Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
South Oaks Hospital, Amityville, NY.
Am J Ther. 2022 Jul 1;29(4):e394-e399. doi: 10.1097/MJT.0000000000001527.
Older adults with serious mental illness have a high prevalence of coronary artery disease and of its major risk factors, that is, arterial hypertension, dyslipidemia, and diabetes mellitus. The prevalence and clinical control of these conditions have not been compared in geropsychiatric inpatients with dementia versus those with mood or psychotic disorders.
What is the prevalence and acuity of coronary artery disease, arterial hypertension, dyslipidemia, and diabetes mellitus among patients with dementia, mood, and psychotic disorders admitted for geropsychiatric care?
Patients 65 years of age or older were identified in a cohort of 1000 patients consecutively admitted over a 3-year period to the geropsychiatric unit of a 200-bed mental health hospital in suburban New York. All patients had a structured clinical and laboratory evaluation within 72 hours of admission.
Primary psychiatric diagnoses, medical history, the frequency of poorly controlled cardiometabolic comorbidity requiring an immediate change in the management plan, and the Charlson Comorbidity Index (CCI).
The 65 years and older patient sample (N = 689) had a mean age of 74.8 years, and 58.8% of the subjects were women. The 205 patients with dementia were older ( P < 0.001) than the 337 patients with mood disorders and the 147 patients with psychotic syndromes. The numbers of medical conditions and the CCI after exclusion of dementia were similar in patients with dementia versus patients without dementia. A substantial number of patients had poorly controlled arterial hypertension (51.2%), dyslipidemia (25.4%), diabetes (24.2%), and coronary artery disease (15.4%). Patients with dementia had a lower prevalence of poorly controlled dyslipidemia ( P = 0.0006), diabetes ( P = 0.0089), and coronary artery disease ( P = 0.045).
Compared with mood or psychotic disorder, a diagnosis of dementia with behavioral disturbance seemed to be associated with better control of coronary artery disease, dyslipidemia, and diabetes mellitus in geropsychiatric inpatients.
患有严重精神疾病的老年人冠心病及其主要危险因素（即动脉高血压、血脂异常和糖尿病）的患病率较高。在接受老年精神科护理的痴呆症患者与心境或精神病患者中，尚未对这些疾病的患病率和临床控制情况进行比较。
在因老年精神科护理而入院的痴呆症、心境和精神病患者中，冠心病、动脉高血压、血脂异常和糖尿病的患病率和严重程度如何？
在纽约郊区一家 200 床位精神卫生医院的老年精神科病房中，对连续入院的 1000 名患者队列中的 65 岁及以上患者进行了识别。所有患者在入院后 72 小时内接受了结构化的临床和实验室评估。
主要精神科诊断、病史、需要立即改变管理计划的控制不良的心血管代谢合并症的频率，以及 Charlson 合并症指数（CCI）。
65 岁及以上患者样本（N=689）的平均年龄为 74.8 岁，58.8%的患者为女性。205 名痴呆症患者比 337 名心境障碍患者和 147 名精神病综合征患者年龄更大（P<0.001）。排除痴呆症后，患者的医疗条件数量和 CCI 相似。相当多的患者存在控制不良的动脉高血压（51.2%）、血脂异常（25.4%）、糖尿病（24.2%）和冠心病（15.4%）。痴呆症患者的控制不良血脂异常（P=0.0006）、糖尿病（P=0.0089）和冠心病（P=0.045）的患病率较低。
与心境或精神病障碍相比，伴有行为障碍的痴呆症诊断似乎与老年精神科住院患者的冠心病、血脂异常和糖尿病的控制更好相关。
