Clinical factors associated with Activities of Daily Living and their decline in patients with severe and profound dementia
Clinical factors associated with Activities of Daily Living and their decline in patients with severe and profound dementia
复制标题
重度和深度痴呆患者的日常生活活动及其下降相关的临床因素
DOI：
10.1111/psyg.12502
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发表时间：
2019
期刊：
影响因子：
2
通讯作者：
Nishikawa T
中科院分区：
文献类型：
--
作者：
Tanaka H;Nagata Y;Ishimaru D;Ogawa Y;Fukuhara K;Nishikawa T
背景为了确定影响基线和6个月后日常生活活动（ADL）的临床因素。方法我们在2015年4月至2017年3月的6个月（基线和6个月后）的两个时间点在日本兵库县一家拥有270个床位的乡村康复医院进行了一项单中心观察性研究。参与者总数为 131 人（男性 33 人，女性 98 人；平均年龄：87.0±7.0；轻度和中度痴呆 38 人；重度痴呆 93 人）。使用的测量量表包括用于评估 ADL 的个人自我维护量表 (PSMS)、用于评估认知功能的严重痴呆症简易精神状态检查和认知测试 (CTSD)、用于评估痴呆症行为/心理症状的神经精神病学量表-疗养院版和康奈尔痴呆症抑郁量表 (CSDD)、用于评估营养状况的简易营养评估简表 (MNA-SF)、高级疼痛评估疼痛性痴呆、查尔森合并症指数 (CCI) 以及基于累积疾病评定量表老年病学的疾病类别数量。多元回归分析确定了 PSMS 评分作为因变量和其他变量作为自变量之间的关联。结果在患有严重痴呆的参与者中，基线时的 PSMS 评分与 CTSD、CCI、MNA-SF 和 CSDD 评分显着相关。在纵向分析中，只有 CTSD 评分与 6 个月后的 PSMS 评分显着相关。值得注意的是，对于患有严重痴呆的参与者，通过 CTSD 评分评估，6 个月后与 ADL 相关的唯一因素是认知功能。 结论 预测功能下降的最重要因素是认知功能，即使在严重和深度阶段也是如此。
BackgroundTo identify the clinical factors affecting activities of daily living (ADL) at baseline and after 6 months.MethodsWe conducted a single‐centre observational study at two time points across 6 months (baseline and after 6 months) from April 2015 to March 2017. in a 270‐bed rural recuperation hospital at Hyogo prefecture in Japan. The total number of participants was 131 (male 33, female 98; mean age: 87.0 ± 7.0; mild and moderate dementia, 38; severe dementia, 93). Measurement scales used were Personal Self‐Maintenance Scale (PSMS) for assessing ADL, Mini‐Mental State Examination and Cognitive Test in Severe Dementia (CTSD) for cognitive function, Neuropsychiatric Inventory‐Nursing Home version and Cornell Scale for Depression in Dementia (CSDD) for behavioural/psychological symptoms of dementia, Mini Nutritional Assessment Short form (MNA‐SF) for nutritional status, Pain Assessment in Advanced Dementia for pain, and Charlson comorbidity index (CCI) and the number of illness categories based on Cumulative Illness Rating Scale Geriatrics for comorbidities. Multiple regression analyses identified the association between PSMS score as the dependent variable and other variables as independent variables.ResultsIn participants with severe dementia, the PSMS scores at baseline were significantly associated with CTSD, CCI, MNA‐SF, and CSDD scores. In the longitudinal analysis, only CTSD score was significantly associated with PSMS score after 6 months. It is noteworthy that for participants with severe dementia, the only factor associated with ADL after 6 months was cognitive function, as assessed by CTSD score.ConclusionsThe most important factor predicting functional decline is cognitive function, even at the severe and profound stage.