An association of incidence of pneumonia with dementia, from the point of view of swallowing modality, immune and nutritional status.

2020 Fiscal Year Final Research Report

• Project/Area Number: 17K15903
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: Kyorin University
• Principal Investigator: Miyamoto Takahide 杏林大学, 医学部, 医員 (60792603)
• Project Period (FY): 2017-04-01 – 2021-03-31
• Keywords: 肺炎 / 嚥下機能 / 認知症高齢者 / 低栄養 / 胆嚢

Outline of Final Research Achievements

Pneumonia-associated morbidity and mortality are increasing with population aging. Morbidity of aspiration pneumonia (AP) occurred in half the institutional residents with advanced dementia. An etiology of AP is silent aspiration due to blunting of the upper respiratory protective reflexes. However, the association of AP-related factors and cerebral degeneration, with the morbidity and mortality of HCAP has not been fully investigated. Furthermore, in clinical settings, untreatable biliary sludge in the gallbladder can be observed in older adults with advanced dementia.
Therefore, we executed a cross-sectional, retrospective and prospective-cohort study for the association of AP-related factors and the ability of oral intake with dementia. As results, the deteriorated upper respiratory reflexes, fasting status, malnutrition and atrial filtration were associated with the morbidity and mortality of HCAP and the biliary sludge formation in older adults with dementia.

Free Research Field

老年医学

Academic Significance and Societal Importance of the Research Achievements

認知症病型間で肺炎罹患率に違いを認め、肺炎罹患に関連する因子を解明したことで、認知罹患高齢者における肺炎発症の予測ができることを示した。肺炎罹患高齢者に低栄養、上気道防御反射低下および心房細動が存在すると、入院90日以内に死亡するリスクが高いことを示した。また、認知症が進行すると摂食量が低下し、ほとんど摂食できない患者が増えることを示し、絶食状態が続くと胆泥形成を促進することが分かった。以上、認知症罹患高齢者の誤嚥性肺炎・摂食嚥下障害の入り口と出口（死亡）に認められることを明らかにした。これは、認知症患者およびその家族に病態の進行予測を示す根拠になると考えられる。