アルツハイマー病患者におけるEAT-10の使用：誰が情報源となるべきか？

Use of EAT-10 in Individuals with Alzheimer's Disease: Who Should be the Source of Information?

抄録

本研究の目的は、アルツハイマー病患者（IwAD）とその介護者から得られた摂食評価ツール（EAT-10）の結果の適合性を調べ、IwADと介護者から得られたEAT-10の結果をファイバースコープ内視鏡嚥下評価（FEES）の結果と比較することである。EAT-10の質問はIwADに音読され、同時に介護者は別室にいるIwADを思い浮かべながらEAT-10を記入するよう求められた。誤嚥、貫通、残渣の状態は、まずFEESを用いて「あり」または「なし」で評価し、次に貫通誤嚥スケール（PAS）を用いた。EAT-10項目はIwADと介護者の一致を分析した。誤嚥、浸透、残留に関するIwADと介護者のEAT-10結果の感度と特異度を評価した。EAT-10のカットオフスコアは、異なる情報源に従ってIwADのために決定された。IwADと介護者のEAT-10合計測定値の一致は不良であると判断された。PASスコアとEAT-10合計IwADスコア（p=0.072）および介護者スコア（p=0.195）の間には統計的に有意な相関は認められなかった。参加者の吸引、浸透、残渣の測定において、ROC曲線下面積は、IwADと介護者の回答ともに統計的に有意ではなかった（p>0.05）。結論として、本研究では、岩ADまたは介護者から得られた情報によると、EAT-10とFEESの結果の一致度は低く、特に誤嚥を伴う岩ADを認識することは困難であった。したがって、IwADにおけるEAT-10の使用は適切な診断を提供しない。IwADに特化した嚥下の有効性と安全性に関する情報も提供する他の嚥下評価ツールを開発する必要がある。

This study aimed to examine the compatibility between individuals with Alzheimer's disease (IwAD) and Eating Assessment Tool (EAT-10) results obtained from their caregivers and to compare EAT-10 results obtained from IwAD and caregivers with fiberoptic endoscopic swallow evaluation (FEES) results. EAT-10 questions were read aloud to the IwAD; simultaneously, the caregiver was asked to complete the EAT-10 by thinking of the IwAD in a different room. Aspiration, penetration, and residual status were first assessed as "present" or "absent" using FEES, then the Penetration Aspiration Scale (PAS) was used. EAT-10 items were analyzed with agreement between IwAD and caregiver.The sensitivity and specificity of IwAD and caregiver EAT-10 results for aspiration, penetration, and residue were assessed. EAT-10 cut-off scores were determined for IwAD according to different sources of information.Agreement of the EAT-10 total measurements of IwAD and caregiver was determined to be poor. There was no statistically significant correlation between PAS scores and EAT-10 total IwAD (p = 0.072) and caregiver (p = 0.195) scores. In the aspiration, penetration, and residue measurements of the participants, the area under the ROC curve was not statistically significant (p > 0.05) according to both IwAD and caregiver responses. It was observed that IwAD's statement for aspiration, penetration, and residue in mild stage AD; IwAD for aspiration, caregiver for penetration, both for residue in moderate stage; caregivers for advanced stage gave more accurate results in differentiating individuals with aspiration, penetration, and residue.In conclusion, in this study, according to the information obtained from IwAD or caregivers, it was determined that the agreement between EAT-10 and FEES results was low, especially in recognizing IwAD with aspiration. Therefore, the use of the EAT-10 in IwAD does not provide adequate diagnosis; there is a need to develop other swallowing assessment tools that also provide information about the effectiveness and safety of swallowing specific to IwAD.