痴呆患者淡漠症状相关研究进展

从淡漠的起源及概述、痴呆患者淡漠症状的发生情况及不良影响、测评工具和干预措施等方面进行综述,以期提高医护人员及照顾者对痴呆患者淡漠症状的重视,并为临床实践和研究提供参考.     

痴呆患者淡漠症状评估工具的研究进展

阐述国内外痴呆患者淡漠症状评估工具,重点介绍普适性和特异性痴呆患者淡漠症状评估工具,并分析其优缺点,指出部分评估工具的信效度及适用性仍有待验证.建议根据现有评估工具,汉化或开发我国本土化痴呆患者淡漠症状评估工具,促进淡漠症状的早期筛查与识别,预防患者病情恶化,为后续相关研究及构建针对性干预措施提供参考.     

基于实证的团体干预对社区养老院老年人满意度的影响

目的 了解社区养老院老年人满意度现况,并探讨针对性团体干预对社区养老院老年人满意度的影响。方法 将58名社区养老院老年人按照楼层分为观察组和对照组,采用汉化版养老院入住老年人满意度问卷进行调查,对照组给予院内常规服务,观察组在此基础上根据满意度调查结果实施每周3次的团体活动。比较干预前后两组老年人满意度评分。结果 社区养老院老年人满意度评分为(127.02±18.66)分;干预后观察组活动、照顾者、幸福感、餐饮维度及满意度总分显著高于对照组(均P<0.05)。结论 养老院老年人满意度处于中等水平,基于调查结果实施团体干预能有效提升老年人满意度。     

手球训练对养老院老年人认知功能的影响

目的探讨手球训练对养老院老年人认知功能的影响。方法将入选的60名养老院老年人随机分为训练组和对照组各30人。对照组维持原有的生活娱乐方式,如打扑克等,不进行干预;训练组在课题组人员的带领下进行手球训练,每周5d,每天30min,持续6个月。干预前后对两组分别进行基本认知能力测验。结果干预后训练组在数字拷贝、汉字比较反应时间及汉字旋转、心算答案广度、双字词再认、无意义图形再认方面评分显著优于对照组(均P<0.01)。结论手球训练可以在一定程度上改善养老院老年人的认知功能。     

痴呆患者淡漠症状测量工具及非药物干预的研究进展

对痴呆患者淡漠症状的概念、诊断、特异性测量工具(包括痴呆症淡漠面谈和评定量袁、里尔淡漠评定量表)及非药物干预方法(包括多感觉刺激、音乐治疗、艺术治疗、认知刺激、宠物治疗和综合干预)进行综述,旨在为制订合适的痴呆患者淡漠症状治疗及护理方案提供参考,为临床实践提供理论依据.     

老年痴呆患者基于精神运动康复学理论的干预

目的探讨基于精神运动康复学理论的干预对老年痴呆患者认知、生活自理能力及抑郁的影响。方法将44例老年痴呆患者按时间段分为观察组21例和对照组23例,两组患者均接受常规护理,观察组在此基础上进行为期24周的基于精神运动康复学理论的干预,包括多元运动计划、多感官刺激疗法、改善生理障碍和改善心理障碍4个方面。分别在干预前、干预后采用简易智能状态量表(MMSE)、Barthel指数和康奈尔痴呆抑郁量表(CSDD)进行效果评价。结果干预后,观察组MMSE的记忆力、回忆能力、语言及视空间能力得分和Barthel指数得分显著高于对照组,抑郁得分显著低于对照组(P<0.05,P<0.01)。结论基于精神运动康复学理论的干预有助于改善老年痴呆患者部分认知功能和日常生活活动能力,减轻抑郁症状。     

回忆疗法对养老机构老年人抑郁情绪的影响

目的 探讨回忆疗法改善养老机构老年人抑郁情绪的效果.方法 用老年抑郁量表(GDS)筛选出符合研究要求的老年人74人,随机分成对照组(38人)和干预组(36人).对照组正常生活,干预组在此基础上进行为期6周的回忆性心理干预,分别在干预前及干预6周后测评老年人抑郁状态,并进行对比分析.结果 干预后干预组GDS评分显著低于本组干预前及对照组干预后(均P＜0.01).结论 回忆疗法有助于缓解养老机构老年人的抑郁情绪,提高老年人对环境的适应能力.     

个体认知刺激疗法对痴呆患者心理健康干预效果的系统评价

目的 系统评价个体认知刺激疗法对痴呆患者心理健康的干预效果.方法 按照循证医学的原则和方法,计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Embase、CINAHL、Web of Science、Cochrane Library和APA PsycNet数据库,查找关于个体认知刺激疗法对痴呆患者心理健康干预效果的随机对照试验,检索时限自建库至2021年4月.由2名研究人员按照纳入和排除标准独立文献筛选、资料提取和质量评价,采用RevMan5.3软件对纳入的数据进行分析.结果 共纳入8篇RCT研究,共1324例研究对象.Meta分析结果显示,与对照组相比,个体认知刺激能够减轻痴呆患者精神行为症状(P＜0.01).亚组分析显示,与家庭照顾者实施3～6个月的个体认知刺激相比较,专业照顾者实施3个月以内的个体认知刺激对痴呆患者精神行为症状的改善更显著(P＜0.01).结论 由专业照顾者实施的个体认知刺激较家庭照顾者更能有效缓解痴呆患者的精神行为症状.     

回忆疗法对养老机构老年人抑郁情绪的影响

目的探讨回忆疗法改善养老机构老年人抑郁情绪的效果。方法用老年抑郁量表（GDS）筛选出符合研究要求的老年人74人,随机分成对照组（38人）和干预组（36人）。对照组正常生活,干预组在此基础上进行为期6周的回忆性心理干预,分别在干预前及干预6周后测评老年人抑郁状态,并进行对比分析。结果干预后干预组GDS评分显著低于本组干预前及对照组干预后（均P〈0.01）。结论回忆疗法有助于缓解养老机构老年人的抑郁情绪,提高老年人对环境的适应能力。     

社区老年人认知功能与抑郁水平的相关性研究

目的了解社区老年人认知功能与抑郁水平的关系,为制定针对性的干预措施提供参考。方法采用简易智能状态检查表(MMSE)、汉密尔顿抑郁量表(HAMD)对武汉市13个社区的628名老年人进行调查。结果社区老年人MMSE总均分为(26.41±3.89),9.24%有认知功能下降,不同年龄、婚姻状态、文化程度、兴趣爱好者认知功能下降发生率不同,有无抑郁症状的老年人定向力维度及MMSE总分差异有统计学意义(均P0.05);HAMD总均分为3.00(1.00,6.00),17.52%有抑郁症状,不同性别、文化程度、记忆力状态、兴趣爱好者抑郁症状发生率不同,MMSE是否下降的老年人认知障碍及迟缓维度得分差异有统计学意义(P0.05,P0.01)。相关性分析显示,MMSE总分与HAMD总分及认知障碍、睡眠障碍、迟缓、绝望感维度呈负相关(P0.05,P0.01)。结论武汉社区认知功能下降和有抑郁症状的老年人占一定比例,且认知功能下降者更容易出现抑郁症状。需积极采取措施预防老年人认知功能下降,改善抑郁情绪,促进健康老龄化。     

Comparison of nursing home residents with and without traumatic brain injury: use of the Minimum Data Set

OBJECTIVE: To describe the magnitude of the population with traumatic brain injury (TBI) in Colorado living in nursing homes and compare these residents to the nursing home residents with neither TBI nor dementia. METHODS: The standardized Minimum Data Set of resident assessments was used to describe the behavior, cognitive performance, activities of daily living, and discharge potential of residents. RESULTS: There were 16,478 nursing home residents in 2005, of whom 1.4% had TBI but not dementia, 0.7% had both TBI and dementia, and 50.2% had neither diagnosis. The prevalence of TBI in this population was 2.1%. TBI residents without dementia were younger (median age 53 years). A larger proportion consisted of men (64%), from a racial/ethnic minority (24%), and needed greater assistance with eating, toileting, and hygiene. The percent with severe cognitive impairment was greater for individuals with TBI (22%) compared to those with neither TBI nor dementia (5%). Fewer TBI residents expressed a preference to return to the community. CONCLUSION: These differences suggest the need for increased training and staffing to care for nursing home residents with TBI.     

Treatment of Apathy in Huntington’s Disease and Other Movement Disorders

Apathy is one of the most prevalent neurobehavioral symptoms in Huntington’s disease (HD), occurring in approximately 70% of the symptomatic HD population. Apathy scores in patients with HD are highly correlated with duration of illness, suggesting that apathy is an inevitable consequence of advanced disease. Although less distressing than symptoms like depression and less disruptive than irritability or aggression, apathy has a considerable adverse impact on those affected with HD because it leads to a decrease of the goal-directed behaviors that contribute much to the day-to-day quality of life. As a neuropsychiatric syndrome, apathy is also common in patients with other neuropsychiatric disorders such as Parkinson’s disease, traumatic brain injury, cerebrovascular accident, dementia, and other neurodegenerative conditions. The nosologic status of apathy and lack of a clear definition has probably contributed to the paucity of therapeutic evidence in this area. Several different scales are available to measure apathy, including the Apathy Evaluation Scale, Apathy Inventory, Lilles Apathy Rating Scale, and the apathy items from the Unified HD Rating Scale, the Problem Behaviours Assessment for HD, and the Neuropsychiatric Inventory, but all are based on slightly different definitions of apathy, so the scores obtained may not be directly comparable. Assessment may also be complicated by overlap between the manifestations of apathy and other complications of HD such as depression, so the identification and treatment of these comorbid conditions is important. No adequate evidence currently supports any specific pharmacologic or psychological intervention for apathy in HD. Evidence can only be extrapolated from interventional studies done in other basal ganglia disorders such as Parkinson’s disease or other neurodegenerative disorders such as dementia. The neurobiology of apathy points towards three areas of functional connectivity: connections between the dorsolateral prefrontal cortex (PFC) and basal ganglia, orbitomedial PFC and basal ganglia, and dorsomedial PFC and basal ganglia. Pharmacologic interventions such as cholinesterase inhibitors, the dopaminergic antidepressant bupropion, amantadine, levodopa, bromocriptine, methylphenidate, and atypical antipsychotics have all been tried in other neurodegenerative disorders, but not in HD. Psychosocial interventions such as cognitive stimulation therapy and multisensory stimulation, which have been used in patients with dementia, have not been properly studied in HD. Individualized treatment should be considered, using a combination of methods, as there is no evidence to support one particular type of treatment. Multidisciplinary input, environmental modifications, improved psychosocial support, and psychoeducation programs designed to help caregivers to understand and compensate for the deficits caused by this symptom may all have a role to play in the treatment of apathy.     

Six‐month mortality risks in long‐term care residents with chronic ulcers

Chronic ulcers are a common problem in long‐term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6‐month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six‐month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6‐month mortality with an odds ratio of 1·32 (95% CI 1·07–1·63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1·75. Higher haemoglobin and venous insufficiency were protective of 6‐month mortality. Ulcer number is an important predictor for 6‐month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.     

社会支持干预改善2型糖尿病患者抑郁状况

目的探讨社会支持干预对2型糖尿病合并抑郁患者抑郁状况的影响。方法将93例合并轻中度抑郁症状的社区2型糖尿病患者随机分为对照组46例和干预组47例。对照组给予常规糖尿病药物治疗和社区护理,干预组在对照组的基础上接受社会支持干预,包括成立糖友之家,进行社会支持相关讲座,鼓励家属参与,鼓励患者向朋友倾诉等。在干预前、干预4周末、8周末和12周末分别用抑郁自评量表(SDS)进行测量。结果两组SDS得分比较,组间效应、时间效应、交互效应均存在统计学意义(均P0.01)。结论社会支持干预可有效改善2型糖尿病合并抑郁患者的抑郁状况。     

Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

Summary   

This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings.     

Poststroke neuropsychiatric illness: An integrated approach to diagnosis and management

Opinion statement Patients who have had stroke are at significant risk for various neuropsychiatric illnesses. The most common and important of these are poststroke depression and poststroke dementia (attributable to vascular dementia, Alzheimer’s dementia, or a combination of mechanisms). Poststroke neuropathology may lead some patients to experience concurrent and ‘overlapping’ mood and cognitive symptoms. Less frequently, poststroke anxiety disorders, psychosis, isolated pathologic expressions of emotions, and apathy or fatigue may be encountered. The authors review the current literature on poststroke neuropsychiatry and offer an integrated approach to pathophysiologic concepts and clinical surveillance, screening, diagnosis, and evidencebased pharmacologic and nonpharmacologic intervention for these clinical problems on the clinical boundary between neurology and psychiatry.     

Predicting nursing-home resident responsiveness to a urinary incontinence treatment protocol

Urinary incontinence in nursing homes is a health problem that costs close to $2 billion annually. Prompted voiding is a validated procedure to treat urinary incontinence in this setting. Past research has found this technique to be effective in approximately one-third of incontinent nursing home residents. Nursing staff can only maintain the prompted voiding procedure with these responsive residents; it is therefore necessary to separate those who will be responsive from those who will not. The purpose of this paper is to identify resident variables that discriminate between these two groups. The identification of such variables may suggest supplementary treatment for nursing home residents who do not respond to prompted voiding alone. Data from 155 residents from seven separate nursing homes were analyzed. Prompted voiding was implemented by the research team, and the residents were separated into responsive and unresponsive groups based on the level of continence attained during a 6-day treatment period. A stepwise multiple regression analysis was performed, and the following variables were found to be most predictive of responsiveness: the resident's maximum voided urine volume, length of residency in the nursing home, baseline frequency of voiding, age and mental status score. Less responsive residents had smaller maximum voided urine volumes, a longer length of residency, and a larger postvoid residual. These variables may be useful in assisting NH staff in designing an effective and efficient strategy to manage urinary incontinence.     

The link between tissue oxygen and hydration in nursing home residents with pressure ulcers: preliminary data.

Pressure ulcers are prevalent in nursing home residents. They heal slowly and result in pain and impaired quality of life. Strategies to enhance healing of pressure ulcers are critical to the treatment regime in nursing homes. This article explores the possibility that nursing home residents with pressure ulcers may experience low tissue oxygen and impaired hydration. Pilot data are presented suggesting that some proportion of nursing home residents with pressure ulcers experience low subcutaneous oxygen and that fluid administration increases the low tissue oxygen. Further research in this area is warranted.