Schubert Cathy C, Boustani Malaz, Callahan Christopher M, Perkins Anthony J, Carney Caroline P, Fox Christopher, Unverzagt Frederick, Hui Siu, Hendrie Hugh C
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Am Geriatr Soc. 2006 Jan;54(1):104-9. doi: 10.1111/j.1532-5415.2005.00543.x.
To compare the medical comorbidity of older patients with and without dementia in primary care.
Cross-sectional study.
Wishard Health Services, which includes a university-affiliated, urban public hospital and seven community-based primary care practice centers in Indianapolis.
Three thousand thirteen patients aged 65 and older attending seven primary care centers in Indianapolis, Indiana.
An expert panel diagnosed dementia using International Classification of Diseases, 10th Revision, criteria. Comorbidity was assessed using 10 physician-diagnosed chronic comorbid conditions and the Chronic Disease Score (CDS).
Patients with dementia attending primary care have on average 2.4 chronic conditions and receive 5.1 medications. Approximately 50% of dementia patients in this setting are exposed to at least one anticholinergic medication, and 20% are prescribed at least one psychotropic medication. After adjusting for patients' age, race, and sex, patients with and without dementia have a similar level of comorbidity (mean number of chronic medical conditions, 2.4 vs 2.3, P=.66; average CDS, 5.8 vs 6.2, P=.83).
Multiple medical comorbid conditions are common in older adults with and without dementia in primary care. Despite their cholinergic deficit, a substantial proportion of patients with dementia are exposed to anticholinergic medications. Models of care that incorporate this medical complexity are needed to improve the treatment of dementia in primary care.
比较初级保健中患有和未患痴呆症的老年患者的合并症情况。
横断面研究。
威沙德健康服务机构，包括一家大学附属医院、位于印第安纳波利斯的城市公立医院以及七个社区初级保健实践中心。
印第安纳州印第安纳波利斯市七个初级保健中心的3013名65岁及以上的患者。
一个专家小组使用《国际疾病分类》第10版标准诊断痴呆症。使用10种医生诊断的慢性合并症和慢性病评分（CDS）评估合并症情况。
在初级保健机构就诊的痴呆症患者平均患有2.4种慢性病，服用5.1种药物。在这种情况下，约50%的痴呆症患者至少使用过一种抗胆碱能药物，20%的患者至少被开具过一种精神药物。在对患者的年龄、种族和性别进行调整后，患有和未患痴呆症的患者合并症水平相似（慢性疾病的平均数量，2.4对2.3，P = 0.66；平均CDS，5.8对6.2，P = 0.83）。
在初级保健中，患有和未患痴呆症的老年人中多种合并症都很常见。尽管痴呆症患者存在胆碱能缺陷，但相当一部分患者仍接触抗胆碱能药物。需要纳入这种医疗复杂性的护理模式来改善初级保健中痴呆症的治疗。
