Predictors of nursing home placement in Huntington disease
Predictors of nursing home placement in Huntington disease
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DOI：
10.1212/01.wnl.0000052992.58107.67
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发表时间：
2003-03-25
期刊：
影响因子：
9.9
通讯作者：
Shoulson, I
中科院分区：
文献类型：
--
作者：
Wheelock, VL;Tempkin, T;Shoulson, I
目的：确定亨廷顿病（HD）的运动、行为或精神症状是否可预测专业护理机构（SNF）的安置。研究方法：受试者是1994年1月至1999年9月期间亨廷顿研究组的统一亨廷顿疾病评定量表数据库（罗切斯特，纽约）的参与者。使用卡方（2）和Student t检验分析居住在家中和SNF的受试者的特定运动、精神和行为变量。对于存在纵向数据的受试者子集，使用控制年龄、性别和疾病持续时间的考克斯比例风险模型。结果：在入组的4，809例受试者中，3，070例患有临床确诊的HD。其中，228人（7.4%）居住在SNF。SNF居民的平均年龄为52岁，平均病程为8.6年，主要是女性（63%）。SNF居民的运动功能更差（舞蹈病、运动迟缓、步态异常和不平衡，p < 0.0001）;更容易有强迫观念、强迫行为、妄想和幻听;更具攻击性、破坏性（p < 0.0001）和易激惹行为（p = 0.0012）。对于1，559名受试者，存在纵向数据（平均随访时间，1.9年），87名（5%）从家中转移到SNF。在考克斯模型中，运动迟缓（HR 1.965，95% CI 1.083 - 3.564）、步态受损（HR 3，004，95% CI 1.353 - 6.668）和串联行走受损（HR 2.546，95% CI 1.460 - 4.439）可预测SNF置入。结论：住院的HD患者在运动、精神和行为方面比在家生活的患者受损更严重。然而，运动变量单独预测机构化。延缓HD运动功能障碍进展的治疗策略可能会推迟住院治疗的需要。
Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement. Methods: Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using chi(2) and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used. Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p < 0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p < 0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% Cl 1.083 to 3.564), impaired gait (HR 3,004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement. Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.