入院期心不全患者の軽度認知機能障害がADL 改善効果に及ぼす影響
【目的】心不全における軽度認知機能障害（以下，MCI）が理学療法（以下，PT）によるADL 改善効果を制限するかについて検討する。【方法】病前ADL が自立であった心不全患者155 例を，MCI 群108 例と対照群47 例に分け，PT 開始時および退院時の身体機能を比較した。また，重回帰分析で退院時Barthel Index（以下，BI）の関連因子を検討した。【結果】PT 開始時のBI と下肢機能（以下，SPPB）はMCI 群で有意に低値であった。MCI 群の退院時BI は対照群と差がない値まで改善したが，MCI 群のSPPB は退院時も対照群よりも低値であった。MCI 患者の退院時BI の...
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| Published in | 理学療法学 Vol. 48; no. 4; pp. 362 - 369 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益社団法人日本理学療法士協会
2021
日本理学療法士協会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-3770 2189-602X |
| DOI | 10.15063/rigaku.11971 |
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| Abstract | 【目的】心不全における軽度認知機能障害（以下，MCI）が理学療法（以下，PT）によるADL 改善効果を制限するかについて検討する。【方法】病前ADL が自立であった心不全患者155 例を，MCI 群108 例と対照群47 例に分け，PT 開始時および退院時の身体機能を比較した。また，重回帰分析で退院時Barthel Index（以下，BI）の関連因子を検討した。【結果】PT 開始時のBI と下肢機能（以下，SPPB）はMCI 群で有意に低値であった。MCI 群の退院時BI は対照群と差がない値まで改善したが，MCI 群のSPPB は退院時も対照群よりも低値であった。MCI 患者の退院時BI の関連因子は退院時SPPB であった。【結論】MCI では非MCI よりも入院時BI が低下するリスクが高いが，PT 実施によるBI 改善効果はMCI の有無にかかわらず同様であることが示された。 |
|---|---|
| AbstractList | 【目的】心不全における軽度認知機能障害（以下，MCI）が理学療法（以下，PT）によるADL 改善効果を制限するかについて検討する。【方法】病前ADL が自立であった心不全患者155 例を，MCI 群108 例と対照群47 例に分け，PT 開始時および退院時の身体機能を比較した。また，重回帰分析で退院時Barthel Index（以下，BI）の関連因子を検討した。【結果】PT 開始時のBI と下肢機能（以下，SPPB）はMCI 群で有意に低値であった。MCI 群の退院時BI は対照群と差がない値まで改善したが，MCI 群のSPPB は退院時も対照群よりも低値であった。MCI 患者の退院時BI の関連因子は退院時SPPB であった。【結論】MCI では非MCI よりも入院時BI が低下するリスクが高いが，PT 実施によるBI 改善効果はMCI の有無にかかわらず同様であることが示された。 「要旨」【目的】心不全における軽度認知機能障害(以下, MCI)が理学療法(以下, PT)によるADL改善効果を制限するかについて検討する. 【方法】病前ADLが自立であった心不全患者155例を, MCI群108例と対照群47例に分け, PT開始時および退院時の身体機能を比較した. また, 重回帰分析で退院時Barthel Index(以下, BI)の関連因子を検討した. 【結果】PT開始時のBIと下肢機能(以下, SPPB)はMCI群で有意に低値であった. MCI群の退院時BIは対照群と差がない値まで改善したが, MCI群のSPPBは退院時も対照群よりも低値であった. MCI患者の退院時BIの関連因子は退院時SPPBであった. 【結論】MCIでは非MCIよりも入院時BIが低下するリスクが高いが, PT実施によるBI改善効果はMCIの有無にかかわらず同様であることが示された. |
| Author | 髙橋, 蓮 松川, 祐子 松島, 圭亮 横田, 純一 |
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| Copyright | 2021 日本理学療法士学会 |
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| References | 20) American Psychiatric Association: Diagnostic and Statistical Manual of Manual of Mental Disorders, 5th ed, American Psychiatric Association, Virginia, 2013. 7) Zuccalà G, Cattel C, et al.: Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997; 63: 509–512. 30) Massimo FP, Viviane C, et al.: Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. 36) Wellwood I, Dennis MS, et al.: A comparison of the Barthel Index and the OPCS disability instrument used to measure outcome after acute stroke. Age Ageing. 1995; 24: 54–57. 1) Shimokawa H, Miura M, et al.: Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015; 17: 884–892. 39) Puthucheary ZA, Hart N: Skeletal muscle mass and mortality — but what about functional outcome? Crit Care. 2014; 18: 110. 43) Nasreddine ZS, Phillips NA, et al.: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53: 695–699. 12) Provencher V, Sirois MJ, et al.: Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc. 2015; 63: 860–868. 22) O'Bryant SE, Humphreys JD, et al.: Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008; 65: 963–967. 34) Sacre JW, Ball J, et al.: Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease. Eur Heart J Cardiovasc Imaging. 2018; 19: 285–292. 8) van den Hurk K, Reijmer YD, et al.: Heart failure and cognitive function in the general population: the Hoorn Study. Eur J Heart Fail. 2011; 13: 1362–1369. 19) Folstein MF, Folstein SE, et al.: “Mini-mental state”: a practical method of grading the cognitive function of patients for the clinician. J Psychiatr Res. 1975; 12: 189–198. 11) Cannon JA, Moffitt P, et al.: Cognitive Impairment and Heart Failure: Systematic Review and Meta-Analysis. J Card Fail. 2017; 23: 464–475. 38) Pedersen MM, Holt NE, et al.: Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study. J Gerontol A Biol Sci Med Sci. 2014; 69: 1511–1518. 21) Creavin ST, Wisniewski S, et al.: Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016; 1: CD011145. 24) Kim H, Awata S, et al.: Cognitive frailty in community-dwelling older Japanese people: Prevalence and its association with falls. Geriatr Gerontol Int. 2019; 19: 647–653. 37) Steere HK, Quach L, et al.: Evaluating the Influence of Social Engagement on Cognitive Impairment and Mobility Outcomes Within the Boston RISE Cohort Study. Am J Phys Med Rehabil. 2019; 98: 685–691. 15) Tsutsui H, Isobe M, et al.: JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure —Digest Version. Circ J. 2019; 83: 2084–2184. 17) Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Med J. 1965; 14: 61–65. 40) Covinsky KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. 13) Petersen RC, Doody R, et al.: Current concepts in mild cognitive impairment. Arch Neurol. 2001; 58: 1985–1992. 4) Hawkins MA, Gunstad J, et al.: Greater body mass index is associated with poorer cognitive functioning in male heart failure patients. J Card Fail. 2014; 20: 199–206. 32) Glantz SA, Palmer RM, et al.: Multicollinearity and What to Do About It. In: Glantz SA, Slinker BK, (eds): Primer of Applied Regression and Analysis of Variance, 2nd ed, McGraw-Hill Education, New York, 2001, pp. 185–240. 27) Guralnik JM, Simonsick EM, et al.: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49: M85–M94. 41) Pastva AM, Hugenschmidt CE, et al.: Cognition, Physical Function, and Quality of Life in Older Patients With Acute Decompensated Heart Failure. J Card Fail. 2020. doi: 10.1016/j.cardfail.2020.09.007. 2) Vogels RL, Scheltens P, et al.: Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007; 9: 440–449. 6) Festa JR, Jia X, et al.: Association of low ejection fraction with impaired verbal memory in older patients with heart failure. Arch Neurol. 2011; 68: 1021–1026. 29) Ignacio de Ulíbarri J, González-Madroño A, et al.: CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005; 20: 38–45. 14) Ishihara K, Izawa KP, et al.: Influence of mild cognitive impairment on activities of daily living in patients with cardiovascular disease. Heart Vessels. 2019; 34: 1944–1951. 26) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166: 111–117. 18) Kay R, Wong KS, et al.: Dichotomizing stroke outcomes based on self-reported dependency. Neurology. 1997; 49: 1694–1696. 5) Baldasseroni S, Mossello E, et al.: Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure. Aging Clin Exp Res. 2010; 22: 308–313. 42) Davey RJ, Jamieson S: The validity of using the mini mental state examination in NICE dementia guidelines. J Neurol Neurosurg Psychiatry. 2004; 75: 343–344. 23) Pozueta A, Rodriguez-Rodriguez E, et al.: Detection of early Alzheimer's disease in MCI patients by the combination of MMSE and an episodic memory test. BMC Neurol. 2011; 11: 78. 25) Yancy CW, Jessup M, et al.: 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128: e240–e327. 33) Yohannes AM, Chen W, et al.: Cognitive Impairment in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: A Systematic Review and Meta-analysis of Observational Studies. Am Med Dir Assoc. 2017; 18: 451. 16) Intzandt B, Black SE, et al.: Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment? Can Geriatr J. 2015; 18: 65–72. 31) 日本循環器学会：心血管疾患におけるリハビリテーションに関するガイドライン（2012 年改訂版），2012．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf （2020 年10 月1 日引用） 28) Izawa K, Hirano Y, et al.: Improvement in physiological outcomes and health-related quality of life following cardiac rehabilitation in patients with acute myocardial infarction. Circ J. 2004; 68: 315–320. 10) Sauvé MJ, Lewis WR, et al.: Cognitive impairments in chronic heart failure: a case controlled study. J Card Fail. 2009; 15: 1–10. 3) Noguchi-Shinohara M, Yuki S, et al.: Differences in the prevalence of dementia and mild cognitive impairment and cognitive functions between early and delayed responders in a community-based study of the elderly. J Alzheimers Dis. 2013; 37: 691–698. 9) Knecht S, Oelschlager C, et al.: Atrial fibrillation in stroke free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J. 2008; 29: 2125–2132. 35) van der Putten JJ, Hobart JC, et al.: Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999; 66: 480–484. |
| References_xml | – reference: 23) Pozueta A, Rodriguez-Rodriguez E, et al.: Detection of early Alzheimer's disease in MCI patients by the combination of MMSE and an episodic memory test. BMC Neurol. 2011; 11: 78. – reference: 30) Massimo FP, Viviane C, et al.: Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. – reference: 32) Glantz SA, Palmer RM, et al.: Multicollinearity and What to Do About It. In: Glantz SA, Slinker BK, (eds): Primer of Applied Regression and Analysis of Variance, 2nd ed, McGraw-Hill Education, New York, 2001, pp. 185–240. – reference: 28) Izawa K, Hirano Y, et al.: Improvement in physiological outcomes and health-related quality of life following cardiac rehabilitation in patients with acute myocardial infarction. Circ J. 2004; 68: 315–320. – reference: 16) Intzandt B, Black SE, et al.: Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment? Can Geriatr J. 2015; 18: 65–72. – reference: 36) Wellwood I, Dennis MS, et al.: A comparison of the Barthel Index and the OPCS disability instrument used to measure outcome after acute stroke. Age Ageing. 1995; 24: 54–57. – reference: 2) Vogels RL, Scheltens P, et al.: Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007; 9: 440–449. – reference: 7) Zuccalà G, Cattel C, et al.: Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997; 63: 509–512. – reference: 35) van der Putten JJ, Hobart JC, et al.: Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999; 66: 480–484. – reference: 37) Steere HK, Quach L, et al.: Evaluating the Influence of Social Engagement on Cognitive Impairment and Mobility Outcomes Within the Boston RISE Cohort Study. Am J Phys Med Rehabil. 2019; 98: 685–691. – reference: 3) Noguchi-Shinohara M, Yuki S, et al.: Differences in the prevalence of dementia and mild cognitive impairment and cognitive functions between early and delayed responders in a community-based study of the elderly. J Alzheimers Dis. 2013; 37: 691–698. – reference: 17) Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Med J. 1965; 14: 61–65. – reference: 12) Provencher V, Sirois MJ, et al.: Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc. 2015; 63: 860–868. – reference: 10) Sauvé MJ, Lewis WR, et al.: Cognitive impairments in chronic heart failure: a case controlled study. J Card Fail. 2009; 15: 1–10. – reference: 5) Baldasseroni S, Mossello E, et al.: Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure. Aging Clin Exp Res. 2010; 22: 308–313. – reference: 14) Ishihara K, Izawa KP, et al.: Influence of mild cognitive impairment on activities of daily living in patients with cardiovascular disease. Heart Vessels. 2019; 34: 1944–1951. – reference: 39) Puthucheary ZA, Hart N: Skeletal muscle mass and mortality — but what about functional outcome? Crit Care. 2014; 18: 110. – reference: 42) Davey RJ, Jamieson S: The validity of using the mini mental state examination in NICE dementia guidelines. J Neurol Neurosurg Psychiatry. 2004; 75: 343–344. – reference: 1) Shimokawa H, Miura M, et al.: Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015; 17: 884–892. – reference: 19) Folstein MF, Folstein SE, et al.: “Mini-mental state”: a practical method of grading the cognitive function of patients for the clinician. J Psychiatr Res. 1975; 12: 189–198. – reference: 26) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166: 111–117. – reference: 34) Sacre JW, Ball J, et al.: Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease. Eur Heart J Cardiovasc Imaging. 2018; 19: 285–292. – reference: 24) Kim H, Awata S, et al.: Cognitive frailty in community-dwelling older Japanese people: Prevalence and its association with falls. Geriatr Gerontol Int. 2019; 19: 647–653. – reference: 4) Hawkins MA, Gunstad J, et al.: Greater body mass index is associated with poorer cognitive functioning in male heart failure patients. J Card Fail. 2014; 20: 199–206. – reference: 21) Creavin ST, Wisniewski S, et al.: Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016; 1: CD011145. – reference: 40) Covinsky KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. – reference: 22) O'Bryant SE, Humphreys JD, et al.: Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008; 65: 963–967. – reference: 33) Yohannes AM, Chen W, et al.: Cognitive Impairment in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: A Systematic Review and Meta-analysis of Observational Studies. Am Med Dir Assoc. 2017; 18: 451. – reference: 29) Ignacio de Ulíbarri J, González-Madroño A, et al.: CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005; 20: 38–45. – reference: 13) Petersen RC, Doody R, et al.: Current concepts in mild cognitive impairment. Arch Neurol. 2001; 58: 1985–1992. – reference: 18) Kay R, Wong KS, et al.: Dichotomizing stroke outcomes based on self-reported dependency. Neurology. 1997; 49: 1694–1696. – reference: 31) 日本循環器学会：心血管疾患におけるリハビリテーションに関するガイドライン（2012 年改訂版），2012．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf （2020 年10 月1 日引用） – reference: 20) American Psychiatric Association: Diagnostic and Statistical Manual of Manual of Mental Disorders, 5th ed, American Psychiatric Association, Virginia, 2013. – reference: 41) Pastva AM, Hugenschmidt CE, et al.: Cognition, Physical Function, and Quality of Life in Older Patients With Acute Decompensated Heart Failure. J Card Fail. 2020. doi: 10.1016/j.cardfail.2020.09.007. – reference: 43) Nasreddine ZS, Phillips NA, et al.: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53: 695–699. – reference: 6) Festa JR, Jia X, et al.: Association of low ejection fraction with impaired verbal memory in older patients with heart failure. Arch Neurol. 2011; 68: 1021–1026. – reference: 8) van den Hurk K, Reijmer YD, et al.: Heart failure and cognitive function in the general population: the Hoorn Study. Eur J Heart Fail. 2011; 13: 1362–1369. – reference: 9) Knecht S, Oelschlager C, et al.: Atrial fibrillation in stroke free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J. 2008; 29: 2125–2132. – reference: 15) Tsutsui H, Isobe M, et al.: JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure —Digest Version. Circ J. 2019; 83: 2084–2184. – reference: 27) Guralnik JM, Simonsick EM, et al.: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49: M85–M94. – reference: 11) Cannon JA, Moffitt P, et al.: Cognitive Impairment and Heart Failure: Systematic Review and Meta-Analysis. J Card Fail. 2017; 23: 464–475. – reference: 38) Pedersen MM, Holt NE, et al.: Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study. J Gerontol A Biol Sci Med Sci. 2014; 69: 1511–1518. – reference: 25) Yancy CW, Jessup M, et al.: 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128: e240–e327. |
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| Snippet | 【目的】心不全における軽度認知機能障害（以下，MCI）が理学療法（以下，PT）によるADL 改善効果を制限するかについて検討する。【方法】病前ADL が自立であった心不全患者155... 「要旨」【目的】心不全における軽度認知機能障害(以下, MCI)が理学療法(以下, PT)によるADL改善効果を制限するかについて検討する. 【方法】病前ADLが自立であった心不全患... |
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| SubjectTerms | Activities of daily living 心不全 理学療法 軽度認知機能障害 |
| Title | 入院期心不全患者の軽度認知機能障害がADL 改善効果に及ぼす影響 |
| URI | https://www.jstage.jst.go.jp/article/rigaku/48/4/48_11971/_article/-char/ja http://mol.medicalonline.jp/library/journal/download?GoodsID=cb3physi/2021/004804/002&name=0362-0369j |
| Volume | 48 |
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| ispartofPNX | 理学療法学, 2021, Vol.48(4), pp.362-369 |
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