Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan.
PLoS One. 2019 Jul 16;14(7):e0219538. doi: 10.1371/journal.pone.0219538. eCollection 2019.
In clinical settings, untreatable biliary sludge in the gallbladder can be observed in older adults with advanced dementia. The underlying cause of biliary sludge existence in patients with dementia is currently unknown. Therefore, we aimed to investigate the prevalence, risk factors, and related outcomes of biliary sludge formation in the gallbladder of older adults with dementia.
Cross-sectional study.
Geriatric ward of University Hospital in Japan.
Inpatients aged 80 and older living with dementia.
We evaluated the presence of biliary sludge by diagnostic ultrasonography and collected data regarding patient demographic information, cognition (mini-mental state examination [MMSE]), physical activity (Barthel Index), oral food intake (food intake level scale [FILS]), clinical stage of dementia (functional assessment staging [FAST] of dementia), and patient performance status (Zubrod/ Karnofsky score).
Male sex, larger gallbladder volume and calories from oral intake were significantly associated with the presence of biliary sludge (P = .02, .02, .002, respectively). There was a significant negative correlation between the FAST stage and the FILS level in all patients (P < .001). More advanced dementia and dysphagia was more likely to be found in patients with Alzheimer disease (AD) with biliary sludge, compared to patients with AD without biliary sludge (FAST 7a, FILS II and FAST 6c, FILS V, respectively, P = .06, 04). A logistic regression analysis revealed that the eating status of FILS I and II, generally called "fasting or anorexia", was a significant risk factor for forming biliary sludge in older adults with dementia (P = .031, odds ratio: 5.25, 95% confidence interval: 1.16-23.72).
Fasting status may be associated with the existence of biliary sludge in older adults with dementia. Therefore, supportive care for eating might be an important solution to comfortable end-of-life care for older adults with advanced dementia.
在临床环境中，患有晚期痴呆症的老年人的胆囊中可能会出现无法治疗的胆汁泥。目前尚不清楚痴呆症患者存在胆汁泥的根本原因。因此，我们旨在调查老年痴呆症患者胆囊中胆汁泥形成的患病率、危险因素和相关结局。
横断面研究。
日本大学医院老年病房。
年龄在 80 岁及以上、患有痴呆症的住院患者。
我们通过诊断超声评估胆汁泥的存在，并收集患者人口统计学信息、认知（简易精神状态检查[MMSE]）、身体活动（巴氏指数）、口服食物摄入（食物摄入水平量表[FILS]）、痴呆临床分期（痴呆功能评估分期[FAST]）和患者表现状态（Zubrod/卡诺夫斯基评分）的数据。
男性、更大的胆囊体积和口服摄入的热量与胆汁泥的存在显著相关（P =.02、.02、.002，分别）。所有患者的 FAST 分期与 FILS 水平呈显著负相关（P <.001）。与无胆汁泥的阿尔茨海默病（AD）患者相比，有胆汁泥的 AD 患者更有可能患有更严重的痴呆和吞咽困难（FAST 7a、FILS II 和 FAST 6c、FILS V，P =.06、04）。逻辑回归分析显示，FILS I 和 II 的进食状态，通常称为“禁食或厌食”，是老年痴呆症患者形成胆汁泥的显著危险因素（P =.031，优势比：5.25，95%置信区间：1.16-23.72）。
禁食状态可能与老年痴呆症患者胆汁泥的存在有关。因此，对饮食的支持性护理可能是为晚期痴呆症老年患者提供舒适临终关怀的重要解决方案。
