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題 名 | 周全性老年評估個案報告:巴金森氏症合併多重慢性病患者之體重減輕=Comprehensive Geriatric Assessment of a Patient with Parkinsonism and Unintentional Weight Loss: A Case Report |
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作 者 | 李雅萍; 陳晶瑩; 蔡兆勳; 黃國晉; 陳慶餘; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
卷 期 | 8:2 2013.05[民102.05] |
頁 次 | 頁106-116 |
分類號 | 417.7 |
關鍵詞 | 周全性老年評估; 體重減輕; 巴金森氏症; Comprehensive geriatric assessment; Weight loss; Parkinsonism; |
語 文 | 中文(Chinese) |
中文摘要 | 非自願性體重減輕佔65歲以上老年人的15-20%,和罹病率及死亡率相關。臨床及流行病學的研究發現在某些族群有較高的盛行率,在社區老人佔27%,在護理之家的老人佔50-60%。非自願性體重減輕的原因很多,最常見的原因包括:癌症、非惡性腸胃道疾病,及精神疾病(特別是憂鬱症及失智症)。在巴金森氏症病人,體重減輕是常見、但較難以理解的。巴金森氏症的腸胃道症狀,如:噁心、腹脹、吞嚥困難及胃活動機能障礙,可能和巴金森氏症的體重減輕有關。雖然很多原因可以造成非自願性體重減輕,但觀察型的研究發現,有25%的老人即使經過詳細的檢查,還是沒有發現體重減輕的原因。本個案為一位罹患巴金森氏症、高血壓及僧帽瓣脫垂之八十五歲男性病患,因為體重減輕一年就醫,但在反覆就醫的過程裡無法得到確切的答案。由於目前對於老年人體重減輕並沒有臨床指引,故吾人嘗試以周全性老年評估的方式介入,經過詳細的整體回顧及評估,推測其體重減輕應與巴金森氏症的非動作症狀及憂鬱情緒有關,並透過跨領域的醫療團隊幫助病人建立治療及追蹤的方向。 |
英文摘要 | Unintentional weight loss, which occurs in 15-20% of older adults (those aged over 65 years), is associated with increased morbidity and mortality. Clinical and epidemiological studies have reported an even higher prevalence in certain populations, with as many as 27% of elderly community dwellers and 50-60% of nursing home residents being affected. Unintentional weight loss in older patients derives from a variety of causes, and some of the most common ones include cancer, non-malignant gastrointestinal disease, and psychiatric problems (particularly dementia and depression). Weight loss is common but poorly understood in patients with Parkinson's disease. Gastrointestinal dysfunction in Parkinson's disease includes nausea, bloating, dysphagia and gastroparesis. These factors may contribute to unintentional weight loss in Parkinson's disease. Although weight loss may be caused by other reasons, observational studies have shown that in as many as 25% of the cases no identifiable cause is found despite extensive investigations. In this article, an 85-year-old gentleman with Parkinsonism, hypertension and, mitral valve prolapse presented with unintentional weight loss for one year. Repeated evaluations at different hospitals produced no definite results. Since there are no published guidelines on how to investigate and manage patients with unintentional weight loss, we conducted a comprehensive geriatric assessment and diagnosed his weight loss as related to non-motor symptoms of Parkinson's disease and depression. Through interdisciplinary team assessment, we endeavored to develop an integrated plan for treatment and follow-up of his weight loss. |
本系統中英文摘要資訊取自各篇刊載內容。