Demanslı Hastalarda Ağrı Değerlendirilmesi
Özet
Dementia, which is characterized by the impairment of memory and the other cognitive functions, is a progressive neurodegenerative disorder of central nervous system. Dementia affects social and business life of patients and may result in death. Alzheimer?s disease, vascular dementia, Lewy body dementia and frontotemporal dementia are the most common reasons of dementia. Pain is one of the most frequent symptoms in elderly people and it may impact their daily activities and quality of life. The physician should have self-reports of patients for the pain assessment. However, self-reports may not be sufficient in dementia patients due to reasons such as cognitive impairment, communication problems. Thus the physician should also have reports of caregivers and make assessments based on their personal observation. Some pain scales have been developed for an objective pain assessment in patients with dementia. In this study, it was intended to assess pain and examine its relationship between the other geriatric symptoms, daily activities and behavioral symptoms in patients with dementia. 75 patients, who were diagnosed with dementia and from Seyranbağları Nursing and Rehabilitation Center for Aged and Ümitköy Ankara Nursing and Rehabilitation Center for Aged, were included in this study. Following a comprehensive geriatric assessment and relevant tests, the patients were asked whether they have pain and then, PAİNAD (Pain Assessment in Advanced Dementia) , DS-DAT (Discomfort Scale for Dementia of the Alzheimer's Type) , PADE (Pain Assessment for the Dementing Elderly) , FACES (Wong?Baker Faces Pain Rating Scale) and NS ( Numeric Rating Scale) tests were applied. CMAI (Cohen-Mansfield Agitation Inventory) and NPI (Neuropsychiatric Inventory ) tests were applied for the evaluation of psychiatric symptoms. Average age of patients was 81.1±7.0 and 46.7% (n=35) were female, 53.7% (n=40) were male. 93.3% (n=70) of patients had Alzheimer?s disease while 6.7% (n=5) was suffering from vascular dementia. 32% (n=24) of patients had early-stage dementia, 24% (n=18) was at moderate-stage and 44% (n=33) at advanced-stage. The number of patients reporting pain was 23. However, results of PADE, PAINAD, DS-DAT pain tests were similar in groups with and without self-reports of pain. The percentage of patient reporting pain was lower in early-stage compared to moderate- and advanced-stage, although this finding was not statistically significant (early-stage 48.7%; moderate-stage 22.2%; advanced stage 27.3%). Furthermore, it was found that advanced-stage PADE, PAINAD and DS-DAT scores are significantly high to indicate the presence of pain (p<0.001). Pain was found to be related with geriatric syndromes in dementia patients. Depression was associated with both PADE (p=0.02), PAINAD (p=0.01) and DS-DAT (p=0.02) among pain tests and NPI (p=0.04), which shows the severity of psychiatric symptoms. According to the correlation analysis results, PADE and Numeric Scale were associated with all of the geriatric assessment tests (MMSE, Geriatric Depression Scale, ADL, İADL, MNA); WB Faces test was related with ADL, İADL, MNA; PAINAD and DS-DAT were found to be associated with all tests except GDS. The relation of PDE with all geriatric assessment tests was a remarkable result. As a result of this study in which pain assessment in dementia patients was intended, it was indicated that the pain is not a rarely seen case and it may adversely affect cognitive functions, depression, functionality and nutritional status of patient. In addition, it was observed that dementia patients may not verbalize their pain and this situation becomes apparent in advanced stages of disease. It should be considered that questioning the patient with dementia may be misleading for pain assessment, regular application of pain assessment tools to these patients would provide a more accurate pain evaluation and thus unfavorable affect of pain can be prevented.
