痴呆患者日常生活能力下降模式的研究

Study on the decreasing pattern of activities of daily living in patients with dementia

目的了解痴呆患者日常生活能力（ADL）下降的情况和模式。方法收集痴呆患者204例，其中阿尔茨海默病（AD）106例，血管性痴呆（VD）54例，其他类型痴呆44例；根据简易智能状态检查表（MMSE），轻、中、重度痴呆患者分别为42例、37例、125例。采用Barthel指数（BI）对患者ADL进行测评，比较不同认知程度、AD和VD痴呆及不同文化程度痴呆患者的日常生活能力。结果痴呆患者ADL保留最多项目的是大便（48．5％）、小便（44．1％）和梳洗（40．2％）三项，能力保留最少的项目是上楼梯（25．5％）和洗澡（18．1%）；随着认知损害的加重，痴呆患者的BI得分也是明显下降，其中重度（23．2士29．3）分、中度（65．5±26．4）分、轻度痴呆（87．4土22．7）分，其差异有统计学意义（X^2=99．686，P=0．000）；AD与VD比较，日常活动能力保留率（16．98％～53．77％）明显高于VD患者（1．85％～33．33％）；不同文化程度痴呆患者BI得分小学及以下（40．1±39．0）分、中学组（45．3±39．6）分、大专及以上组（53．1±37．7）分，其差异无统计学意义（X^2=3．653，P-0．161）。结论中国痴呆患者最易丧失的日常生活功能是洗澡、上楼梯，最易保留的是大便、小便和梳洗。日常生活能力受痴呆程度和类型影响，但与文化程度无明显相关性。

Objective To investigate the decreasing pattern of activities of daily living （ADL） in patients with dementia. Methods A total of 204 patients with dementia were collected, among which 106 cases were with Alzheimer＇s diseases（AD）, 54 cases with vascular dementia（VD）, 44 cases with other types of dementia. According to the scores of mini-mental state examination（MMSE）, mild, moderate and severe dementia were 42 cases, 37 cases and 125 cases, respectively. All of them were assessed by Barthel index（BI） and compared among degrees of dementia, between AD and VD, and levels of education. Results The most reserved items were bowel movement （48.5%）, urination （44.1%） and grooming （40.2%）, while the most vulnerable items were climbing stairs （25.5%） and bathing（18.1%）. With increasing impairment of cognition, the scores of BI were getting decreasing. There were significant differences among severe [（23.20±29.27）scores], moderate[（65.54±26.35）scores] and mild[（87.38±22.69） scores] groups （Z2 =99.686, P= 0. 000）. Basic ADL were more reserved in AD （16.98%-53.77%） compared with VD （1.85M- 33.33 %） patients. No significant differences were found（zz = 3. 653, P = 0.161） among patients with education of primary school and below [（40.14±39.0） scores], middle school[（45.3 ± 39.6） scores], and high school and above〈（53.1 4±37.7） scores;. Conclusions Among patients with dementia, bowel control, bladder control and grooming are well reserved, climbing stairs and bathing are vulnerable functions. Basic activities of daily living may be affected by cognitive status and the types of dementia but not levels of culture.