急性期脳血管障害患者における嚥下障害の予後予測

Purpose: Stroke is a major etiological factor in dysphagia. The purpose of this study was to investigate the factors affecting difficulty of oral intake in patients with acute cerebrovascular disorder. Subjects: We recruited the stroke patients with suspected stroke-related dysphagia who were referred to speech, language, and hearing therapists at the emergency hospital for a swallowing examination between March 2009 and March 2010. Method: Multivariate analyses were performed to identify variables significantly associated with thepossibility of oral intake. Results: The mean age of the patients was 76.8 (SD12.7) years. A total of 158 patients suffered from ischemic stroke while 56 suffered from hemorrhagic stroke. At the point of discharge from the hospital, 107 patients (50.0%) resumed a regular diet. Logistic regression analysis identified 12 factors that significantly predicted the resumption of normal oral intakes. Conclusions: Normal or slight disturbance of consciousness (Japan Coma Scale: 0 or I-1), a food test profile score of 4 or above, normal swallowing sound on cervical auscultation, and a score > 0 on the Barthel Index were predictors of oral intake in patients with acute stage of cerebrovascular disorder

Are saving appearance responses typical communication patterns in Alzheimer's disease?

INTRODUCTION:To keep up appearances, people with dementia sometimes pretend to know the correct answer, as seen during administration of neuropsychological tests such as the Mini-Mental State Examination (MMSE). These saving appearance responses (SARs) of people with dementia often lead to caregivers and/or medical staff underestimating the severity of dementia and impede proper early initiation of treatment. However, most descriptions of SARs are based on empirical knowledge of clinicians. In this study, we investigated whether SARs are typical communication patterns in people with Alzheimer's disease (AD), compared with mild cognitive impairment (MCI) or dementia with Lewy bodies (DLB). METHODS:The participants were 107 outpatients with AD, 16 with mixed AD with cerebrovascular dementia, 55 with MCI, and 30 with DLB. We assessed the occurrence of SARs during the MMSE. The relationships between the SARs and AD were examined by the χ2 test and logistic regression analysis. RESULTS:People with AD who showed SARs were 57.9%, whereas those with MCI were 18.2% and DLB were 20.0% (P with Bonferroni correction < 0.05). Although there were significant differences in some variables in each group of diagnosis, logistic regression analysis showed that people with AD were more likely to show SARs than those with MCI (Odds ratio = 3.48, 95% Confidential Interval = 1.18-10.28) and DLB (Odds ratio = 4.24, 95% Confidential Interval = 1.50-12.01), even after controlling for sex, estimated disease duration, MMSE, and frontal assessment battery scores. CONCLUSION:The occurrence of SARs could be found most frequently in people with AD. Clinicians should develop a respectful attitude toward dementia patients with SARs because SARs imply conflicted feelings about questions that patients cannot answer correctly

Results of logistic regression analysis for the relationship between saving appearance responses and AD in people with AD and MCI.

<p>Results of logistic regression analysis for the relationship between saving appearance responses and AD in people with AD and MCI.</p

The percentages of people who had the saving appearance responses (SARs).

<p>MCI: mild cognitive impairment; AD: Alzheimer’s disease; DLB: dementia with Lewy bodies; *: <i>P</i> < 0.05 with Bonfferoni correction.</p

Results of logistic regression analysis for the relationship between saving appearance responses and AD in people with AD and DLB.

<p>Results of logistic regression analysis for the relationship between saving appearance responses and AD in people with AD and DLB.</p

Demographics of participants.

<p>Demographics of participants.</p