Laguna P, Moya M, Gazapo T, Salgado R, Calabrese S
Servicio de Urgencias, Clínica Puerta de Hierro, Madrid.
Rev Clin Esp. 1997 May;197(5):336-40.
An increasing proportion of patients attended at hospital emergence departments (HED) are elderly people.
a) To check the reliability of the usual medical assessment to detect the cognitive deterioration in elderly people attended at HED, compared with that performed systematically by means of an evaluation test of cognitive functions; b) to study the applicability of such a test in HED, on the basis of the time necessary for its administration, and c) to describe the deterioration prevalence in that group of patients and identify the possible associated risks for its detection in patients.
Prospective study including patients aged > or = 60 years attended at a HED, using the orientation, memory and concentration test (OMC) to perform the cognitive assessment.
A total of 352 patients who had no exclusion criteria out of the 536 attended during the study period were included. Cognitive deterioration was not detected in 111 patients (31.5%); it was mild in 147 (41.8%), moderate in 71 (20.2%) and severe in 23 (6.5%). In patients with moderate-severe deterioration according to the OMC test, such a deterioration was detected by the usual medical evaluation in 7% of cases. The mean time in completing the test was 2.6 +/- 0.9 minutes. An age > or = 80 years was associated with an increased relative risk for detecting moderate-severe cognitive deterioration (1.98; 95% CI, 1.42-2.78; p < 0.001), whereas the discharge diagnosis of respiratory disease was associated with a decrease of the relative risk (0.41; 95% CI, 0.19-0.89; p < 0.05). No association was observed with other factors, such as gender, home residence or final destination from the emergency department.
The prevalence of cognitive deterioration in elderly people attended at HED is high and increases with age. The OMC test can be administered at HED to detect cognitive deterioration, which is not frequently detected by the usual medical assessment.
在医院急诊科就诊的患者中，老年人的比例日益增加。
a）与通过认知功能评估测试系统进行的评估相比，检验常规医学评估在检测急诊科就诊老年人认知功能衰退方面的可靠性；b）根据测试实施所需时间，研究该测试在急诊科的适用性；c）描述该组患者中认知功能衰退的患病率，并确定患者中可能存在的与认知功能衰退检测相关的风险因素。
前瞻性研究纳入了在急诊科就诊的年龄≥60岁的患者，使用定向、记忆和注意力测试（OMC）进行认知评估。
在研究期间就诊的536名患者中，共有352名无排除标准的患者被纳入研究。111名患者（31.5%）未检测到认知功能衰退；147名患者（41.8%）为轻度衰退，71名患者（20.2%）为中度衰退，23名患者（6.5%）为重度衰退。在根据OMC测试为中度至重度衰退的患者中，常规医学评估仅在7%的病例中检测到这种衰退。完成测试的平均时间为2.6±0.9分钟。年龄≥80岁与检测到中度至重度认知功能衰退的相对风险增加相关（1.98；95%置信区间，1.42 - 2.78；p<0.001），而呼吸系统疾病的出院诊断与相对风险降低相关（0.41；95%置信区间，0.19 - 0.89；p<0.05）。未观察到与其他因素（如性别、家庭住址或急诊科最终去向）存在关联。
在急诊科就诊的老年人中，认知功能衰退的患病率较高，且随年龄增长而增加。OMC测试可在急诊科用于检测认知功能衰退，而常规医学评估往往难以发现这种衰退。
