Differences in self-awareness of functional deficits between amnestic single- and multidomain mild cognitive impairment

Introduction: Prior research examining self-awareness of deficits in those with mild cognitive impairment (MCI) has been inconsistent, suggesting that preservation of insight at this disease stage may be conditional on the domain(s) examined as well as individual characteristics. The current study is the first to examine differences in objective performance and self-awareness of difficulties between older adults with amnestic single- (MCI–ASD) and multidomain MCI (MCI–AMD) across six instrumental activities of daily living (IADLs).

Method: Seventy-five individuals (M_age = 73.9 years, range = 55–88 years; 56% female) with MCI–ASD (n = 30) and MCI–AMD (n = 45) were recruited primarily from a hospital-based memory disorders clinic. Participants were administered self-report and objective measures assessing six functional domains: financial management, driving, telephone use, nutrition evaluation, grocery shopping, and medication management. Self-awareness discrepancy scores were calculated for each of these IADLs, and participants were classified as either “overestimating ability” or “accurately/underestimating ability.”

Results: Individuals with MCI–AMD performed significantly worse on objective measures of financial management, driving, and nutrition evaluation than those with MCI–ASD. Across MCI subtypes, participants were most likely to lack awareness of their difficulties in nutrition evaluation (31%), financial management (25%), and driving (23%) domains. Individuals with MCI–AMD were significantly more likely than those with MCI–ASD to overestimate performance on driving and telephone use domains.

Conclusion: Individuals with MCI–AMD are more likely than those with MCI–ASD to have impairment in their everyday function and to lack awareness into their IADL difficulties. When possible, clinicians should obtain objective measures in combination with detailed informant reports of functional abilities in order to evaluate capacity to independently engage in various daily activities. Finally, level of self-awareness varies across IADL domains, providing further evidence that insight is not a unitary construct.     

阿替普酶治疗老年急性脑梗死的疗效研究

目的研究老年急性脑梗死患者应用阿替普酶治疗的临床疗效。方法92例老年急性脑梗死患者,随机分为实验组和对照组,各46例。对照组患者采用传统对症治疗,实验组患者在对照组基础上应用阿替普酶治疗。观察比较两组患者的治疗效果及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力评定量表评分(Barthel指数)。结果实验组总有效率97.8%高于对照组的78.3%,差异有统计学意义(P<0.05)。治疗后,实验组NIHSS评分(4.86±2.12)分低于对照组的(7.58±3.12)分,Barthel指数(53.32±13.85)分高于对照组的(42.45±13.01)分,差异有统计学意义(P<0.05)。结论老年急性脑梗死患者应用阿替普酶治疗,能有效提高治疗效果,明显改善患者的神经功能缺损情况和日常生活活动能力,值得被推广。     

高血压性脑卒中患者日常生活活动能力与生存质量的关系

目的探讨高血压性脑卒中患者日常生活活动能力与生存质量的关系。方法选取2016年6月至2018年10月在本院门诊或住院部就诊的原发性高血压合并脑卒中患者232例。收集患者人口学特征,使用Barthel指数评定量表评估患者的日常生活活动能力,使用简明健康状况调查表(SF-36)评估患者的生存质量。结果年龄<60岁的患者日常生活活动能力得分为(80.93±17.11),明显高于M60岁患者的(72.76±15.08),差异有统计学意义(P<0.05);不同受教育程度和月收入患者的日常生活活动能力和总体健康水平之间比较差异均有统计学意义(均P<0.05)。脑力劳动者和医保患者的日常生活活动能力和总体健康水平明显高于体力劳动者和自费患者,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,日常生活活动能力与总体健康、生理功能、情感功能、生理职能、躯体疼痛、精神健康及活力呈正相关(均P<0.05),与社会功能无明显相关性(P>0.05)。多元逐步回归分析显示,受教育程度、职业类型、医保类型、月收入是患者日常生活活动能力和总体健康水平的独立影响因素(均P<0.05)。结论髙血压性脑卒中患者日常生活活动能力和生存质量均偏低,应针对受教育程度、职业类型、医保类型及月收入不同的患者制订针对性干预措施。     

Prevalence of Spasticity in Nursing Home Residents

ObjectivesTo determine the prevalence, rate of underdiagnosis and undertreatment, and association with activities of daily living dependency of spasticity in a nursing home setting.DesignCross-sectional study.Setting and participantsThis study is an analysis of a deidentified data set generated by a prior quality improvement project at a 240-bed nursing home for residents receiving long-term care or skilled nursing care services.MethodsEach resident was examined by a movement disorders specialist neurologist to determine whether spasticity was present and, if so, the total number of spastic postures present in upper and lower limbs was recorded. Medical records, including the Minimum Data Set, were reviewed for neurologic diagnoses associated with spasticity, activities of daily living (ADL) dependency, and prior documentation of diagnosis and past or current treatments. Ordinary least squares linear regression models were used to evaluate the association between spasticity and ADL dependency.ResultsTwo hundred nine residents (154 women, 81.9 ± 10.9 years) were included in this analysis. Spasticity was present in 22% (45/209) of residents examined by the neurologist. Only 11% of residents (5/45) had a prior diagnosis of spasticity and were receiving treatment. Presence of spasticity was associated with greater ADL dependency (χ² = 51.72, P < .001), which was driven by lower limb spasticity (χ² = 14.56, P = .006).Conclusions and implicationsThese results suggest that spasticity (1) is common in nursing homes (1 of 5 residents), (2) is often not diagnosed or adequately treated, and (3) is associated with worse ADL dependency. Further research is needed to enhance the rates of diagnosis and treatment of spasticity in long-term care facilities.     

中国老年人体质对日常生活活动能力的影响

目的 了解中国老年人日常生活活动能力的受损情况,并探究身体素质与ADL之间的关系。方法 数据来源为2015年中国健康与养老全国追踪调查（CHARLS）,采用 χ²检验比较不同特征老年人日常生活活动能力受损率的差异,采用二分类logistic回归模型探讨身体素质与日常生活活动能力之间的关系。结果 297例（6.6%）老年人存在基本日常生活活动能力受损的情况,1 167例（26.0%）老年人存在工具性日常生活活动能力受损的情况。BMI、肌肉力量、平衡能力和活动能力都与老年人日常生活活动能力存在密切关系,而血压对日常生活活动能力的影响不显著。结论 身体素质与老年人日常生活活动能力的受损情况存在相关关系,BMI值过高或过低、肌肉力量较差、平衡能力和活动能力不佳的老年人发生日常生活活动能力受损的可能性高于身体素质较好的老年人。     

Moving beyond symptom management towards cancer rehabilitation for older adults: Answering the 5W's

Older adults with cancer are quickly becoming the largest group of cancer survivors. Chronological age is a poor predictor of cancer treatment outcomes and of the need for rehabilitation services. While newer symptom management systems and assessments are slowly becoming used in the clinic to improve communication between providers and survivors, such assessments are rarely used to trigger a referral to rehabilitation. Cancer rehabilitation for older adults with cancer has the potential to improve the quality of life and decrease disability caused by cancer and its treatments. One barrier to referral to cancer rehabilitation remains an understanding of what cancer rehabilitation is, and who, when, where, and why to refer to rehabilitation services. This report utilizes examples of three popular geriatric, distress and symptom measures to help answer these questions.