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K Nakajoh

Publications and source records attributed to K Nakajoh.

5 recordsLinked to original sources
PubMed2000

Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding.

OBJECTIVES: Although attenuated protective reflexes have been implicated in the development of aspiration pneumonia, the relation between the incidence of pneumonia and the state of these reflexes has not been investigated. Furthermore, the role of feeding tube placement in preventing pneumonia in patients with attenuated protective reflexes is unknown. We studied the relationship between the incidence of pneumonia and the state of cough and swallowing reflexes in post-stroke patients with oral or tube feeding. DESIGN: The incidence of pneumonia was prospectively analysed for 1 year in three groups of post-stroke patients on the basis of the following clinical conditions: oral feeding without dysphagia (n = 43); oral feeding with dysphagia (n = 48); and nasogastric tube feeding with dysphagia (n = 52). We also studied the incidence of pneumonia in bedridden patients with nasogastric tube feeding (n = 14). Before the start of the study, the swallowing and cough reflexes of each patient were measured. The swallowing reflex was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The cough threshold of citric acid aerosols was defined as the concentration at which the patient coughed five times. RESULTS.;: The incidence of pneumonia was observed in patients having both a latency of response longer than 5 s and a cough threshold for citric acid higher than a concentration of 1.35 (log mg mL-1). The incidence of pneumonia was significantly higher in patients with oral feeding than in those with tube feeding (54.3 vs. 13.2%, P < 0.001). In bedridden patients with tube feeding, the latency of response was longer than 20 s and no patient coughed at the highest concentration of citric acid. The incidence of pneumonia was 64.3% in such patients. CONCLUSIONS: The state of protective reflexes had a significant relation to the incidence of pneumonia. Feeding tube placement may have a beneficial role in preventing aspiration pneumonia in mildly or moderately disabled post-stroke patients with attenuated protective reflexes. Bedridden patients who were tube-fed had the highest incidence of pneumonia.

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PubMed2000

Silent cerebral infarction: a potential risk for pneumonia in the elderly.

OBJECTIVE: To determine whether patients who have silent cerebral infarction are more likely to develop pneumonia than are controls without silent cerebral infarction. DESIGN: We examined 269 community-residing participants of the senior day-care centre without history of previous stroke, and then followed them over a two-year period to assess pneumonia. On the basis of computerized tomography scans, they were divided into two groups: no infarction (n = 102) and cerebral hemispheric infarction (n = 167). Cerebral infarcts were further divided into deep and superficial infarcts. RESULTS: The incidence of pneumonia was significantly higher in subjects with silent cerebral infarction (19.8%) than in controls (4. 9%) (odds ratio, 4.67 [95% CI, 1.87-11.67]; P < 0.01). Deep infarcts were more closely associated with the incidence of pneumonia (29.1%) than superficial infarcts (7.6%) (odds ratio, 5.00 [CI, 1.91-13.08]; P < 0.01). CONCLUSIONS: Elderly subjects with silent cerebral infarction were more likely to develop pneumonia than were controls without silent cerebral infarction. Amongst hemispheric silent cerebral infarcts, those located in the deep brain structures may be an important predictor of the development of pneumonia.

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PubMedDate not supplied

Risk factors of aspiration pneumonia in Alzheimer's disease patients.

BACKGROUND: Pneumonia is the reported cause of death of a high proportion of Alzheimer's disease (AD) patients. OBJECTIVES: This study assessed swallowing function to explore the potential risk factors of aspiration pneumonia in AD patients. METHODS: Data were gathered on 121 AD patients (mean age 78.2, SD 7.5, male/female ratio = 48/73) treated in two psychiatric hospitals. Multiple logistic regression analysis was used to estimate odds ratios for the risk of aspiration pneumonia. The following risk factors were considered: age, severity of dementia, silent brain infarction (SBI) in the basel ganglia, use of psychotropic drugs (neuroleptics and benzodiazepines), and gender. The latency time of the swallowing reflex was analyzed (1) among groups based on the severity of dementia; (2) between groups with and without SBI in the basal ganglia; (3) before and after the use of psychotropic drugs in the group without SBI in the basal ganglia, and (4) between males and females. RESULTS: Aspiration pneumonia in ambulatory AD patients was significantly and independently associated with severe dementia, presence of SBI in the basal ganglia, intake of neuroleptics, and the male gender. The mean latency of the swallowing reflex in the severe AD group was significantly longer compared to that in the mild-to-moderate AD group. The mean latency of the swallowing reflex after the intake of neuroleptics was significantly prolonged compared to that obtained before any neuroleptic intake, whereas there was no significant difference in the mean latency of the swallowing reflex before and after benzodiazepine intake. CONCLUSION: We recommend the use of the smallest efficacious dosage of neuroleptics especially in treating severely demented AD patients with basal-ganglia infarction. As soon as the behavioral and psychiatric problems are resolved, drug tapering or discontinuation should be considered in order to prevent life-threatening aspiration pneumonia.

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