Department of Geriatrics, County Hospital Ryhov, Region Jönköping County, Jönköping, Sweden,
Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,
Dement Geriatr Cogn Disord. 2019;47(4-6):209-218. doi: 10.1159/000499671. Epub 2019 Jul 3.
BACKGROUND/OBJECTIVES: Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care.
A total of 428 nursing home residents were investigated during 2008-2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality.
Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group.
Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents.
背景/目的：痴呆和认知障碍在养老院中很常见。很少有研究探讨未被发现的认知障碍对医疗护理的影响。本研究旨在评估瑞典养老院居民样本中认知障碍诊断失败的患病率，并分析诊断失败是否与医疗护理受损有关。
在 2008 年至 2011 年间，对 428 名养老院居民进行了调查。未被诊断为痴呆的受试者根据 Mini 精神状态检查（MMSE）的结果进行分组，其中得分<24 分的受试者为可能的痴呆组，其余受试者为对照组。第三组由诊断为痴呆的受试者组成。根据基线数据、实验室发现、药物使用和死亡率比较这三组。
181 名受试者（42%）之前被诊断为痴呆。在没有痴呆诊断的受试者中，72%存在认知障碍，可能患有痴呆（MMSE<24）。这些受试者年龄明显更大，未接受抗痴呆治疗，脑利钠肽水平较高，与诊断为痴呆的组相比，但营养不良和压疮的风险与痴呆组相似。
养老院居民中普遍存在未被发现的认知障碍，可能隐藏着其他潜在可治疗的疾病，如心力衰竭。研究结果强调需要更加关注养老院居民的认知障碍。
