Association between caregiver burden and comorbidity in elderly patients with cognitive impairment / 中华老年医学杂志

Objective To examine the association between caregiver burden and comorbidity in elderly patients with cognitive impairment.Methods The study was conducted in 212 patients at the Memory Clinic and the Departments of Geriatrics and Neurology of Fuxing Hospital from September 2014 to September 2016.Recruited patients were assigned into a dementia group and a non-dementia group according to their cognitive status and were examined using mini mental state examination (MMSE),auditory verbal learning test (AVLT),activity of daily living (ADL),neuropsychiatric inventory(NPI),and Charlson comorbidity index(CCI).Their caregivers were surveyed with Zarit burden inventory (ZBI).Results The ZBI score was significantly correlated with patients' age,gender,CCI,MMSE,NPI,and ADL.The ZBI score was higher in male patients(21.21 ± 11.24)than in female patients(18.33±10.38).Age(r=0.10,P＜0.001),NPI(r=0.32,P＜0.001),ADL(r=0.29,P ＜0.001),and CCI(r =0.38,P ＜0.001) were positively correlated with caregiver burden,while MMSE(r =-0.28,P ＜ 0.001) was negatively correlated with it.Multiple linear regression model analysis indicated that MMSE,NPI,ADL,and CCI were influencing factors for caregiver burden.When CCI was stratified into CCIno dementia and CCIdementi8,influencing factors for caregiver burden were identified as MMSE,NPI,ADL,and CCIdementia.Conclusions Cognitive deterioration,decrease in ADL,and neuropsychiatric symptoms in elderly patients are the major causes of increased caregiver burden.Besides,the number and severity of comorbidity are independent factors for caregiver burden.

Roles of distinguish vascular dementia from Alzheimer's disease with memory and executive screening scale / 中国脑血管病杂志

Objective To investigate the value of differential diagnosis for subcortical ischemic vascular dementia(SIVD)and Alzheimer's disease(AD)with memory and executive screening(MES) scale. Methods Fifty SIVD and 50 AD patients treated in the outpatient and wards of the Department of Neurology,Fuxing Hospital,Capital Medical University from June 2012 to November 2013 were enrolled retrospectively. They were enrolled in either a SIVD group or an AD group. Fifty healthy subjects in Yuetan community of Fuxing hospital were selected as a control group at the same period. The age,sex and education level of the subjects in the 3 groups were matched. The Mini-Mental State Examination( MMSE) and MES were used to measure all subjects and were compared;receiver operating characteristic curves was used to analyze the radio of memory and executive part for SIVD and AD discrimination. Results (1)There was no significant difference in total MMSE score between the SIVD group and the AD group(20. 6 ± 5. 5 vs. 20. 6 ± 3. 3;P>0. 05).(2)There were significant differences in each MES indexes among the patients of the 3 groups(all P>0. 05). The 1,3,4 and 5 scores for the sentence memory in the SIVD group were significantly higher than those of the AD group. There were significant differences(all P0. 05).(3)When MES-R was≥0. 7,the sensitivity and specificity of differentiating SIVD were 76. 7% and 83. 3%,and the total score of MMSE for differentiating the sensitivity and specificity of SIVD were 40. 0% and 0. 7%. Conclusion The differences of MES reflecting sentence memory and executive part may better distinguish the patients with SIVD and AD.

Pseudo-words reading of Chinese patients with mild Alzheimer's disease / 中华行为医学与脑科学杂志

Objective To analyze the language function impairment differences between the two steps from the form to sound processing and from the sound to meaning processing for pseudo-words reading in Alzheimer' s disease (AD).Methods The pseudo-words reading test consists two parts:pseudo-true words and pseudopseudo words.Each part had 10 words.All of the 20 words were presented randomly.Correct reading presents the processing of from form to sound,and correct judging presents the processing of from sound to meaning.Each correct respond get 1 score,otherwise get 0.Each part had a total score of 20.Results The pseudo-words reading test was performed to 41 mild AD participants with Mini-mental State Examination (MMSE) average scores of (21.06 ±2.86),and 135 normal controls with MMSE average scores of (28.08± 1.52).The two groups were matched in age,gender and education.For all of the mild AD group and normal control group,there was no significant difference between reading score and judging score in either pseudo-true words or pseudo-pseudo words (P＞0.05).Comparing with mild AD group and normal control group,there was no significant difference in reading score in either pseudo-true words or pseudo-pseudo words (P＞0.05).For judging score,there was significant difference in pseudotrue words (P＜0.01) but not in pseudo-pseudo words (P＞0.05).Conclusion Understanding real syllable is impaired in patients with mild AD.

Understanding of the 2013 International Association of Pancreatology/American Pancreatic Association evidence-based guidelines for the management of acute pancreatitis / 中华消化外科杂志

Acute pancreatitis is one of the most common acute abdominal disease requiring acute hospitalization worldwide.As severe acute pancreatitis associated with mortality up to 30％,rational diagnosis and management requires up-to-date evidence-based treatment guidelines.The Guidelines for the surgical management of acute pancreatitis composed by the International Association of Pancreatology (IAP) was published in 2002,since then there have been substantial improvements in the management of acute pancreatitis.The collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach in 2013 and published their new guidelines 2013 IAP/APA evidence-based guidelines for the management of acute pancreatitis few months ago.This paper presented the understandings of this new guidelines and compared with related guidelines abroad.

Clinical analysis of acute cerebral infarction combined with deep venous thrombosis of lower extremities in the elderly / 中华老年医学杂志

Objective To summarize the treatment experience of acute cerebral infarction (ACI)combined with deep venous thrombosis (DVT) of lower extremities in the elderly. Methods Thirty cases of elder patients with ACI combined with DVT (ACI group) were enrolled in this study, and 31 cases of elder patients with DVT were served as control group. All the patients were immobilized for 3 days and treated with low molecular heparin calcium (100 IU/kg,Q12 hX14 d). On the tenth day,warfarin was used and INR was controlled in 2.0～2.5. Low molecular dextran was infused intravenously per day for 14 days (500mg/d). Results Edema in the lower limbs of patients were apparently reduced. 4 eases had cerebral hemorrhage in ACI group, and none in the control group.Hemorrhage occured from 3 to 7 days during the treatment with low molecular heparin calcium. One of the patient died of massive intraeranial hemorrhage with lung infection. Conclnsions It should be more careful to use the low molecular heparin to treat the elder patients older than 80 years old with ACI combined with DVT.

Clinical features and correlative factors of senile coronary heart disease accompanied with depression / 中国康复理论与实践

@#ObjectiveTo investigate clinical features, correlative factors and prognosis of senile coronary heart disease accompanied with depression.MethodsFifty two senile patients of coronary hart disease with depression were selected for the observation group, sixty cases without depression as control group. Clinical features, family conditions, society factors and Holter report (supervision) of two groups were analyzed.ResultsClinical features such as severe dyssomnia, anxiety agitation, emotion depressing, loss of interest, feeling waste and sense of guilty in patients of observation group were significant different with those in control group. The rate of family harmoniousness and society supporting between patients of two groups were significantly different. The incidence of ventricular arrhythmias, atrial arrhythmia and myocardial ischemia changes on ST-T in the Holter reports of patients in observation group were higher than those in control group (P<0.05 or P<0.01). The incidence of cardiac sudden death of patients in observation group was also higher than patients in control group (P<0.05).ConclusionClinical symptoms such as severs dyssomnia, anxiety agitation, emotion depressing are easily occurred in senile coronary heart disease patients with depression. Patients with depression have higher incidence of cardiac sudden death, having better relationship and society support are advantageous to prevent and reduce the depression in senile coronary heart disease patients.