Bennett Hayley P, Piguet Olivier, Grayson David A, Creasey Helen, Waite Louise M, Lye Tanya, Corbett Alastair J, Hayes Michael, Broe G Anthony, Halliday Glenda M
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia.
J Am Geriatr Soc. 2006 Jan;54(1):3-10. doi: 10.1111/j.1532-5415.2005.00532.x.
To identify the clinical correlates of functional incapacity in the community living "old-old."
Cross-sectional.
Community-based.
One hundred six nondemented people aged 80 to 94.
Participants were medically and cognitively assessed, underwent magnetic resonance imaging scanning (MRI), and were interviewed regarding their functional status: activities of daily living (ADLs), instrumental ADLs (IADLs), and the complex IADL functions of reading, hobbies, and socializing.
Dependency in IADLs, but not ADLs, was present. After controlling for age, sex, and education, extrapyramidal (EP) signs were significantly associated with two of the three IADLs, with EP signs comprising a composite score of 10 EP signs (e.g., resting tremor) and a 5-meter timed walk. Cognitive test performance on a range of tests was also associated with functional status. A hierarchical model confirmed the association between the EP signs and cognitive test performance and functional scores, but no "pattern" of cognitive association emerged. Hippocampal volume was associated with socializing.
This study has shown that many nondemented very old people living in the community are losing capacity to perform IADL functions and that areas of incapacity are associated with the presence of EP signs and impaired cognition. These results highlight the need for health workers to include an assessment of EP and cognitive status in their evaluation of older persons living in the community, even in the context of a lack of dementia diagnosis. Furthermore, it signifies the need to directly evaluate IADL function to identify need for intervention and support if required. This group of old-old individuals may now be considered the "survivors" of their cohort, and early detection of the difficulties they are experiencing will enable clinicians to respond appropriately, thus providing them a higher quality of life for their years to come.
确定社区居住的高龄老人功能失能的临床相关因素。
横断面研究。
以社区为基础。
106名年龄在80至94岁之间的非痴呆患者。
对参与者进行医学和认知评估，进行磁共振成像扫描（MRI），并就其功能状态进行访谈：日常生活活动（ADL）、工具性日常生活活动（IADL）以及阅读、爱好和社交等复杂的IADL功能。
存在IADL依赖，但不存在ADL依赖。在控制年龄、性别和教育程度后，锥体外系（EP）体征与三项IADL中的两项显著相关，EP体征包括10项EP体征（如静止性震颤）的综合评分和5米定时步行。一系列测试中的认知测试表现也与功能状态相关。分层模型证实了EP体征与认知测试表现和功能评分之间的关联，但未出现认知关联的“模式”。海马体积与社交相关。
本研究表明，许多居住在社区的非痴呆高龄老人正在丧失执行IADL功能的能力，失能领域与EP体征的存在和认知受损有关。这些结果强调，卫生工作者在评估社区居住的老年人时，即使在没有痴呆诊断的情况下，也需要评估EP和认知状态。此外，这表明需要直接评估IADL功能，以确定是否需要干预和支持。这组高龄老人现在可能被视为其同龄人中的“幸存者”，早期发现他们所面临的困难将使临床医生能够做出适当反应，从而在未来岁月为他们提供更高的生活质量。
