摘要
痴呆和虚弱会增加老年人的健康逆境,这是越来越引起研究兴趣的话题。虚弱被认为是一种与年龄相关的生物综合征。虚弱的患者最终可能会在多个系统中出现多种功能障碍,包括中风、短暂性脑缺血发作、血管性痴呆、帕金森病、阿尔茨海默病、额颞叶痴呆、路易体痴呆、皮质基底部变性、多系统萎缩、肌萎缩性侧索硬化和克雅氏病。痴呆和虚弱的患者经常出现营养不良和体重减轻。这些患者通常需要严格的营养、药理学和非药理学干预,这对医疗保健提供者来说是一个具有挑战性的问题。从小养成健康的饮食和生活方式可以降低虚弱和痴呆的风险。为了获得最佳治疗,需要包括临床评估、认知筛查、基本实验室评估、结构成像、功能性神经成像和神经心理学测试在内的准确诊断。诊断程序最好应用临床诊断,确定适合治疗的原因和条件。患者的病史、护理者的面谈、体检、认知评估、实验室测试和结构成像应最佳地参与诊断过程。不同类型的体育锻炼可以帮助治疗这些疾病。营养维持是一个特别重要的因素,例如高热量膳食补充剂和地中海饮食以支持体重增加。本文的核心目的是调查痴呆和虚弱管理的趋势,重点是改善诊断和治疗。大量证据表明,均衡的营养和良好的身体活动是治疗的一个组成部分。值得注意的是,需要更多的循证医学知识。
关键词: 痴呆、虚弱、营养不良、中风、诊断、地中海饮食。
[http://dx.doi.org/10.1016/j.arr.2013.06.004] [PMID: 23831959]
[http://dx.doi.org/10.1007/s00415-021-10580-z] [PMID: 33928432]
[http://dx.doi.org/10.1212/WNL.0000000000004058]
[http://dx.doi.org/10.1212/WNL.0000000000009323] [PMID: 32241955]
[http://dx.doi.org/10.1371/journal.pmed.0030397] [PMID: 17076551]
[http://dx.doi.org/10.1093/ageing/afaa284] [PMID: 33492349]
[http://dx.doi.org/10.1590/0102-311x00046520] [PMID: 33566988]
[http://dx.doi.org/10.1016/S2666-7568(21)00008-8]
[http://dx.doi.org/10.1186/s12877-020-01539-2] [PMID: 32293307]
[http://dx.doi.org/10.2174/156720506779025233] [PMID: 17168640]
[http://dx.doi.org/10.1016/j.jalz.2006.09.002] [PMID: 19595916]
[http://dx.doi.org/10.3233/JAD-191075] [PMID: 32390618]
[http://dx.doi.org/10.1212/WNL.0000000000001831] [PMID: 26180144]
[http://dx.doi.org/10.1212/01.WNL.0000149519.47454.F2] [PMID: 15668425]
[http://dx.doi.org/10.1186/s12916-014-0130-5] [PMID: 25385322]
[http://dx.doi.org/10.1186/s12916-014-0206-2] [PMID: 25385447]
[http://dx.doi.org/10.1503/cmaj.050051] [PMID: 16129869]
[http://dx.doi.org/10.1016/j.jamda.2013.03.022] [PMID: 23764209]
[http://dx.doi.org/10.14283/jpad.2016.94] [PMID: 27547746]
[http://dx.doi.org/10.1007/s12603-016-0828-5] [PMID: 28537326]
[http://dx.doi.org/10.1007/s12603-016-0685-2] [PMID: 27499306]
[http://dx.doi.org/10.1007/978-3-030-33330-0_3] [PMID: 31894543]
[http://dx.doi.org/10.3233/JAD-170963] [PMID: 29562543]
[http://dx.doi.org/10.1016/j.ijnurstu.2013.03.001] [PMID: 23548170]
[http://dx.doi.org/10.7861/futurehosp.3-1-49] [PMID: 31098179]
[http://dx.doi.org/10.1016/j.nedt.2019.104207] [PMID: 31669968]
[http://dx.doi.org/10.1177/1049909118766316] [PMID: 29580073]
[http://dx.doi.org/10.7189/jogh.09.020310] [PMID: 31777656]
[http://dx.doi.org/10.2147/RMHP.S168750] [PMID: 30858741]
[http://dx.doi.org/10.1093/ageing/afu138] [PMID: 25336440]
[http://dx.doi.org/10.1177/1355819617752971] [PMID: 29325443]
[http://dx.doi.org/10.1016/S0140-6736(19)31785-4] [PMID: 31609229]
[http://dx.doi.org/10.1016/j.jamda.2018.01.003] [PMID: 29526597]
[http://dx.doi.org/10.2147/CIA.S36739] [PMID: 24204133]
[http://dx.doi.org/10.1093/gerona/glx085] [PMID: 28575291]
[http://dx.doi.org/10.1016/j.pcad.2014.07.005] [PMID: 25216613]
[http://dx.doi.org/10.1016/j.pcad.2014.07.004] [PMID: 25216612]
[http://dx.doi.org/10.1089/rej.2012.1397] [PMID: 23327448]
[http://dx.doi.org/10.1186/s12877-015-0155-4] [PMID: 26626157]
[http://dx.doi.org/10.1016/j.jamda.2017.04.018] [PMID: 28648901]
[http://dx.doi.org/10.1016/j.amjmed.2015.06.017] [PMID: 26159634]
[http://dx.doi.org/10.1097/00002093-200301000-00001] [PMID: 12621314]
[http://dx.doi.org/10.1111/j.1532-5415.2000.tb04785.x] [PMID: 10983909]
[http://dx.doi.org/10.1016/j.jalz.2007.02.001] [PMID: 19595921]
[http://dx.doi.org/10.1001/jama.288.12.1475] [PMID: 12243634]
[http://dx.doi.org/10.1212/01.CON.0000429175.29601.97]
[http://dx.doi.org/10.3390/nu13020536] [PMID: 33562065]
[http://dx.doi.org/10.1093/ijpp/riab001] [PMID: 33729534]
[http://dx.doi.org/10.1159/000503830] [PMID: 32241012]
[http://dx.doi.org/10.1017/S0317167100005497]
[http://dx.doi.org/10.7326/0003-4819-144-2-200601170-00004] [PMID: 16418406]
[http://dx.doi.org/10.1186/s12877-017-0633-y] [PMID: 29126383]
[http://dx.doi.org/10.1093/gerona/61.3.262] [PMID: 16567375]
[http://dx.doi.org/10.1093/gerona/62.7.722] [PMID: 17634318]
[http://dx.doi.org/10.1002/14651858.CD011145.pub2] [PMID: 26760674]
[http://dx.doi.org/10.4103/0028-3886.32779] [PMID: 17558112]
[http://dx.doi.org/10.1371/journal.pone.0196104] [PMID: 29672647]
[http://dx.doi.org/10.1016/j.archger.2007.08.012] [PMID: 17936377]
[http://dx.doi.org/10.1177/070674370705200508] [PMID: 17542384]
[http://dx.doi.org/10.1111/j.1532-5415.2005.53221.x] [PMID: 15817019]
[http://dx.doi.org/10.2147/NDT.S229555] [PMID: 31819448]
[http://dx.doi.org/10.30773/pi.2017.08.24] [PMID: 29475235]
[http://dx.doi.org/10.1212/WNL.0b013e3181c34b47] [PMID: 19933974]
[http://dx.doi.org/10.1177/0891988712455235] [PMID: 22859702]
[http://dx.doi.org/10.1016/j.jamda.2012.04.007] [PMID: 22579590]
[http://dx.doi.org/10.1001/jama.2019.4782] [PMID: 31638686]
[http://dx.doi.org/10.1055/s-0039-1683445] [PMID: 30925609]
[http://dx.doi.org/10.1186/s42490-019-0007-y] [PMID: 32903310]
[http://dx.doi.org/10.1016/j.jalz.2011.09.223] [PMID: 23245560]
[http://dx.doi.org/10.1159/000496537]
[http://dx.doi.org/10.1503/cmaj.070798] [PMID: 18362376]
[http://dx.doi.org/10.1503/cmaj.150508] [PMID: 27067820]
[http://dx.doi.org/10.1007/s40520-020-01559-3] [PMID: 32356135]
[http://dx.doi.org/10.1016/j.gerinurse.2021.02.003] [PMID: 33714024]
[http://dx.doi.org/10.1080/09540260802095099] [PMID: 18925484]
[http://dx.doi.org/10.1159/000353859] [PMID: 23970189]
[PMID: 29671539]
[http://dx.doi.org/10.5770/cgj.15.42] [PMID: 23259021]
[http://dx.doi.org/10.1377/hlthaff.2010.0440] [PMID: 20439877]
[http://dx.doi.org/10.3389/fpsyt.2020.615758] [PMID: 33551877]
[http://dx.doi.org/10.1016/j.pmn.2012.08.007] [PMID: 24602437]
[http://dx.doi.org/10.1080/13607860410001725018] [PMID: 15511740]
[http://dx.doi.org/10.1001/jama.298.20.2409] [PMID: 18042918]
[PMID: 23205063]
[http://dx.doi.org/10.1111/jgs.16247] [PMID: 31792940]
[http://dx.doi.org/10.1002/14651858.CD006211.pub3] [PMID: 28898390]
[http://dx.doi.org/10.1097/WAD.0b013e3181a6bebc] [PMID: 19568149]
[http://dx.doi.org/10.7326/0003-4819-145-7-200610030-00006] [PMID: 17015866]
[http://dx.doi.org/10.1001/archinte.165.13.1493] [PMID: 16009864]
[http://dx.doi.org/10.1136/qshc.2005.016444] [PMID: 16751463]
[http://dx.doi.org/10.1007/s11606-007-0393-z] [PMID: 18373151]
[http://dx.doi.org/10.1159/000269933] [PMID: 20150733]
[http://dx.doi.org/10.1007/s12603-011-0126-1] [PMID: 21968870]
[http://dx.doi.org/10.3810/pgm.2010.07.2178] [PMID: 20675974]
[http://dx.doi.org/10.1111/j.1365-2702.2007.02220.x] [PMID: 18416791]
[http://dx.doi.org/10.1016/j.jdiacomp.2017.05.003] [PMID: 28669464]
[PMID: 25087440]
[http://dx.doi.org/10.1016/S0140-6736(20)30367-6] [PMID: 32738937]
[http://dx.doi.org/10.1016/j.jalz.2016.08.007] [PMID: 27693188]
[http://dx.doi.org/10.1016/S1474-4422(08)70194-7] [PMID: 18771956]
[http://dx.doi.org/10.1074/jbc.M110.193433] [PMID: 21454553]
[http://dx.doi.org/10.1016/j.neurobiolaging.2016.03.001] [PMID: 27143419]
[http://dx.doi.org/10.1523/JNEUROSCI.3081-17.2018] [PMID: 29378861]
[http://dx.doi.org/10.1177/0890117117737409] [PMID: 29108442]
[http://dx.doi.org/10.3233/JAD-171141] [PMID: 29614667]
[http://dx.doi.org/10.1017/S0714980820000069] [PMID: 32366352]
[http://dx.doi.org/10.3390/ijms20133327] [PMID: 31284573]
[http://dx.doi.org/10.1177/1471301217746769] [PMID: 29271252]
[http://dx.doi.org/10.3390/pharmaceutics13030379] [PMID: 33809385]
[http://dx.doi.org/10.1007/s10465-016-9221-5]
[PMID: 28155990]
[PMID: 30496547]
[http://dx.doi.org/10.7326/0003-4819-156-1-201201030-00008] [PMID: 22213494]
[http://dx.doi.org/10.1016/j.psc.2010.11.006] [PMID: 21333844]
[http://dx.doi.org/10.1016/j.mhpa.2009.01.002]
[http://dx.doi.org/10.3390/molecules25225389] [PMID: 33217959]
[http://dx.doi.org/10.1007/s11892-014-0487-z] [PMID: 24623199]
[http://dx.doi.org/10.1016/S0140-6736(17)31363-6] [PMID: 28735855]
[http://dx.doi.org/10.1016/j.neuro.2017.03.006] [PMID: 28363508]
[http://dx.doi.org/10.1001/jama.292.12.1447] [PMID: 15383515]
[http://dx.doi.org/10.1176/appi.ajp.2017.17040404] [PMID: 29179578]
[http://dx.doi.org/10.1056/NEJMoa050151] [PMID: 15829527]
[http://dx.doi.org/10.1177/1471301211431362] [PMID: 24336954]
[http://dx.doi.org/10.1016/j.ejphar.2017.11.041] [PMID: 29183836]
[http://dx.doi.org/10.1001/jama.291.3.317] [PMID: 14734594]
[http://dx.doi.org/10.1371/journal.pmed.1002862] [PMID: 31374073]
[http://dx.doi.org/10.1186/s13643-017-0632-2] [PMID: 29258596]
[PMID: 21500874]
[http://dx.doi.org/10.1136/jech-2017-209811] [PMID: 29089367]
[http://dx.doi.org/10.3390/ma15030804] [PMID: 35160749]
[http://dx.doi.org/10.3390/biology11010147] [PMID: 35053145]
[http://dx.doi.org/10.2174/1566523221666210303100805] [PMID: 33655857]
[http://dx.doi.org/10.1001/archneurol.2009.201] [PMID: 19822776]
[http://dx.doi.org/10.2174/156800705774322021] [PMID: 16266284]
[http://dx.doi.org/10.1155/2013/784520] [PMID: 24959566]
[http://dx.doi.org/10.1212/01.wnl.0000271090.28148.24] [PMID: 17568013]
[http://dx.doi.org/10.1111/jgs.16762] [PMID: 32909259]
[http://dx.doi.org/10.1002/14651858.CD011905.pub2] [PMID: 30383288]
[http://dx.doi.org/10.1177/026010600601800304] [PMID: 17180867]
[http://dx.doi.org/10.3390/molecules27010233] [PMID: 35011465]
[http://dx.doi.org/10.1056/NEJMe068086] [PMID: 16807420]
[http://dx.doi.org/10.1186/s12877-017-0443-2] [PMID: 28196475]
[http://dx.doi.org/10.1111/nyas.13058] [PMID: 27116242]
[http://dx.doi.org/10.1159/000318570] [PMID: 20628264]
[http://dx.doi.org/10.1007/s11920-016-0721-2] [PMID: 27481112]
[http://dx.doi.org/10.1097/YCO.0b013e3282f97b1f] [PMID: 18382231]
[http://dx.doi.org/10.1017/S0033291705006264] [PMID: 16207391]
[http://dx.doi.org/10.1212/01.wnl.0000192165.99963.2a] [PMID: 16291928]
[http://dx.doi.org/10.1159/000313433]
[http://dx.doi.org/10.1016/j.jamda.2020.05.004] [PMID: 32669236]
[http://dx.doi.org/10.1007/s40520-018-0918-9] [PMID: 29476480]
[http://dx.doi.org/10.1007/s10620-020-06746-w] [PMID: 33385264]
[http://dx.doi.org/10.1016/j.clnu.2020.07.032] [PMID: 32826110]
[http://dx.doi.org/10.3390/nu13041259] [PMID: 33921207]
[http://dx.doi.org/10.1080/21548331.2021.1905414] [PMID: 33729898]
[http://dx.doi.org/10.1038/nrneurol.2009.175] [PMID: 19918254]
[http://dx.doi.org/10.1161/STROKEAHA.110.595082] [PMID: 21212395]
[http://dx.doi.org/10.1002/ana.21208] [PMID: 17879383]
[http://dx.doi.org/10.1016/S1474-4422(07)70057-1] [PMID: 17362834]
[http://dx.doi.org/10.1016/j.jalz.2007.07.009] [PMID: 19595960]
[http://dx.doi.org/10.1111/1747-0080.12144]
[http://dx.doi.org/10.1212/WNL.0b013e3181d55f24] [PMID: 20231670]
[http://dx.doi.org/10.1519/JPT.0000000000000172] [PMID: 29286983]
[http://dx.doi.org/10.1212/01.wnl.0000215428.46057.3d] [PMID: 16606910]
[http://dx.doi.org/10.1136/jnnp-2014-307659] [PMID: 24828899]
[http://dx.doi.org/10.1176/appi.ajp.2015.14121582] [PMID: 26085043]
[http://dx.doi.org/10.1007/s12603-019-1273-z] [PMID: 31641726]
[http://dx.doi.org/10.1097/MCO.0000000000000411] [PMID: 28806178]
[http://dx.doi.org/10.1186/s12883-014-0175-2] [PMID: 25213690]
[http://dx.doi.org/10.1007/BF03324818] [PMID: 19934620]
[http://dx.doi.org/10.1177/0269215507078318] [PMID: 17984150]
[http://dx.doi.org/10.1080/01634372.2014.882466]
[http://dx.doi.org/10.1002/gps.1293] [PMID: 15852459]
[http://dx.doi.org/10.1097/00002093-198802040-00003] [PMID: 3196468]
[http://dx.doi.org/10.1111/j.1748-3743.2010.00235.x] [PMID: 21539720]
[http://dx.doi.org/10.1093/ageing/afw247] [PMID: 28064173]
[http://dx.doi.org/10.1093/gerona/glu099] [PMID: 25387728]
[http://dx.doi.org/10.1111/cns.12484] [PMID: 26778658]
[http://dx.doi.org/10.1007/s13670-019-0269-1] [PMID: 31341757]
[http://dx.doi.org/10.1007/s00228-013-1575-8] [PMID: 24019054]
[PMID: 25999704]
[http://dx.doi.org/10.1093/gerona/61.3.278] [PMID: 16567378]
[http://dx.doi.org/10.1186/s12877-016-0196-3] [PMID: 26801619]
[http://dx.doi.org/10.1016/j.clnu.2006.01.012] [PMID: 16735082]
[http://dx.doi.org/10.3390/ijms222312638] [PMID: 34884440]
[http://dx.doi.org/10.1111/1467-8500.12131]
[http://dx.doi.org/10.1057/bp.2014.19]
[http://dx.doi.org/10.1017/S0144686X17001295]
[http://dx.doi.org/10.1007/s12126-016-9244-8] [PMID: 28890585]
[http://dx.doi.org/10.3390/ijerph17165956] [PMID: 32824512]