O'Donnell B F, Drachman D A, Barnes H J, Peterson K E, Swearer J M, Lew R A
Department of Neurology, University of Massachusetts Medical Center, Worcester.
J Geriatr Psychiatry Neurol. 1992 Jan-Mar;5(1):45-52. doi: 10.1177/002383099200500108.
Factors predicting the early institutionalization of demented patients were studied in 143 outpatients using univariate and multivariate life-table methods. Four types of factors were evaluated for prognostic value: severity of functional impairment, behavioral disorders, individual patient characteristics, and type of caregiver. After follow-up of 19 +/- 12 months, 51 patients had been institutionalized. Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization. The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence. Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization. Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia.
采用单变量和多变量生命表法，对143名门诊痴呆患者中预测早期住院的因素进行了研究。评估了四种类型的因素的预后价值：功能损害的严重程度、行为障碍、患者个体特征和照顾者类型。经过19±12个月的随访，51名患者已住院。痴呆症整体严重程度增加、存在麻烦和破坏性行为以及大小便失禁会增加住院的可能性。住院的最佳预测因素是偏执、攻击行为和大小便失禁。患者个体特征（年龄、教育程度和性别）以及照顾者与患者的关系（男性配偶、女性配偶以及男性或女性子女）均未影响住院情况。由于导致住院的麻烦行为障碍是痴呆症潜在可治疗的方面，因此对其管理应成为痴呆症治疗的主要重点。
