Valcour V G, Masaki K H, Curb J D, Blanchette P L
Geriatric Medicine Program, John A. Hartford Center of Excellence in Geriatric Medicine, University of Hawaii at Manoa, 347 N Kuakini St, HPM-9, Honolulu, HI 96817, USA.
Arch Intern Med. 2000 Oct 23;160(19):2964-8. doi: 10.1001/archinte.160.19.2964.
Recognition and medical record documentation of dementia in the primary care setting are thought to be poor. To our knowledge, previous studies have not examined these issues in private practice office settings within the United States.
To determine the rate of unrecognized and undocumented dementia in a primary care internal medicine private practice.
This was a cross-sectional study of 297 ambulatory persons aged 65 years and older attending an internal medicine private group practice within an Asian American community of Honolulu, Hawaii. Of the subjects, 95% had been with their current primary care physician for at least 1 year. Each subject's primary care physician noted the presence or absence of dementia by questionnaire at the time of an office visit. An investigating physician (V.G.V.) subsequently assessed cognitive function using the Cognitive Abilities Screening Instrument, and confirmed the presence of dementia and its severity, if present, using Benson and Cummings' criteria and the Clinical Dementia Rating Scale, respectively. A trained research assistant completed telephone interviews to proxy informants for collateral information concerning cognition, behavior, and occupational or social function. Subjects' outpatient medical records were reviewed for documentation of problems with cognition.
Twenty-six cases of dementia were identified. Of these 26, 17 (65%) (95% confidence interval, 44.3-82.8) were not documented in outpatient medical records; of 18 patients, 12 (67%) (95% confidence interval, 40.9-86.7) were not thought to have dementia by their physicians at the time of the office visit. Recognition and documentation rates increased with advancing stage of disease.
Dementia is often unrecognized and undocumented in private practice settings. Arch Intern Med. 2000;160:2964-2968
在初级保健机构中，对痴呆症的识别和病历记录情况被认为较差。据我们所知，此前的研究尚未在美国的私人诊所环境中考察这些问题。
确定在初级保健内科私人诊所中未被识别和未记录的痴呆症发生率。
这是一项横断面研究，对夏威夷檀香山一个亚裔美国人社区的297名65岁及以上的门诊患者进行了调查，这些患者均在一家内科私人诊所就诊。其中95%的患者至少已在其现任初级保健医生处就诊1年。每位患者的初级保健医生在门诊就诊时通过问卷记录是否存在痴呆症。随后，一名调查医生（V.G.V.）使用认知能力筛查工具评估认知功能，并分别使用本森和卡明斯标准以及临床痴呆评定量表确认是否存在痴呆症及其严重程度。一名经过培训的研究助理通过电话访谈向代理人 informant 收集有关认知、行为以及职业或社会功能的补充信息。查阅了受试者的门诊病历，以了解认知问题的记录情况。
共识别出26例痴呆症病例。在这26例中，有17例（65%）（95%置信区间为44.3 - 82.8）在门诊病历中未被记录；在18名患者中，有12例（67%）（95%置信区间为40.9 - 86.7）在门诊就诊时其医生未认为患有痴呆症。识别率和记录率随着疾病阶段的进展而增加。
在私人诊所环境中，痴呆症常常未被识别且未被记录。《内科学文献》。2000年；160:2964 - 2968
