De Lepeleire J, Heyrman J
Academisch Centrum Huisartsgeneeskunde KULeuven Katholieke Universiteit Leuven, Belgium.
Theor Med Bioeth. 1999 Jun;20(3):215-28. doi: 10.1023/a:1005488328563.
Diagnosis of dementia in primary care is both difficult and important. The recommendations by several authors to improve the diagnosis of dementia by general practitioners are important, but insufficient. It is argued that perhaps the disease concept in itself is a cause of confusion for clinicians. Primary care physicians need an adapted procedure, gradually leading to the final diagnosis of dementia. It has to be a stepwise labelling strategy, using global descriptions and non-disease specific labels in the beginning, ending up with well-defined disease criteria. In this process, there is circularity: previous diagnoses have to be kept in mind because symptoms and signs may gradually change during the progression of the disease, leading to reconsideration of previous deleted options. To frame this properly, the primary care physician needs to adopt a broad "frail elderly" geriatric concept. Implementation of this concept not only helps the diagnostic process, but also stimulates the care for dementing patients and their caregivers. Relevant arguments for early diagnostic involvement of primary care physicians can be put forward on condition that a new concept, adapted procedures and adapted instruments are used.
基层医疗中痴呆症的诊断既困难又重要。几位作者提出的关于改善全科医生对痴呆症诊断的建议很重要，但还不够。有人认为，疾病概念本身可能是临床医生困惑的一个原因。基层医疗医生需要一种适应性程序，逐步得出痴呆症的最终诊断。这必须是一种逐步的标签策略，开始时使用总体描述和非疾病特异性标签，最终采用明确的疾病标准。在这个过程中存在循环性：由于症状和体征可能在疾病进展过程中逐渐变化，导致重新考虑之前排除的选项，因此必须牢记先前的诊断。为了正确构建这一过程，基层医疗医生需要采用广泛的“体弱老年人”老年医学概念。实施这一概念不仅有助于诊断过程，还能促进对痴呆症患者及其护理人员的照护。如果使用新的概念、适应性程序和适应性工具，就可以提出基层医疗医生早期参与诊断的相关论据。
