Dementia and Geriatric Cognitive Disorders Extra最新文献_第10页

Nursing Staff's Knowledge and Attitudes toward Dementia: A Pilot Study from an Indian Perspective 护理人员对痴呆症的知识和态度:一项来自印度视角的初步研究

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-10-01 DOI: 10.1159/000502770

B. S. Strøm, K. Engedal, Lasse Andreassen

Background: Despite the increased prevalence of dementia in India, reports indicate little awareness of the disease. Symptoms are often misinterpreted or neglected, which could lead to late diagnosis, reducing the choices available regarding future care. Considering that most nurses caring for the elderly will work with people with dementia in the future, there is concern surrounding their ability to meet the needs of these patients, requiring them to obtain the necessary knowledge and positive attitudes for treatment. Aims: To describe the knowledge of and attitudes toward dementia among nursing staff working in residential care facilities for elderly populations in India. Methods: A cross-sectional survey was conducted in 3 nursing homes in India in which 15 nursing staff conducted self-assessments of their knowledge and attitudes toward dementia using the Alzheimer’s Disease Knowledge Scale (ADKS) and the Attitude toward Alzheimer’s Disease and Related Dementias Scale (DAS) for each respective assessment. Descriptive statistics were used to describe staffs’ attitudes and knowledge concerning dementia. Continuous variables were presented as means ± SD, while the categorical variables were presented as percentages. Results: Although the majority of the participants answered that Alzheimer’s disease cannot be cured, about half reported that people with dementia, in rare cases, can recover from the disease. While all participants agreed that people with dementia can feel when others are kind to them, almost half disagreed that people living with dementia can enjoy life. Conclusion: These findings reveal that nursing staff have limited knowledge of dementia, but their attitudes toward people living with dementia tend to be positive.

背景:尽管痴呆症在印度的患病率增加，但报告显示人们对这种疾病的认识很少。症状往往被误解或忽视，这可能导致诊断迟缓，减少了未来护理的选择。考虑到大多数护理老年人的护士未来将与痴呆症患者一起工作，人们担心他们是否能够满足这些患者的需求，要求他们获得必要的知识和积极的治疗态度。目的:描述在印度老年人居住护理机构工作的护理人员对痴呆症的知识和态度。方法:采用横断面调查方法，对印度3家养老院进行调查，其中15名护理人员分别使用阿尔茨海默病知识量表(ADKS)和阿尔茨海默病及相关痴呆态度量表(DAS)对其痴呆知识和态度进行自我评估。使用描述性统计描述员工对痴呆症的态度和知识。连续变量以均数±SD表示，分类变量以百分比表示。结果:虽然大多数参与者回答说阿尔茨海默病无法治愈，但大约一半的人报告说，在极少数情况下，痴呆症患者可以从疾病中恢复过来。虽然所有的参与者都同意，当别人对他们友好时，痴呆症患者会有感觉，但几乎一半的人不同意痴呆症患者可以享受生活。结论:这些发现表明护理人员对痴呆症的认识有限，但对痴呆症患者的态度趋于积极。

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引用次数: 19

Effects of Cognitive Performance and Affective Status on Fatigue in Parkinson's Disease 认知表现和情感状态对帕金森病患者疲劳的影响

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-09-24 DOI: 10.1159/000498883

Susan Spirgi, A. Meyer, P. Calabrese, U. Gschwandtner, P. Fuhr

Background: Fatigue is a common non-motor symptom in Parkinson’s disease (PD) and is typically assessed via self-reported questionnaires such as the Parkinson’s Fatigue Scale (PFS). The PFS captures the presence of subjective experience of physical fatigue as well as its impact on daily functioning. Objectives: We aimed to investigate whether different variables (cognition, neuropsychiatric symptoms, disease-related measures) are associated with the experience of physical fatigue in comparison to fatigue affecting daily functioning. Method: Sixty-two non-demented PD patients were evaluated through questionnaires assessing fatigue, daytime sleepiness, apathy, depression, anxiety, and cognition. Items of fatigue were classified and summarized into two index variables measuring either the subjective experience of physical fatigue or the impact of fatigue on daily functioning. Linear regression with a stepwise elimination procedure was conducted to select the significant predictors for each index variable separately. Results: Subjective experience of physical fatigue (Model 1; r2 = 0.46; p <0.01) was significantly associated with higher levels of depression (b =0.07; p <0.01), anxiety (b =0.03; p <0.05), and lower performances in verbal episodic memory (b =–0.16; p <0.05). Fatigue affecting daily functioning (Model 2; r2 = 0.44; p <0.05) was significantly related to higher levels of depression (b = 0.07; p < 0.01), anxiety (b = 0.03; p > 0.05), and lower motor functioning (b = 0.01; p = 0.05). Conclusions: In conclusion, our work supports associations between fatigue and other neuropsychiatric symptoms in PD and extends prior work suggesting that motor disturbances are specifically linked to fatigue-related impairment of daily functioning, but not to the subjective experience of physical fatigue.

背景:疲劳是帕金森病(PD)常见的非运动症状，通常通过帕金森疲劳量表(PFS)等自我报告问卷进行评估。PFS捕捉到身体疲劳的主观体验以及它对日常功能的影响。目的:我们的目的是研究不同的变量(认知、神经精神症状、疾病相关措施)是否与身体疲劳体验相关，而不是疲劳影响日常功能。方法:采用疲劳、日间嗜睡、冷漠、抑郁、焦虑、认知等问卷对62例非痴呆性PD患者进行评估。疲劳项目被分类并归纳为两个指标变量，测量身体疲劳的主观体验或疲劳对日常功能的影响。采用逐步消除法进行线性回归，分别选取各指标变量的显著性预测因子。结果:身体疲劳的主观体验(模型1;R2 = 0.46;P 0.05)，运动功能下降(b = 0.01;P = 0.05)。结论:总之，我们的工作支持疲劳和PD中其他神经精神症状之间的联系，并扩展了先前的工作，表明运动障碍与疲劳相关的日常功能损害有关，但与身体疲劳的主观体验无关。

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引用次数: 7

Polypharmacy Associated with Cognitive Decline in Newly Diagnosed Parkinson's Disease: A Cross-Sectional Study. 新诊断帕金森病患者认知能力下降的多药治疗：一项横断面研究。

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-09-10 eCollection Date: 2019-09-01 DOI: 10.1159/000502351

Nobuyuki Ishii, Hitoshi Mochizuki, Katsuya Sakai, Go Ogawa, Kazutaka Shiomi, Masamitsu Nakazato

Aims: Polypharmacy is well known to affect cognitive function in community-dwelling older adults. However, the effect of polypharmacy on cognitive function in patients with newly diagnosed Parkinson's disease remains unknown. Here, we evaluated the association between polypharmacy and cognitive function in patients with newly diagnosed Parkinson's disease.

Methods: This cross-sectional study enrolled 131 consecutive hospitalized patients with newly diagnosed Parkinson's disease. Cognitive function was evaluated with the Mini-Mental State Examination and analyzed between groups of patients with or without polypharmacy. Comparisons were adjusted for confounders by performing inverse probability weighting with propensity scores.

Results: After inverse probability weighting, patients in the polypharmacy group had a significantly lower Mini-Mental State Examination score than patients in the nonpolypharmacy group (26.2 vs. 27.7, p = 0.001).

Conclusion: Polypharmacy was associated with cognitive decline in patients with newly diagnosed Parkinson's disease. This finding suggests that medication reduction might serve as a promising intervention to prevent the development of dementia in patients with early Parkinson's disease. Further prospective studies are needed to determine whether medication reduction improves cognitive function in patients with newly diagnosed Parkinson's disease.

目的：众所周知，多药治疗会影响社区老年人的认知功能。然而，多药治疗对新诊断的帕金森病患者认知功能的影响仍然未知。在这里，我们评估了新诊断的帕金森病患者的多药治疗与认知功能之间的关系。方法：这项横断面研究纳入了131名连续住院的新诊断帕金森病患者。认知功能通过迷你精神状态检查进行评估，并在使用或不使用多种药物的患者组之间进行分析。通过对倾向得分进行反向概率加权，对混杂因素进行比较调整。结果：经过逆概率加权后，多药治疗组的患者的迷你精神状态检查得分显著低于非多药组（26.2比27.7，p=0.001）。结论：多药治疗与新诊断的帕金森病患者的认知能力下降有关。这一发现表明，减少药物治疗可能是一种很有前途的干预措施，可以预防早期帕金森病患者患痴呆症。需要进一步的前瞻性研究来确定减少药物治疗是否能改善新诊断的帕金森病患者的认知功能。

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引用次数: 12

Social Networks, Community Engagement, and Cognitive Impairment among Community-Dwelling Chinese Older Adults 中国社区居住老年人的社会网络、社区参与与认知障碍

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-09-10 DOI: 10.1159/000502090

Jinlei Li, Zijuan Wang, Z. Lian, Zhikai Zhu, Yuanli Liu

Aims: To examine the association of social networks and community engagement with cognitive impairment among community-dwelling Chinese older adults. Methods: From November 2017 to May 2018, we selected 1,115 elderly individuals from 3 Chinese communities (Beijing, Hefei, and Lanzhou) using a random-cluster sampling method, and recorded data on demographics, social network characteristics, community activities, and cognitive function. The odds ratios (ORs) of these associations were adjusted for potential confounders in logistic regression models. Results: The prevalence of cognitive impairment was 25.7% (n = 287). An adequate social network (OR 0.55; 95% confidence interval [CI] 0.33–0.91) and enough social support from friends (OR 0.43; 95% CI 0.29–0.62) were negatively associated with cognitive impairment. Family support was not significantly associated with cognitive impairment (OR 0.64; 95% CI 0.34–1.21). Taking part in elderly group travel, communication with others using WeChat, and community activities such as Tai Chi and walking together were negatively associated with cognitive impairment. Conclusion: Social network characteristics and community engagement were found to be related to cognitive function among community-dwelling Chinese elderly adults.

目的:探讨社区居住的中国老年人的社会网络和社区参与与认知障碍的关系。方法:2017年11月至2018年5月，采用随机整群抽样方法，从北京、合肥和兰州3个华人社区抽取1115名老年人，记录人口统计学、社会网络特征、社区活动和认知功能等数据。在逻辑回归模型中对这些关联的比值比(ORs)进行了校正，以排除潜在的混杂因素。结果:认知功能障碍患病率为25.7% (n = 287)。充足的社交网络(OR 0.55;95%可信区间[CI] 0.33-0.91)和来自朋友的足够的社会支持(OR 0.43;95% CI 0.29-0.62)与认知障碍呈负相关。家庭支持与认知障碍无显著相关性(OR 0.64;95% ci 0.34-1.21)。参加老年人团体旅游、使用b微信与他人交流、以及太极和一起散步等社区活动与认知障碍呈负相关。结论:社会网络特征和社区参与与社区居住老年人的认知功能有关。

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引用次数: 10

Psychometric Properties of the Czech Version of the Falls Efficacy Scale-International in Patients with Early-Stage Dementia 国际瀑布疗效量表捷克版对早期痴呆患者的心理测量特性

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-08-29 DOI: 10.1159/000501676

Helena Kisvetrová, D. Školoudík, R. Herzig, K. Langová, Petra Kurková, J. Tomanová, Yukari Yamada

Introduction: A fear of falling marks an important psychological factor connected with a reduction in the life space of people with dementia. The Czech version of the Falls Efficacy Scale-International (FES-I) has not been validated in patients with early-stage dementia. Methods: The tests were administered to 282 patients with early-stage dementia. The test battery included the following: the FES-I, the Short Physical Performance Battery, the Geriatric Depression Scale, the Bristol Activity Daily Living Scale, and the Quality of Life-Alzheimer’s Disease Scale. Internal reliability (Cronbach’s α and intraclass correlation [ICC]), Pearson’s and Spearman’s correlations, exploratory factor analysis, and a t test for independent samples were used for statistical analyses. Results: The Czech version of the FES-I had excellent internal and test-retest reliability (Cronbach’s α = 0.98, ICC = 0.90; 95% CI 0.82–0.94). Factor analysis suggested 2 relevant factors. A significantly higher FES-I score was associated with patients with early-stage dementia who were older (p = 0.003) or female (p = 0.001), lived alone (p = 0.0001), spent >8 h a day alone (p = 0.032), used mobility aids (p < 0.0001), or had severe hearing (p = 0.004) or vision impairment (p < 0.0001) or a lower education (r = –0.16, p = 0.007). Conclusion: The Czech version of the FES-I had very good reliability and validity and may be useful in future cross-cultural comparisons in research among patients with early-stage dementia.

引言：对跌倒的恐惧是一个重要的心理因素，与痴呆症患者生活空间的减少有关。捷克版的国际瀑布疗效量表（FES-I）尚未在早期痴呆患者中得到验证。方法：对282例早期痴呆患者进行测试。测试组包括以下内容：FES-I、短期体能测试组、老年抑郁症量表、布里斯托尔日常生活活动量表和阿尔茨海默病生活质量量表。内部可靠性（Cronbachα和组内相关性[ICC]）、Pearson和Spearman相关性、探索性因素分析和独立样本的t检验用于统计分析。结果：捷克版FES-I具有良好的内部和重测可靠性（Cronbachα=0.98，ICC=0.90；95%CI 0.82–0.94）。因子分析表明有2个相关因素。早期痴呆患者年龄较大（p=0.003）或女性（p=0.001）、独自生活（p=0.0001）、每天独自生活时间>8小时（p=0.032）、使用助行器（p<0.0001）、，或有严重听力（p=0.004）或视力障碍（p<0.0001）或受教育程度较低（r=-0.16，p=0.007）。结论：捷克版本的FES-I具有很好的可靠性和有效性，可能有助于未来对早期痴呆患者进行跨文化比较研究。

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引用次数: 7

Efficacy, Safety, and Tolerability of Switching from Oral Cholinesterase Inhibitors to Rivastigmine Transdermal Patch with 1-Step Titration in Patients with Mild to Moderate Alzheimer's Disease: A 24-Week, Open-Label, Multicenter Study in Japan 轻度至中度阿尔茨海默病患者从口服胆碱酯酶抑制剂转为利匹的明透皮贴剂1步滴定的疗效、安全性和耐受性：一项在日本进行的24周开放标签多中心研究

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-08-15 DOI: 10.1159/000501364

Kengo Ueda, S. Katayama, T. Arai, Nobuo Furuta, S. Ikebe, Y. Ishida, K. Kanaya, S. Ouma, H. Sakurai, M. Sugitani, Makio Takahashi, Toshihisa Tanaka, N. Tsuno, Y. Wakutani, Ankita Shekhawat, Ayan Das Gupta, Kazuki Kiyose, Kazuhiro Toriyama, Yu Nakamura

Background: Few studies have investigated treatment options for patients with Alzheimer’s disease (AD) showing a poor response to oral cholinesterase inhibitors (ChEIs) in Japan. Objective: To investigate the efficacy and safety of switching from oral ChEIs to rivastigmine transdermal patch in patients with AD. Methods: In this multicenter, open-label, phase IV study in outpatient clinics in Japan, patients with mild-moderate AD who had a poor response to or experienced difficulty in continuing donepezil or galantamine were switched to rivastigmine transdermal patch (5 cm2; loaded dose 9 mg, delivery rate 4.6 mg/24 h) with a 1-step titration in week 4 (10 cm2; loaded dose 18 mg, delivery rate 9.5 mg/24 h), which was continued for 4 weeks in the titration period and 16 weeks in a maintenance period. The primary endpoint was the change in Mini-Mental State Examination (MMSE) total score from baseline to week 24. Results: A total of 118 patients were enrolled and switched to rivastigmine, of which 102 completed the 24-week study. The MMSE total score was essentially unchanged during the study, with a least-square mean change (SD) of −0.35 (2.64) at week 24 (p = 0.1750). Exploratory analysis with a mixed-effect model comparing changes in MMSE between the pre- and post-switch periods suggested that switching to rivastigmine prevented a worsening of MMSE. Application site skin reactions/irritations occurred in 30.5% of patients overall, in 22.0% in the 8-week titration period, and in 10.2% in the 16-week maintenance period. Conclusion: Within-class switching from an oral ChEI to rivastigmine transdermal patch might be an efficacious and tolerable option for AD patients showing a poor or limited response to a prior oral ChEI.

背景：在日本，很少有研究调查阿尔茨海默病（AD）患者对口服胆碱酯酶抑制剂（ChEIs）反应不佳的治疗方案。目的：研究AD患者从口服ChEIs转为利瓦斯汀透皮贴剂的疗效和安全性。方法：在日本门诊进行的这项多中心、开放标签的IV期研究中，对多奈哌齐或加兰他敏反应不佳或难以继续使用的轻度-中度AD患者在第4周通过一步滴定（10 cm2；负荷剂量18 mg，给药率9.5 mg/24 h）改用利瓦斯汀透皮贴剂（5 cm2；负荷量9 mg，给药剂量4.6 mg/24小时），其在滴定期中持续4周，在维持期中持续16周。主要终点是从基线到第24周的简易精神状态检查（MMSE）总分的变化。结果：共有118名患者入组并改用利瓦斯汀，其中102人完成了为期24周的研究。在研究期间，MMSE总分基本上没有变化，在第24周时，最小均方变化（SD）为-0.35（2.64）（p=0.1750）。通过比较切换前后MMSE变化的混合效应模型进行的探索性分析表明，改用利伐他明可防止MMSE恶化。用药部位皮肤反应/刺激发生在30.5%的患者中，22.0%发生在8周滴定期，10.2%发生在16周维持期。结论：对于对先前口服ChEI反应不佳或有限的AD患者，从口服ChEI到利瓦斯汀透皮贴剂的类内转换可能是一种有效且可耐受的选择。

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引用次数: 6

Accuracy of the Cognitive Assessment Battery in a Primary Care Population 初级保健人群认知评估的准确性

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-08-14 DOI: 10.1159/000501365

A. S. Kvitting, Maria M. Johansson, J. Marcusson

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. Objective: To investigate the accuracy of the CAB in a primary care population. Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes (“no cognitive impairment” or “cognitive impairment”). Results: The “cognitive impairment” group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849. Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

背景:在初级保健中有几种认知评估工具，如简易精神状态检查(MMSE)和蒙特利尔认知评估。认知评估电池(CAB)被引入作为一种敏感的工具来检测初级保健的认知能力下降。然而，缺乏初级保健验证。因此，我们在初级保健人群中调查了CAB的准确性。目的:探讨初级保健人群CAB的准确性。方法:对46例认知障碍患者和33例因躯体非认知症状就诊的初级保健患者的资料进行分析。他们接受了MMSE、CAB和一系列神经心理学测试的调查;他们还接受了老年专家的咨询。使用c-statistics评估CAB的准确性，并使用受试者工作特征曲线下面积(AUC)量化二元结果(“无认知障碍”或“认知障碍”)。结果:认知障碍组与非认知障碍组在CAB各子测试上均有显著性差异。当精度基于CAB的一个或几个域的二进制显著降低或不显著降低时，AUC在0.685和0.772之间变化。然而，当对几个子类别进行求和或逻辑回归时，使用每个子类别的数值，AUC为>0.9。相比之下，MMSE的AUC为0.849。结论:在初级保健人群中，当使用二元截止时，CAB的准确性从差到好。当使用子类别的数值数据的总和或逻辑回归时，精度可以提高到很高。考虑到CAB的时间，缺乏足够的年龄规范，以及MMSE的良好准确性，根据本研究的结果，目前不建议在初级保健中实施CAB。

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引用次数: 2

Responding to Varying Levels of Certainty about Pain in People with Dementia after Initial Pain Assessment 痴呆症患者初始疼痛评估后对不同程度疼痛确定性的反应

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-08-13 DOI: 10.1159/000501030

Mohammad J Rababa, M. Aldalaykeh

Introduction: Pain is still inadequately treated in people with dementia (PWD) due to the complexity of assessing it. Pain assessment in PWD is still challenging because of patient-related or nurse-related factors. The patient-related factors have been studied extensively. However, the nurse-related factors, e.g., nurses’ certainty regarding suspected pain in PWD, have been given little attention by researchers. Purpose: This study aims to investigate how the degree of nurses’ certainty is compromised after pain assessment and how this affects levels of pain and agitation in PWD. Method: A descriptive, correlational design was used, and a convenience sample of 104 nursing home residents with dementia were recruited. Results: This study found that nurses’ certainty after the pain assessment mediates the relationship between the type of pain assessment and patient outcomes when the nurses had a high initial certainty. When nurses had a low initial certainty, their certainty after the assessment and the type of assessment predicted the levels of pain and agitation in PWD. Conclusion: Understanding how nurses’ certainty can be compromising after pain assessment and how this relates to pain management in PWD is crucial.

引言：由于评估的复杂性，痴呆症患者的疼痛仍然没有得到充分的治疗。由于患者或护士相关的因素，痴呆症的疼痛评估仍然具有挑战性。与患者相关的因素已被广泛研究。然而，与护士相关的因素，例如护士对PWD疑似疼痛的确定性，很少受到研究人员的关注。目的：本研究旨在调查疼痛评估后护士的确定度是如何受到影响的，以及这如何影响PWD的疼痛和激动程度。方法：采用描述性相关设计，以104名痴呆症疗养院居民为方便样本。结果：本研究发现，当护士具有较高的初始确定性时，护士在疼痛评估后的确定性介导了疼痛评估类型与患者结果之间的关系。当护士最初的确定性较低时，他们在评估后的确定性和评估类型预测了PWD的疼痛和激动程度。结论：了解护士在疼痛评估后的确定性是如何受损的，以及这与PWD疼痛管理的关系至关重要。

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引用次数: 6

Association between Chronic Obstructive Pulmonary Disease and Dementia: Systematic Review and Meta-Analysis of Cohort Studies 慢性阻塞性肺疾病与痴呆的关系:队列研究的系统回顾和荟萃分析

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-07-11 DOI: 10.1159/000496475

Ying Wang, Xiaotong Li, Biying Wei, T. Tung, P. Tao, Ching-Wen Chien

Background: Chronic obstructive pulmonary disease (COPD) is a common disease among the elderly, which has been linked to cognitive decline. However, the relationship between COPD and dementia remains unclear. Summary: We conducted a systematic literature review by searching databases such as Pubmed, Embase, EBSCO, and Cochrane Library (from inception to April 18, 2018) for studies on COPD that also investigated the prevalence of dementia. We found 3 cohort studies including a total of 39,392 COPD patients. Then we applied the Newcastle-Ottawa Scale to evaluate the risk of bias. Key Messages: COPD patients faced a higher risk of dementia (HR 1.46; 95% CI 1.22–1.75; p < 0.001). Subgroup analysis on gender determined that the association between COPD and dementia was stronger in male patients (HR 1.49, 95% CI 1.20–1.86, p < 0.001) than in female patients (HR 1.41, 95% CI 1.27–1.57, p < 0.001). A subset study of patients aged >65 years revealed that the HR was greater for patients aged ≥75 years (HR 1.46, 95% CI 1.07–2.00, p = 0.02) than for those aged 65–74 years (HR 1.40, 95% CI 1.28–1.53, p < 0.001). The cohort studies included were from similar population-based databases, suggesting possible regional limitations and publication bias.

背景:慢性阻塞性肺疾病(COPD)是老年人的常见病，与认知能力下降有关。然而，COPD与痴呆之间的关系尚不清楚。摘要:我们通过检索Pubmed、Embase、EBSCO和Cochrane图书馆等数据库(从成立到2018年4月18日)进行了系统的文献综述，以寻找COPD的研究，并调查痴呆的患病率。我们发现了3项队列研究，共包括39,392名COPD患者。然后我们应用纽卡斯尔-渥太华量表来评估偏倚风险。关键信息:COPD患者面临更高的痴呆风险(HR 1.46;95% ci 1.22-1.75;P < 0.001)。性别亚组分析表明，男性患者COPD与痴呆之间的相关性(HR 1.49, 95% CI 1.20-1.86, p < 0.001)强于女性患者(HR 1.41, 95% CI 1.27-1.57, p < 0.001)。一项针对bb0 ~ 65岁患者的亚组研究显示，≥75岁患者的HR (HR 1.46, 95% CI 1.07 ~ 2.00, p = 0.02)高于65 ~ 74岁患者(HR 1.40, 95% CI 1.28 ~ 1.53, p < 0.001)。纳入的队列研究来自相似的基于人群的数据库，提示可能存在区域局限性和发表偏倚。

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引用次数: 19

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department. 急诊科老年患者虚弱和谵妄的关系。

IF 2.3 Q4 CLINICAL NEUROLOGY

Dementia and Geriatric Cognitive Disorders Extra

Pub Date : 2019-06-21 eCollection Date: 2019-05-01 DOI: 10.1159/000499707

Sandra Choutko-Joaquim, Nadine Tacchini-Jacquier, Géraldine Pralong D'Alessio, Henk Verloo

Background: Switzerland's demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium.

Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland.

Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants' cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant's most significant informal caregiver.

Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference.

Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

背景：瑞士的人口趋势显示，与地球上其他地方一样，老年人和高龄老人的数量在增加。这表明，其医疗保健系统将受到严重影响，包括在护理使用方面，尤其是在紧急服务使用方面。大量老年人将有患多种慢性疾病的风险，包括一种或多种老年综合征，如虚弱和谵妄。迄今为止，很少有研究记录虚弱和谵妄之间的联系。目的：探讨在瑞士急诊科咨询的老年患者（n=114）的虚弱和谵妄之间的关系。方法：在瑞士法语区的一家外围医院急诊科进行横断面研究。使用Tilburg脆弱性指标（TFI）评估脆弱性。使用混淆评估方法（CAM）对谵妄进行评估。参与者的认知状态使用6项认知障碍测试（6CIT）和老年人认知能力下降告知问卷（IQ-CODE）进行评估，该问卷由参与者最重要的非正式照顾者完成。结果：参与者的平均年龄为77.6岁（SD=7.7）；大多数受试者是女性（54%）。参与者平均每天服用4.7种不同的药物（SD=3.2，中位数=4）。超过一半（62%）的参与者身体虚弱；2和14%分别出现谵妄和亚综合征性谵妄的体征和症状。虚弱和谵妄评分之间存在微弱但显著的相关性（p<0.05），临床观察证实了这一点。ED中谵妄的4小时随访测量显示没有显著或临床差异。结论：尽管文献描述了在外科手术室和社区护理环境中虚弱和谵妄之间的强烈关联，但本研究仅证明了在我们的ED中虚弱与谵妄之间存在弱至中度关联。

{"title":"Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department.","authors":"Sandra Choutko-Joaquim, Nadine Tacchini-Jacquier, Géraldine Pralong D'Alessio, Henk Verloo","doi":"10.1159/000499707","DOIUrl":"10.1159/000499707","url":null,"abstract":"Background: Switzerland's demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium.Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland.Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants' cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant's most significant informal caregiver.Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference.Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.","PeriodicalId":38017,"journal":{"name":"Dementia and Geriatric Cognitive Disorders Extra","volume":"9 2","pages":"236-249"},"PeriodicalIF":2.3,"publicationDate":"2019-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000499707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37420242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9