입원 치매환자에서 동반된 신체질환

Abstract

Objectives: Patients with dementia are accompanied with poor autonomy and multiple disability. Therefore more cost and medical service are required than non-dementia patients. In order to insure comprehensive, systematic care for dementia patients, knowledge of the associated disease of different types of dementia is warranted. This study evaluate the characteristics of associated disease in inpatients with dementia, to be used as basic reference for effective treatment.

Methods: The study population consist of 92 patient with dementia admitted between January 1, 1996 and September 30, 1997 to geriatric department, Yonsei University Kwangju Severance Psychiatric Hospital. Diagnoses were based on DSM-IV and NINCDS. Severity of dementia was evaluated by GDS (Global Deterioration Scale). Associated diseases was recorded in separated checklist. x-test, Fisher´s exact test, ANOVA, T-test, Wilcoxon rank sum test, Kruskal-Wallis test were used to determine statistical differences among the dementia subgroup.

Results: The mean age was 71.8±9.2 with 31 male (33.7%) subjects and 61 female subject (66.3%). The types of dementia among the 92 demented patients were as follows : 50 (54%) with Alzheimer´s disease, 30 (33%) with vascular dementia, 12 (13%) with unclassified dementia. Mean GDS score was 5.4±1.1. The mean duration of admission was 66.9±88.9 days. Types of discharge were normal discharge 33 (35.9%), discharge against doctors´ advice 28(30.4%), transfer 23 (25.0%). The average number of diagnoses was 4.9±2.4. (4.5±2.4 in Alzheimer´s disease, 6.1±2.4 in vascular dementia, 5.3±2.1 in unclassified dementia in respectively(p<0.05). The most common associated disease were gastrointestinal disorders (24.8%), cardiovascular disorders (11.8%), urinary tract infection (6.8%), musculoskeletal disorder (6.6%), diabetes mellitus (4.5%). Associated diseases that their frequency showed significant differences in different types of dementia were hypertension, diabetes mellitus, urinary incontinence, oral cavity disease, anemia (p<0.01).

Conclusions: Associated disease are different in different type of dementia. Patients with vascular dementia had more associated disease and received more drugs for associated disease than Alzheimer´s disease. Our data emphasize comprehensive and systematic treatment plan according to type of dementia.