肌少症合并认知障碍对老年病人出院后不良预后的影响

doi:10.3969/j.issn.1003-9198.2022.01.009

摘要/Abstract

摘要： 目的对老年科出院的病人进行6个月随访,探讨肌少症合并认知障碍与死亡、跌倒、再入院、生活质量下降和自理能力减退等不良预后之间的关系。方法对2019年10月至2020年1月纳入的116例研究对象进行为期6个月的随访。根据诊断结果把研究对象分为4组:无肌少症(SP)、无认知障碍(CI)组(n=48);仅有SP组(n=19);仅有CI组(n=28);SP合并CI组(n=21)。对4组间一般资料及结局情况进行比较分析。结果本研究中住院老年病人SP的检出率为34.38%;CI的检出率为42.24%;SP合并CI的检出率为18.10%。SP合并CI组研究对象年龄更大,CRP水平更高,躯体活动能力得分、营养得分、生活质量得分、自理能力得分更差(P＜0.05)。随访6个月后,SP合并CI组基本日常生活活动能力量表得分的改变显著大于无SP、无CI组和仅有SP组(P<0.05)。COX回归分析显示,在调整混杂因素后,SP合并CI是影响老年病人出院后6个月内再入院的独立风险因素(HR=4.27,95%CI:1.01~18.02,P=0.048)。结论对于从老年科出院6个月内的病人,SP合并CI可以预测其日常生活自理能力的下降,并增加再入院风险。

关键词: 肌少症, 认知障碍, 住院病人, 老年人, 预后

Abstract: Objective To explore the relationship between sarcopenia complicated with cognitive impairment and adverse survival outcomes, such as fall, readmission,decline in self-care ability, decline in quality of life and death in the elderly who were followed up for 6 months after discharge. Methods A total of 116 subjects enrolled from October 2019 to January 2020 were followed up for 6 months. The subjects were divided into four groups according to their diagnosis: no sarcopenia and no cognitive impairment group (n=48), only sarcopenia group (n=19), only cognitive impairment group (n=28), and sarcopenia complicated with cognitive impairment group (n=21). The general data and outcomes of the four groups were compared and analyzed. Results The detection rate of sarcopenia, cognitive impairment and sarcopenia combined with cognitive impairment in hospitalized elderly patients was 34.38%, 42.24%, and 18.10% respectively. The subjects with sarcopenia and cognitive impairment presented with older age, higher serum level of CRP, and lower scores of physical activity, nutrition, quality of life and self-care ability (P<0.05). After 6-month follow-up, the change of basic activity of daily living after follow-up in the sarcopenia combined with cognitive impairment group was more significant than that in no sarcopenia and no cognitive impairment group and only sarcopenia group (P<0.05). Cox proportional hazards regression modle showed that after adjusting the confounding factors, sarcopenia combined with cognitive impairment was an independent factor affecting the readmission of the elderly patients within 6 months after discharge (HR=4.27,95%CI:1.01-18.02). Conclusions For the patients discharged from Departement of Geriatrics within 6 months, sarcopenia with cognitive impairment can predict the decline of self-care ability of daily life and increase the risk of readmission.

Key words: sarcopenia, cognitive impairment, hospitalized patients, aged, prognosis

中图分类号:

R 749.1

张栌尹, 莫永珍, 欧阳晓俊, 王洁, 沈晓星, 朱海琼, 王小蓉, 陈娴. 肌少症合并认知障碍对老年病人出院后不良预后的影响[J]. 实用老年医学, 2022, 36(1): 31-36.

ZHANG Lu-yin, MO Yong-zhen, OUYANG Xiao-jun, WANG Jie, SHEN Xiao-xing, ZHU Hai-qiong, WANG Xiao-rong, CHEN Xian. Effects of sarcopenia complicated with cognitive impairment on poor prognosis of elderly patients after discharge[J]. Practical Geriatrics, 2022, 36(1): 31-36.

参考文献

[1] CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.e2.
[2] BEAUDART C, ZAARIA M, PASLEAU F, et al. Health outcomes of sarcopenia: a systematic review and meta-analysis[J]. PLoS One, 2017, 12(1): e0169548.
[3] FERRI C P, PRINCE M, BRAYNE C, et al. Global prevalence of dementia: a Delphi consensus study[J]. Lancet, 2005, 366(9503): 2112-2117.
[4] NISHIGUCHI S, YAMADA M, FUKUTANI N, et al. Differential association of frailty with cognitive decline and sarcopenia in community-dwelling older adults[J]. J Am Med Dir Assoc, 2015, 16(2): 120-124.
[5] ZENGARINI E, GIACCONI R, MANCINELLI L,et al. Prognosis and interplay of cognitive impairment and sarcopenia in older adults discharged from acute care hospitals[J]. J Clin Med, 2019, 8(10):1693.
[6] TIRSCHWELL D. In 85-year-old adults, MMSE predicted 5-year risk for first stroke better than Framingham score[J]. Ann Intern Med, 2014, 160(2): JC13.
[7] KOREN-HAKIM T, WEISS A, HERSHKOVITZ A, et al. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients[J]. Clin Nutr, 2016, 35(5): 1053-1058.
[8] CLARK D O, STUMP T E, TU W, et al. A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults[J]. Med Care, 2012, 50(6): 534-539.
[9] BIER N, BELCHIOR PDA C, PAQUETTE G, et al. The instrumental activity of daily living profile in aging: a feasibility study[J]. J Alzheimers Dis, 2016, 52(4): 1361-1371.
[10] LUO N, LIU G, LI M, et al. Estimating an EQ-5D-5L value set for China[J]. Value Health, 2017, 20(4): 662-669.
[11] ROFFMAN C E, BUCHANAN J, ALLISON G T. Charlson Comorbidities Index[J]. J Physiother, 2016, 62(3): 171.
[12] PHU S, KIRK B, BANI HASSAN E, et al. The diagnostic value of the short physical performance battery for sarcopenia[J]. BMC Geriatr, 2020, 20(1): 242.
[13] CRUZ-JENTOFT A J, LANDI F, SCHNEIDER S M, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)[J]. Age Ageing, 2014, 43(6): 748-759.
[14] MAYHEW A J, AMOG K, PHILLIPS S, et al. The prevalence of sarcopenia in community-dwelling older adults, an exploration of differences between studies and within definitions: a systematic review and meta-analyses[J]. Age Ageing, 2019, 48(1): 48-56.
[15] MAEDA K, AKAGI J. Cognitive impairment is independently associated with definitive and possible sarcopenia in hospitalized older adults: the prevalence and impact of comorbidities[J]. Geriatr Gerontol Int, 2017, 17(7): 1048-1056.
[16] GARIBALLA S, ALESSA A. Sarcopenia: prevalence and prognostic significance in hospitalized patients[J]. Clin Nutr, 2013, 32(5): 772-776.
[17] YANG M, HU X, WANG H, et al. Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study[J]. J Cachexia Sarcopenia Muscle, 2017, 8(2): 251-258.
[18] FOGG C, MEREDITH P, CULLIFORD D, et al. Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: a retrospective cohort study[J]. Int J Nurs Stud, 2019, 96: 1-8.
[19] VERGHESE J, ANNWEILER C, AYERS E, et al. Motoric cognitive risk syndrome: multicountry prevalence and dementia risk[J]. Neurology, 2014, 83(8): 718-726.
[20] DOI T, SHIMADA H, MAKIZAKO H, et al. Motoric cognitive risk syndrome: association with incident dementia and disability[J]. J Alzheimers Dis, 2017, 59(1): 77-84.
[21] HARBER M P, KONOPKA A R, DOUGLASS M D, et al. Aerobic exercise training improves whole muscle and single myofiber size and function in older women[J]. Am J Physiol Regul Integr Comp Physiol, 2009, 297(5): R1452-1459.
[22] LIU C J, LATHAM N K. Progressive resistance strength training for improving physical function in older adults[J]. Cochrane Database Syst Rev, 2009,2009(3): CD002759.
[23] CRUZ-JENTOFT A J, BAHAT G, BAUER J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(4): 601.
[24] ERICKSON K I, VOSS M W, PRAKASH R S, et al. Exercise training increases size of hippocampus and improves memory[J]. Proc Natl Acad Sci U S A, 2011, 108(7): 3017-3022.
[25] SCARMEAS N, ANASTASIOU C A, YANNAKOULIA M. Nutrition and prevention of cognitive impairment[J]. Lancet Neurol, 2018, 17(11): 1006-1015.
[26] ABIRI B, VAFA M. Nutrition and sarcopenia: a review of the evidence of nutritional influences[J]. Crit Rev Food Sci Nutr, 2017, 59(9): 1456-1466.