Miyamoto Takahide, Karita Kanae, Kozaki Koichi, Ebihara Takae
Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan.
Department of Hygiene and Public Health, Kyorin University School of Medicine, Tokyo 181-8611, Japan.
J Clin Med. 2025 Sep 2;14(17):6186. doi: 10.3390/jcm14176186.
: The predominant etiology of healthcare-associated pneumonia (HCAP) that frequently manifests in elderly with advanced dementia is aspiration pneumonia in which the deteriorated upper respiratory protective reflexes are significant responsible triggers. However, the association of HCAP with cerebral degeneration has not been investigated. Therefore, a cross-sectional and retrospective cohort study was conducted to elucidate the association of aspiration pneumonia-related factors with HCAP in elderly with dementia. Of the 154 participants (87.9 years), 30 of Alzheimer's type dementia (AD) or 124 of vascular dementia (VaD) were assigned to the pneumonia group or the control group. Participant's characteristics, including cognition, clinical pattern and stage of dementia, physical and eating abilities, latency of the swallowing reflex (LTSR), threshold of CRS, and tongue moisture (TOM), were evaluated. The progression of dementia and the decline in LTSR, CRS, and TOM were synchronized ( < 0.05). Participants in the pneumonia group who were male, with eating difficulties, prolonged LTSR, lacunar infarction, or a smoking history, were significantly observed. The multiple logistic analysis indicated that the LTSR was a significant independent factor for developing HCAP ( = 0.01). Furthermore, as the possessed number of aspiration pneumonia-related factors increased, the odds ratio for HCAP became significantly higher ( < 0.001). Blunted CRS, male gender, and lacunar infarctions were evident in VaD participants but not in AD participants. Finally, the incidence of HCAP in VaD was 2.11 times higher than that in AD ( = 0.005). The higher incidence of HCAP in VaD than AD may be due to different underlying pathophysiological mechanisms between them.
医疗保健相关肺炎（HCAP）在患有晚期痴呆症的老年人中经常出现，其主要病因是吸入性肺炎，其中上呼吸道保护反射功能恶化是重要的触发因素。然而，HCAP与脑变性之间的关联尚未得到研究。因此，进行了一项横断面回顾性队列研究，以阐明痴呆老年人中与吸入性肺炎相关因素与HCAP之间的关联。在154名参与者（平均年龄87.9岁）中，30名阿尔茨海默病型痴呆（AD）患者或124名血管性痴呆（VaD）患者被分为肺炎组或对照组。评估了参与者的特征，包括认知、痴呆的临床模式和阶段、身体和进食能力、吞咽反射潜伏期（LTSR）、咳嗽反射敏感性（CRS）阈值和舌部湿润度（TOM）。痴呆的进展与LTSR、CRS和TOM的下降是同步的（P<0.05）。显著观察到肺炎组中男性、有进食困难、LTSR延长、腔隙性脑梗死或有吸烟史的参与者。多因素逻辑分析表明，LTSR是发生HCAP的一个重要独立因素（P = 0.01）。此外，随着吸入性肺炎相关因素数量的增加，HCAP的优势比显著升高（P<0.001）。CRS迟钝、男性和腔隙性脑梗死在VaD参与者中明显，但在AD参与者中不明显。最后，VaD中HCAP的发生率比AD高2.11倍（P = 0.005）。VaD中HCAP的发生率高于AD，可能是由于它们之间潜在的病理生理机制不同。
