title: The Effects of Percutaneous Endoscopic Gastrostomy on Quality of Life in Patients With Dementia.
abstract: BACKGROUND
  To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia.
  
  
  METHODS
  We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements.
  
  
  RESULTS
  Till October 31st 2010, 1,353 patients with Alzheimer's dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 ± 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia.
  
  
  CONCLUSIONS
  These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.
authors: Department of Surgery, International University of Health and Welfare Hospital 537-3 Iguchi, Nasushiobara-shi, Tochigi 329-2763, Japan.
authors: Yutaka
authors: Y
authors: Suzuki
authors: Department of Molecular Epidemiology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors: Mitsuyoshi
authors: M
authors: Urashima
authors: Department of Internal Medicine, Tokyo-Musashino Hospital, 4-11-11 Komone, Itabashi-ku, Tokyo, 173-0037, Japan.
authors: Masaki
authors: M
authors: Izumi
authors: Suzuki Internal Medicine Clinic, 4-5-43 Heiwadai, Nagareyama-shi, Chiba, 270-0157, Japan.
authors: Yasuhiko
authors: Y
authors: Ito
authors: Department of Surgery, Haramachi Red-Cross Hospital, 698 Haramachi, Higashi-Agatsuma-machi, Gunma, 377-0882, Japan.
authors: Nobuyuki
authors: N
authors: Uchida
authors: Department of Surgery, Kitamihara Clinic, 18-350 Ishikawa-cho, Hakodate-shi, Hokkaido, 041-0802, Japan.
authors: Shingo
authors: S
authors: Okada
authors: Department of Internal Medicine, Seiwa Memorial Hospital, 5-1-1 Kotoni1,Nishi-ku, Sapporo-shi, Hokkaido, 063-0811, Japan.
authors: Hiromi
authors: H
authors: Ono
authors: Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan.
authors: Satoshi
authors: S
authors: Orimo
authors: Department of Surgery, Tone chuou hospital, 1855-1 Higashiharashinmachi, Numata-shi, Gunma, 378-005, Japan.
authors: Takayuki
authors: T
authors: Kohri
authors: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
authors: Hiroaki
authors: H
authors: Shigoka
authors: Department of Neurology, JA Toride Medical Center, 2-1-1 Hongoh, Toride City, Ibaraki, 302-0022, Japan.
authors: Shuzo
authors: S
authors: Shintani
authors: The Internal Department, Uchida hospital, 345-1 Kuyahara, Numata-shi, Gunma, 378-0005, Japan.
authors: Yukiko
authors: Y
authors: Tanaka
authors: Center for Digestive and Liver Diseases, Ohfuna Chuo Hospital, 6-2-24 Ohfuna, Kamakura, Kanagawa, 247-0056, Japan.
authors: Atsushi
authors: A
authors: Yoshida
authors: Department of Internal Medicine, Isesaki Municipal Hospital, 12-1 Tsunatorihonmachi, Isesaki-shi, Gunma, 372-0812, Japan.
authors: Masashi
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authors: Ijima
authors: Department of Surgery, Nakamura Memorial Hospital, Nishi-14,Minami-1,Chuo-ku, Sapporo-shi, Hokkaido, 060-8570, Japan.
authors: Toru
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authors: Ito
authors: Department of Gastroenterology, Sapporo Shirakaba-dai hospital, 2-18-7-26 Tukisamu-Higash,Toyohira-ku, Sapporo-shi, Hokkaido, 062-0052, Japan.
authors: Takao
authors: T
authors: Endo
authors: Department of Gastroenterology, Okano clinic, 3 Higashida-cho,Jodoji, Sakyo-ku, Kyoto-shi, Kyoto, 606-8411, Japan.
authors: Hitoshi
authors: H
authors: Okano
authors: Deaprtment of Surgery, Tokyo Metropolitan Ohkubo Hospital, 2-44-1 Kabukicho, Sinnjyukuku, Tokyo, 160-8488, Japan.
authors: Michio
authors: M
authors: Maruyama
authors: Department of Internal medicine, Kyoto kujo hospial, 10 Karahashi Rajomon-cho Minami-ku, Kyoto-shi, Kyoto, 601-8485, Japan.
authors: Tsuyoshi
authors: T
authors: Iwase
authors: Department of Surgery, Kanazawa Nishi Hospital, 6-15-41 Ekinishihonmachi, Kanazawa-shi, Ishikawa, 920-0025, Japan.
authors: Tsutomu
authors: T
authors: Kikuchi
authors: Department of Surgery, Onishi Hospital, 139-1 Onishi, Fujika-shi, Gunma, 370-1401, Japan.
authors: Michiaki
authors: M
authors: Kudo
authors: Department of Internal Medicine, Tsuruika Kyouritsu Hospotal, 9-34 Fumizono-cho, Tsuruoka-shi, Yamagata, 997-0816, Japan.
authors: Mikako
authors: M
authors: Takahashi
authors: Department of Gastroenterology and Hepatology, Japan Agricultural Cooperatives of Niigata Joetsu General Hospital, 148-1 Daidoufukuda, Joetsu-shi, Niigata, 943-8507, Japan.
authors: Satoshi
authors: S
authors: Goshi
authors: Department of Gastroenterology, Hirosaki Municipal Hospital, 1-8-3 Ohmachi, Hirosaki- shi, Aomori, 036-8004, Japan.
authors: Tatsuya
authors: T
authors: Mikami
authors: Department of Gastroenterology, Social Insurance Shimonoseki Welfare Hospital, 3-3-8 Kamishinchi, Shimonoseki-shi, Yamaguchi, 750-0061, Japan.
authors: Satoyoshi
authors: S
authors: Yamashita
authors: Department of Surgery, Tokatsu-clinic Hospital, 865-2 Hinokuchi, Matsudo-shi, Chiba, 271-0067, Japan.
authors: Kazuhiro
authors: K
authors: Akiyama
authors: Department of Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi-shi, Gunma, 371-0014, Japan.
authors: Tetsushi
authors: T
authors: Ogawa
authors: Department of Neurology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi, 329-2763, Japan.
authors: Tomoko
authors: T
authors: Ogawa
authors: Department of Gastroenterology, Ako City Hospital, 1090 Nakahiro, Ako-shi, Hyogo, 678-0232, Japan.
authors: Shigeki
authors: S
authors: Ono
authors: Department of HomeCareMedicine, Kameda Medical Center, 929 Higashicho, Kamogawa-shi, Chiba, 292-8601, Japan.
authors: Shigeru
authors: S
authors: Onozawa
authors: Department of Surgery, Fujiyoshida Municipal Hospital, 6530 Kamiyoshida, Fujiyoshida-shi, Yamanashi, 403-0005, Japan.
authors: Junya
authors: J
authors: Kobayashi
authors: Department of Internal Medicine, Nara Prefectural Gojo Hospital, 5-2-59 Noharanishi, Gojo-shi, Nara, 637-8511, Japan.
authors: Masami
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authors: Matsumoto
authors: Department of Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, Oita, 874-0011, Japan.
authors: Toshifumi
authors: T
authors: Matsumoto
authors: Director, Jomoto Gastroenteric & Internal Medical Clinic, 5-8-9 Kuhonnji, Kumamoto-shi, Kumamoto, 862-0976, Japan.
authors: Kazuaki
authors: K
authors: Jomoto
authors: Department of Cardiology and Vascular Surgery, Higashi-Washinomiya Hospital, 3-9-3 Sakurada, Kuki-shi, Saitama, 340-0203, Japan.
authors: Akihiro
authors: A
authors: Mizuhara
authors: Department of Gastro-enterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-Hondori Miyakojima-ku, Osaka-shi, Osaka, 534-0021, Japan.
authors: Yukio
authors: Y
authors: Nishiguchi
authors: Department of Internal Medicine, Nishimino Kosei Hospital, 986 Oshikoshi, Yoro-gun Yoro-cho, Gifu, 503-1394, Japan.
authors: Shinji
authors: S
authors: Nishiwaki
authors: Department of Surgery, Ohtawara Red Cross Hospital, 2-7-3 Sumiyoshi-cho, Ohtawara-shi, Tochigi, 324-8686, Japan.
authors: Masahiko
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authors: Aoki
authors: Department of Internal medicine, Kohka Public Hospital, 3-39 Rokushin,Minakuchi-cho, Kohka-shi, Shiga, 528-0014, Japan.
authors: Izumi
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authors: Ishizuka
authors: Department of Gastroenterology, Naganuma Municipal Hospital, 2-2-1 Chuo-minami,Naganuma-cho, Yubari-gun, Hokkaido, 069-1332, Japan.
authors: Toshiroh
authors: T
authors: Kura
authors: Department of Internal Medicine, Murakami Memorial Hospital, 739 Oomachi, Saijo-shi, Ehime, 793-0030, Japan.
authors: Masato
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authors: Murakami
authors: Endoscopy unit, Iwate prefectural central Hospital, 1-4-1 ueda, Morioka-shi, Iwate, 020-0066, Japan.
authors: Akihiko
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authors: Murakami
authors: Center for Gastroenterology, Sapporo Higashi-Tokushukai Hospital, 3-1 North33-East14,Higashi-ku, Sapporo-shi, Hokkaido, 065-0033, Japan.
authors: Tomoyuki
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authors: Ohta
authors: Internal Medicine, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda, Matsue-shi, Shimane, 690-8522, Japan.
authors: Koji
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authors: Onishi
authors: Digestive Endoscopy Center, Sendai Kousei Hospital, 4-8 Hirose-machi,Aoba-ku, Sendai-shi, Miyagi, 980-0873, Japan.
authors: Masato
authors: M
authors: Nakahori
authors: Department of Gastroenterology, Akita City Hospital, 4-30 Kawamotomatsuoka-cho, Akita-shi, Akita, 010-0933, Japan.
authors: Tsuyotoshi
authors: T
authors: Tsuji
authors: Department of Surgery, Kure Kyosai Hospital, 2-3-28 Nishichuou, Kure-shi, Hiroshima, 737-8505, Japan.
authors: Ko
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authors: Tahara
authors: Department of Gastroenterology, Japan Red Cross Date General Hospital, 81 Suenaga, Date-shi, Hokkaido, 052-8511, Japan.
authors: Ikuta
authors: I
authors: Tanaka
authors: Department of Surgery, Tsuchida Hospital, 2-11,South-21,West-9,Chuo-ku, Sapporo-shi, Hokkaido, 064-0921, Japan.
authors: Kazuhiko
authors: K
authors: Kitagawa
authors: Department of Gastroenterology, Hirano General Hospital, 176-5 Kurono, Gifu-shi, Gifu, 501-1192, Japan.
authors: Makoto
authors: M
authors: Shimazaki
authors: Department of Gastroenterology, Japanese Red Cross Society Shimizu Hospital, 2-2 minami,Shimizu-cho, Kamikawa-gun, Hokkaido, 089-0195, Japan.
authors: Takanori
authors: T
authors: Fujiki
authors: Department of Gastroenterology, Higashi Sapporo Hospital, 3-3-7-35 Higashi-Sapporo,Shiroishi-ku, Sapporo-shi, Hokkaido, 003-8585, Japan.
authors: Toshiro
authors: T
authors: Kusakabe
authors: Department of Gastroenterology, Tachikawa General Hospital, 3-2-11 Kandamachi, Nagaoka-shi, Niigata, 940-8621, Japan.
authors: Takao
authors: T
authors: Iiri
authors: Department of Pediatric Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano-shi, Nagano, 380-8582, Japan.
authors: Shuichirou
authors: S
authors: Kitahara
authors: Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane-shi, Nagano, 399-4117, Japan.
authors: Akira
authors: A
authors: Horiuchi
authors: Department of Surgery, Hitachikoh Hospital, 3-4-22 Kujichou, Hitachi-shi, Ibaraki, 319-1222, Japan.
authors: Hitoshi
authors: H
authors: Suenaga
authors: Nutritional Therapy Center, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
authors: Naohiro
authors: N
authors: Washizawa
authors: Department of Neurology, The Jikei University School of Medicine, Aoto Hospital, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
authors: Masahiko
authors: M
authors: Suzuki
keywords: Alzheimer’s dementia; Cerebrovascular dementia; Percutaneous endoscopic gastrostomy; Quality of life; Risk factor