在宅生活の認知症の低栄養

地域在宅生活をしている認知症患者の低栄養の有病割合をみた論文を紹介します。

Marta Roqué, A. Salva, B. Vellas. Malnutrition in community-dwelling adults with dementia (Nutrialz trial). The journal of nutrition, health & aging, doi: 10.1007/s12603-012-0401-9

対象は地域在宅生活をしている認知症患者940人です。栄養状態はMNAで評価しています。結果ですが、低栄養5.2%、低栄養の恐れあり42.6%、栄養状態良好52.2%でした。認知症のタイプ別ではレビー小体型が低栄養18.2%で、他のタイプより低栄養が多かったです。

低栄養は高齢、認知機能低下、機能行動障害、介護負担と有意に関連していました。ADLもしくはIADLのいずれかに介助が必要な場合、低栄養が有意に多かったです。食事に介助を要する場合が最もリスクが高く、調理に介助を要する場合は中等度のリスクでした。

抄録しか読んでいないので詳細不明ですが、思ったより低栄養の割合が少ない印象です。地域在宅で生活できている場合には、この程度なのかもしれません。入院や施設というセッティングになるともっと低栄養の方が多いと思います。レビー小体型認知症で低栄養が多いのは納得できます。

Abstract

Objectives

The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.

Design

Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).

Setting

Community-dwelling individuals attending dementia clinics.

Participants

940 individuals.

Measurements

The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.

Results

5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02–1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.

Conclusion

These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.