, and implications of mental impairment among hemodialysis patients
Prevalence, recognition, and implications of mental impairment among hemodialysis patients
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DOI：
10.1016/s0272-6386(97)90563-1
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发表时间：
1997-07-01
影响因子：
13.2
通讯作者：
Whitehouse, PJ
中科院分区：
文献类型：
--
作者：
Sehgal, AR;Grey, SF;Whitehouse, PJ
透析患者的年龄增长和合并症可能与阿尔茨海默病、中风和其他精神损伤原因的患病率增加有关。我们试图确定慢性血液透析患者中精神损害的患病率、认知度和含义。我们对来自三个透析单位的336名随机选择的患者进行了迷你精神状态检查（MMSE）。为了确定卫生保健提供者对精神损伤的认识，我们将MMSE评分与从每位患者的透析技术人员和医疗记录中获得的精神状态评估进行了比较。为了确定精神障碍的临床意义，我们前瞻性地获得了Kt/V、白蛋白、蛋白质分解代谢率、血压和红细胞压积值。为了确定精神损伤对资源的影响，我们评估了护理每位患者所需的工作人员时间以及住院情况。我们发现22%的受试者有轻度精神障碍（MMSE为18 ~ 23），8%的受试者有中重度精神障碍（MMSE为0 ~ 17）。技师和病案心理状态评估的敏感性分别为57%和15%。在调整人口统计学和医学变量后，低MMSE评分与低蛋白质分解代谢率（优势比，1.5;P = 0.02）、透析后技术人员护理患者的时间增加（优势比，1.5;P = 0.005）和住院天数增加（优势比，1.4;P = 0.03）独立相关。总之，血液透析患者中未被识别的精神损伤发生率很高，这对蛋白质营养状况、工作时间和住院治疗有不利影响。我们建议临床医生定期筛查精神损伤，并针对受损患者进行干预，以改善精神状态和相关的不良后果。(C) 1997年由国家肾脏基金会，Inc。
The increasing age and co-morbidity of dialysis patients may be associated with an increase in the prevalence of Alzheimer's disease, stroke, and other causes of mental impairment. We sought to determine the prevalence, recognition, and implications of mental impairment among chronic hemodialysis patients. We administered the Mini Mental Status Exam (MMSE) to 336 randomly selected patients from three dialysis units. To determine recognition of mental impairment by health care providers, we compared MMSE scores with mental status assessments obtained from each patient's dialysis technician and medical record. To determine the clinical implications of mental impairment, we prospectively obtained Kt/V, albumin, protein catabolic rate, blood pressure, and hematocrit values. To determine the resource implications of mental impairment, we assessed staff time required to care for each patient as well as hospitalizations. We found that 22% of subjects had mild mental impairment (MMSE 18 to 23) and that 8% had moderate-severe mental impairment (MMSE 0 to 17). The sensitivity of technician and medical record mental status assessments were 57% and 15%, respectively. After adjusting for demographic and medical variables, low MMSE score was independently associated with low protein catabolic rate (odds ratio, 1.5; P = 0.02), increased technician time caring for patient after dialysis (odds ratio, 1.5; P = 0.005), and increased hospital days (odds ratio, 1.4; P = 0.03). In conclusion, there is a high prevalence of unrecognized mental impairment among hemodialysis patients that has adverse implications for protein nutritional status, staff time, and hospitalization. We recommend that clinicians routinely screen for mental impairment and target impaired patients for interventions to improve mental status and associated adverse outcomes. (C) 1997 by the National Kidney Foundation, Inc.