Krolak-Salmon P, Mouchoux C
Inserm U1028, Centre de Mémoire, de Ressources et de Recherche de Lyon, Centre des Neurosciences de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, Université Claude-Bernard Lyon-1, 27, rue Gabriel-Péri, 69100 Villeurbanne, France.
Ann Fr Anesth Reanim. 2011 Oct;30(10):e61-3. doi: 10.1016/j.annfar.2011.06.017. Epub 2011 Aug 6.
Hip fracture is an important step in the autonomy evolution in elderly. As gait is particularly jeopardised after such a traumatism, cognition may also be acutely impaired. Elderly post-surgery delirium is frequent, but chronic progression of cognitive impairment and dementia may occur. The concept of cognitive reserve is crucial for understanding risk factors of post-surgery delirium in elderly. The more the cognitive reserve is decreased before such a traumatism, the higher the delirium and dementia progression risk is. A neurodegenerative disease such as Alzheimer's disease may be clinically silent prior the traumatic event, and may decompensate soon after as the cognitive reserve is not sufficient anymore. Dementia may then lead to progressive autonomy loss. A systematic interdisciplinary approach is needed to prevent frail patients from delirium, and to early cure it to decrease the risk of long-term autonomy loss.
髋部骨折是老年人自主性演变中的一个重要阶段。由于此类创伤后步态会受到特别严重的影响，认知功能也可能会急剧受损。老年患者术后谵妄很常见，但认知障碍和痴呆可能会慢性进展。认知储备的概念对于理解老年患者术后谵妄的风险因素至关重要。在遭受此类创伤之前，认知储备下降得越多，发生谵妄和痴呆进展的风险就越高。像阿尔茨海默病这样的神经退行性疾病在创伤事件之前可能在临床上没有症状，但由于认知储备不再充足，创伤后可能很快就会失代偿。痴呆随后可能导致自主性逐渐丧失。需要一种系统的跨学科方法来预防虚弱患者发生谵妄，并尽早治愈谵妄以降低长期自主性丧失的风险。
