Factors Associated with a Decline in Activities of Daily Living in Patients with Dementia at Geriatric Hospitals: A 6 Month Prospective Study

BACKGROUND: Decreased activities of daily living (ADL) in elderly people are related to decreased quality of life and death and are a clinically important issue. However, few studies have investigated the various characteristics and risk factors for a decline in ADL among elderly in-patients in geriatric hospitals in Korea. METHODS: In total, 163 elderly in-patients with dementia in three geriatric hospitals located in Incheon, Gwangju and Yongin, Korea were surveyed prospectively for associated factors of a decline in ADL after 6 months. RESULTS: On average, the subjects were 79.4+/-7.6 years old, and 67.5% were female. Approximately 63% had Alzheimer type dementia, 36.8% only attended primary school, 73.0% were widowed, and 38.7% had been admitted to hospitals for less than 1 year. The Korean version of the Mini Mental State Examination (K-MMSE) score was 14.1+/-6.5, and the clinical dementia rating was 1.9+/-0.9. In total, 8.6% were bed-ridden and 59.5% and 64.6% had never experienced fecal and urinary incontinence, respectively. Total ADL scores declined after 6 months follow-up, and significantly associated factors were low K-MMSE score, fecal incontinence, and co-existence of fecal and urinary incontinence. CONCLUSION: Low K-MMSE scores, fecal incontinence, and the co-existence of fecal and urinary incontinence were associated with ADL declines in elderly in-patients with dementia in long-term care hospitals located in three cities in Korea.

Errors of Rectal Pressure Measurement in Urodynamic Study of Spinal Cord Injured Patients

OBJECTIVE: The intrarectal pressure can make error during urodynamic study and can decrease the accuracy of detrusor pressures. The purpose of this study was to investigate the incidence and cause of the error in measurement of recral pressure. METHOD: Forty-eight patients with spinal cord injury were enrolled. With the patients in the lithotomy position, catheter was placed into the bladder and the rectum, then urodynamic testing began by infusion of normal saline (20~30degrees C) via urethral catheter. The errors by measurement of rectal pressure during urodynamic study were recorded. According to the position of patients and spasticity of hip flexors, difference of rectal pressure was investigated. RESULTS: The error rate of intrarectal pressure during urodynamic study was 41%. Intrarectal pressure was higher in lithotomy position than in lateral lying position. According to modified Ashworth scale of hip flexors, intrarectal pressure in grade 0 was significantly lower than grade 1, 1.5 and 2 (p<0.05). CONCLUSION: There was significant errors in measuring of the intravesical pressure during urodynamic study. These factors might be posture, spasticity of hip flexors, and expelling of the catheter in urodynamic study.

The Increment of Bone Density in Patients with Spinal Cord Injury after Alendronate Therapy

OBJECTIVE: The aim of this study was to investigate the changes of bone mineral density (BMD) according to the postinjury duration, walking ability, and to assess the effect of oral alendronate therapy on BMD and biochemical markers in patients with spinal cord injury. METHOD: Forty-eight subjects with spinal cord injury were enrolled. One tablet of Alend(R) (10 mg of sodium alendronate) was administered daily for 6 months. After this, all subjects received placebo for 6 months as the same manner. The baseline quantitative assessments of BMD and biochemical bone markers, serum osteocalcin and C-terminal telopeptide of type I collagen (ICTP), were performed before the administration of drug. The follow up assessments were performed at 6 and 12 months after drug and placebo administration. RESULTS: The patients treated with oral alendronate showed significantly higher BMD of femur compared with baseline (p <0.05). Also, ICTP showed significant reduction after alendronate therapy. BMD change rate of alendronate therapy was higher in functional ambulation group compared with wheelchair ambulation group. BMD change rate of alendronate therapy was higher than that of placebo administration. CONCLUSION: Alendronate therapy may be useful in prevention of loss of BMD after spinal cord injury.

Characteristics of Bone Mineral Density in Hemiplegic Upper Extremity

OBJECTIVE: Bone mineral loss in the upper extremity of hemiplegic patients can increase the prevalence of fractures that interrupt the rehabilitation program and lower the level of activity. The aim of this study was to investigate any difference between the affected and unaffected forearm's bone mineral density (BMD) and evaluate the relationship between several clinical variables and osteoporosis of hemiplegic forearm. METHOD: Sixty-seven hemiplegic patients (42 males, 25 females, mean age 55.2 years) were enrolled. The BMD of radius was measured using dual energy X-ray absorptiometry in 67 hemiplegic subjects. RESULTS: The BMD of affected forearm was significantly lower than unaffected side (p<0.05). The reduction of BMD in the hemiplegic forearm well correlated with duration of hemiplegia, self care of functional independence measure score, complex regional pain syndrome-type 1 (CRPS-1) (p<0.05). But, there was no correlation between BMD and modified Ashworth scale, muscle power of wrist extension. CONCLUSION: Hemiplegic forearm had high prevalence of osteoporosis like lower extremity. Therefore, increasing level of ADL and early detection of CRPS-1 was necessary for prevention of osteoporosis of forearm.