ABSTRACT
Objective@#To investigate the effect of pre-stroke dependence and pre-stroke combined dementia on the outcome of 3 months after stroke in patients aged more than 65 years.@*Methods@#This study was a retrospective cohort study. A total of 966 patients with acute stroke were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from March 2015 to March 2018, including 168 patients diagnosed with dementia before acute stroke for the dementia group, and the remaining 798 people were treated as the non-dementia group. The demographic differences between the two groups at admission were compared. With the death and independence as the dependent variable within 3 months after the diagnosis of acute stroke, the independent risk of admission and the presence of dementia were used as covariates to make a COX proportional hazard assessment.@*Results@#There was significant difference in the number of medications, consistently taken with warfarin, pre-stroke independence, admission status between the dementia group and the non-dementia group (U=3.42, χ2=4.52, 8.96, 8.76, P<0.01). There was no significant difference in the number of deaths between the two groups during admission (χ2=0.96, P>0.05). There was significant difference in the number of deaths within 3 months after discharge and dependence within 3 months after stroke between the two groups (χ2=5.69, 6.94, P < 0.01). Patients with pre-stroke dementia died during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.00, 1.32, 2.56 compared with those who were completely independent before admission; mild dependence before admission patients who died before the stroke were completely dead during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.42, 1.86, 2.73, respectively. Patients who were moderately dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.68, 2.42, respectively. Patients who were heavily dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.89, 3.24, respectively.@*Conclusions@#Pre-stroke dementia and activity disorder lead to a high risk of death and high disability within 3 months after stroke.
ABSTRACT
Objective:To investigate the risk factors of elderly, sports cognitive risk syndrome falling, repeated falls and fractures after falls.Methods:A total of 3 552 people were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from April 2015 to April 2016. The demographics of each selected individual were recorded. The selected individuals were assessed by MMSE for the presence of Subjective Cognitive Complaint (SCC), and the pace was used to assess whether there was slow walking and whether there was MCR (SCC + slow walking). All individuals were divided into MCR group and non-MCR group according to the evaluation results. The non-MCR group was subdivided into SCC subgroup, slow speed walking subgroup and healthy subgroup. Baseline variables were compared between the two groups, and demographics between subgroups, subgroups, and MCR groups were compared. Follow-up was followed every 4 months for a total of 2 years. The number of people who fell during the follow-up period, repeated falls, and fractures were recorded. With all demographics and SCC, walking at a slower pace, MCR was an independent variable, with a fall during follow-up, repeated falls and post-fall fractures as dependent variables, and a COX proportional hazard regression model of independent and dependent variables.Results:The proportions of the MCR group in higher education, depression, the use of crutches were 10.2% (36/352), 22.4% (79/352), 44.9% (158/352), the BMI, number of medications in the MCR group were (27.0 ± 4.3) kg/m 2, (6.8±3.2), the proportions of non-MCR group in higher education, depression, using crutches ratio were 22.9% (732/3 200), 12.8% (409/3 200), 22.8% (729 /3 200), the BMI, number of medications of non-MCR group were (24.8 ± 3.8) kg/m 2, (5.2 ± 3.1), the two groups showed statistical significant difference( χ2 values were 29.93, 3.45, 24.98, t values were 12.34, 82.71, P<0.05). The proportions of higher education, depression and crutches were 18.9% (289/1531), 13.2% (202 /1531) and 22.5% (344/1531) in SCC subgroup. The difference between MCR group and SCC subgroup was statistically significant ( χ2 values were 14.99, 19.28, 73.56, P<0.05). The higher education level of the slow walking group was 16.6% (34/205), which was significantly different from that of the MCR group ( χ2 value was 4.77, P<0.05). The proportions of higher education level, arthritis, depression and crutches in the healthy subgroup were 27.9% (409/1 464), 12.9 (190/1 464), 11.2% (164/1 464) and 19.7% (288/1 464), while that in the SCC subgroup were 18.9% (289/1 531), 16.2 (248/1 531), 13.2% (202/1 531) and 22.5% (344/1 531), and that in the slow walking subgroup were 16.6% (34/205), 21.5% (44/205), 20.9 (43/205) and 47.3% (97/205). There were significant differences among the three subgroups ( χ2 values were 13.08-78.28, P<0.05). BMI and number of drugs in healthy subgroups were (23.4±4.4) kg/m 2 and (4.7±2.8) , SCC group was (25.2±4.3) kg/m 2 and (5.1±2.9) kinds, and slow walking subgroup were (25.1±3.8) kg/m 2 and (6.7±3.1) kinds. The differences among the three subgroups were statistically significant ( t values were 2.68,7.21, P<0.05). The risks of falling, repeated falling and fracture after falling in MCR patients were 1.22, 1.47 and 2.54 ( P<0.05). Conclusions:Age, MCR is a high risk factor for falls in the elderly, repeated falls and fractures after falls. In clinical care, MCR needs to be evaluated and attention should be payed to the elderly.
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Objective:To study the influencing factors of nursing dependence in patients with moderate to severe dementia.Methods:Eighty-seven patients with moderate to severe dementia were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University. The demographics of each patient were recorded. The Chinese version of the Nursing Dependence Scale (CDS) was evaluated. The simple mental state test (MMSE), severe cognitive impairment series (SIB-S), and 6-minute walk test score (6MWT) for each patient. Mobility Test Score (TUG), US Cornell Depression Table Score (CSDD), Apathy Score (AES-10)were recorded. Demographic variables, MMSE, 6MWT, TUG, CSDD,AES-10, SIB-S as an independent variable, CDS as a dependent variable, multivariate linear logistic regression was analyzed.Results:The median comorbidities were 2, 6MWT, TUG, MMSE, SIB-S, CSDD, AES-10 score was (208.54±74.02) m and (24.56±11.83), (12.67±5.47), (40.85±7.54), (7.92±4.48), (25.28±7.23) points, which were independent factors with statistically significant impact on the care dependency scale ( B value was -0.67-0.67, P < 0.05 or 0.01). Conclusions:Patients with moderate to severe dementia have more comorbidities, lower physical endurance and increased dependence on depression.
ABSTRACT
Objective:To investigate the effect of pre-stroke dependence and pre-stroke combined dementia on the outcome of 3 months after stroke in patients aged more than 65 years.Methods:This study was a retrospective cohort study. A total of 966 patients with acute stroke were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from March 2015 to March 2018, including 168 patients diagnosed with dementia before acute stroke for the dementia group, and the remaining 798 people were treated as the non-dementia group. The demographic differences between the two groups at admission were compared. With the death and independence as the dependent variable within 3 months after the diagnosis of acute stroke, the independent risk of admission and the presence of dementia were used as covariates to make a COX proportional hazard assessment.Results:There was significant difference in the number of medications, consistently taken with warfarin, pre-stroke independence, admission status between the dementia group and the non-dementia group ( U=3.42, χ2=4.52, 8.96, 8.76, P<0.01). There was no significant difference in the number of deaths between the two groups during admission ( χ2=0.96, P>0.05). There was significant difference in the number of deaths within 3 months after discharge and dependence within 3 months after stroke between the two groups ( χ2=5.69, 6.94, P < 0.01). Patients with pre-stroke dementia died during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.00, 1.32, 2.56 compared with those who were completely independent before admission; mild dependence before admission patients who died before the stroke were completely dead during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.42, 1.86, 2.73, respectively. Patients who were moderately dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.68, 2.42, respectively. Patients who were heavily dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.89, 3.24, respectively. Conclusions:Pre-stroke dementia and activity disorder lead to a high risk of death and high disability within 3 months after stroke.