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社区居住的老年患者的口面失用症、口咽吞咽困难和痴呆严重程度。

Buccofacial Apraxia, Oropharyngeal Dysphagia, and Dementia Severity in Community-Dwelling Elderly Patients.

机构信息

Department of Geriatrics, 55052Rouen University Hospital, Rouen, France.

Department of Geriatrics, Evangelisches Krankenhaus Kalk, Cologne, Germany.

出版信息

J Geriatr Psychiatry Neurol. 2021 Mar;34(2):150-155. doi: 10.1177/0891988720915519. Epub 2020 Apr 15.

Abstract

Apraxia occurs frequently in patients with dementia. Buccofacial apraxia (BFA) characteristics have been less investigated than limb or speech apraxia. An association between BFA and oropharyngeal dysphagia (OD) in old patients with dementia has not yet been explored. We aimed to assess the prevalence of BFA in patients with dementia and evaluate the relationship between BFA, OD, and dementia. We have prospectively included 117 outpatients with dementia referred to a geriatric consultation. Oropharyngeal dysphagia was diagnosed using the volume viscosity swallowing test (V-VST). Buccofacial apraxia was evaluated by miming 7 meaningless gestures. A complementary geriatric assessment of 6-domains completed the evaluation. Buccofacial apraxia was present in 54 (48.6%) patients. Proxies reported OD more frequently in the group of patients with BFA compared to the group without ( = .04). Prevalence of OD assessed with the V-VST was similar between patients with and without apraxia ( = .9). Patients with BFA had a significant lower Mini-Mental State Examination suggesting a more severe cognitive decline (18.1 ± 4.5 vs 15.8 ± 5, = .01), a lower activities of daily living relative to disabilities (5 ± 0.8 vs 4.3 ± 1.3, = .001), and had a lower gait speed that indicated frailty ( = .03).In conclusion, our results indicate a relationship between BFA and severity of dementia, disability, and frailty with no significant association between BFA and OD.

摘要

失用症在痴呆患者中很常见。与肢体或言语失用症相比,颊面失用症(BFA)的特征研究较少。在患有痴呆症的老年患者中,BFA 与口咽吞咽困难(OD)之间的关联尚未得到探索。我们旨在评估痴呆患者中 BFA 的患病率,并评估 BFA、OD 和痴呆症之间的关系。我们前瞻性地纳入了 117 名转诊到老年科就诊的痴呆症门诊患者。使用体积粘度吞咽测试(V-VST)诊断口咽吞咽困难。通过模仿 7 个无意义的手势评估颊面失用症。补充的 6 个领域的老年评估完成了评估。54 名(48.6%)患者存在颊面失用症。与无失用症的患者相比,代理报告在存在失用症的患者中更频繁地出现 OD( =.04)。使用 V-VST 评估的 OD 患病率在有和无失用症的患者之间相似( =.9)。有 BFA 的患者的 Mini-Mental State Examination 显著较低,表明认知衰退更严重(18.1 ± 4.5 与 15.8 ± 5, =.01),日常生活活动相对于残疾的能力较低(5 ± 0.8 与 4.3 ± 1.3, =.001),并且步态速度较低,表明虚弱( =.03)。总之,我们的结果表明 BFA 与痴呆症的严重程度、残疾和虚弱之间存在关系,而 BFA 与 OD 之间没有显著关联。

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