CAJ | 학술논문

目的分析痴呆、抑郁、谵妄两者(2D)或三者(3D)重叠的临床特点及预后,提高知晓率. 方法回顾性分析北京协和医院2010年1月至2014年11月收治并随访的16例2D或3D老年患者,并复习相关文献讨论. 结果 2D及3D重叠分别占同期诊断痴呆和诊断抑郁老年患者的10％和3％.16例患者中,女性11例,男性5例,中位年龄82岁,平均年龄(80±6)岁.痴呆重叠抑郁7例、重叠谵妄6例,3D重叠2例,抑郁重叠谵妄1例.16例患者的Charlson共病指数(3.0±1.5);合并老年综合征(4.0±1.6)种,常见为跌倒(62％)、睡眠障碍(56％)、衰弱(50％)、多重用药(43％)及营养不良(37％).其中14例(88％)患者入院时存在部分失能.发生谵妄9例(56％),兴奋型谵妄7例,淡漠型2例.有6例患者为谵妄发生后才被发现患有痴呆.16例患者在住院期间均接受了相应干预.平均随访期(15±13)个月,失访2例.完成随访的患者中,日常生活活动量表(ADL)及工具性日常生活活动量表(IADL)下降≥1分的患者分别占62％,43％的患者认知功能进一步下降,简易精神状态量表(MMSE)评分下降≥3分;2例进入长期照料机构,1例死亡;出院后1年内再住院率为50％. 结论老年人3D重叠国内罕有报告,合并共病及老年综合征多,影响功能状态,再住院率高.有必要进行老年医学多学科团队干预.应注意对发生谵妄的老年患者随访,进行痴呆筛查.
목적 분석치태、억욱、섬망량자(2D)혹삼자(3D)중첩적림상특점급예후,제고지효솔. 방법 회고성분석북경협화의원2010년1월지2014년11월수치병수방적16례2D혹3D노년환자,병복습상관문헌토론. 결과 2D급3D중첩분별점동기진단치태화진단억욱노년환자적10％화3％.16례환자중,녀성11례,남성5례,중위년령82세,평균년령(80±6)세.치태중첩억욱7례、중첩섬망6례,3D중첩2례,억욱중첩섬망1례.16례환자적Charlson공병지수(3.0±1.5);합병노년종합정(4.0±1.6)충,상견위질도(62％)、수면장애(56％)、쇠약(50％)、다중용약(43％)급영양불량(37％).기중14례(88％)환자입원시존재부분실능.발생섬망9례(56％),흥강형섬망7례,담막형2례.유6례환자위섬망발생후재피발현환유치태.16례환자재주원기간균접수료상응간예.평균수방기(15±13)개월,실방2례.완성수방적환자중,일상생활활동량표(ADL)급공구성일상생활활동량표(IADL)하강≥1분적환자분별점62％,43％적환자인지공능진일보하강,간역정신상태량표(MMSE)평분하강≥3분;2례진입장기조료궤구,1례사망;출원후1년내재주원솔위50％. 결론 노년인3D중첩국내한유보고,합병공병급노년종합정다,영향공능상태,재주원솔고.유필요진행노년의학다학과단대간예.응주의대발생섬망적노년환자수방,진행치태사사.
Objective To analyze the clinical characteristics and prognosis of the overlap syndrome of dementia,depression and delirium coexistence in two or three of them (the 2D's or 3D's) in elderly patients,in order to raise awareness.Methods Clinical data of 16 patients aged ＞65 years diagnosed with the 2D's or 3D's admitted to Peking Union Medical College Hospital from 2010 to 2014 were analyzed and relevant literatures were reviewed.Results Patients with the 2D's or 3D' s accounted for 10％ of the elderly demented patients and 3％ of the elderly depressive patients.16 patients [11 females and 5 males,median age 82 years and mean age (80±6) years] were enrolled,with 7 cases of dementia with depression,6 cases of delirium superimposed on dementia,2 cases of the 3D's,and 1 case of coexisting depression and incident delirium.The Charlson comorbidity index of the 16 patients was (3.0± 1.5).(4.0± 1.6) kinds of geriatric syndromes were found,and the most common were falls (62％),sleep disorders (56％),frailty (50％),polypharmacy (43 ％),and malnutrition (37％).Disability was identified in 14 (88％) patients on admission.Delirium was observed in 9 patients (56 ％),with 7 cases of hyperactive delirium and 2 cases of hypoactive delirium.Coexisting underlying dementia was identified after episodes of delirium in 6 cases.16 patients all received corresponding intervention during hospitalization period.During a mean follow-up period of (15±13) months,62 ％ of the patients had more impaired physical function (ADL score reduction≥ 1),and 43％ of the patients had more impaired cognitive function (MMSE score reduction≥3).Two patients were transferred to long-term care facilities and one patient died during follow-up.The readmission rate was 50％ within 1 year after discharge.Conclusions The domestic report of overlap syndrome of dementia,depression and delirium is rare.Patients with the coexistence of the 2D's or 3D's are more commonly combined with geriatric syndromes,which results in further cognitive and physical function impairment with a higher re-admission rate.We should pay attention to the follow-up in elderly patients with delirium for screening dementia.