Gordon M, Goldstein D
Department of Geriatrics at Mount Sinai Hospital, Medical Services and Head of Geriatrics, Internal Medicine at the Baycrest Centre for Geriatric Care in Toronto, Ont.
Can Fam Physician. 2001 Sep;47:1803-6, 1809.
To evaluate reasons for telling or not telling patients about a diagnosis of Alzheimer's disease and to assess the effect of such a decision on patients, families, physicians, and the health care system.
MEDLINE was searched from January 1966 to December 1999 using the key words "Alzheimer's disease" or "dementia" and "truth disclosure" or "attitude to health." There were no randomized controlled trials (level I evidence) in the literature. Articles identified provided level II evidence (case-controlled and cross-sectional studies) or level III evidence (expert opinion). All articles identified were chosen for this study.
In attempting to determine whether or not to communicate a diagnosis of Alzheimer's disease, physicians face a predicament: the desire to communicate honestly and directly with a patient is sometimes at variance with the equally compelling desire to concur with the patient's family's reluctance to disclose the diagnosis. Most Alzheimer's patients should be told of their diagnosis, but the timing of the discussion and the way it occurs are crucial to a good outcome. Most patients accept the information without a catastrophic response. Physicians must gain support from patients' families because it could take time for them to accept disclosure of what is perceived as a "hopeless" diagnosis.
We must continue to support Alzheimer's patients and promote hope.
评估向患者告知或不告知阿尔茨海默病诊断结果的原因，并评估这一决定对患者、家庭、医生及医疗保健系统的影响。
使用关键词“阿尔茨海默病”或“痴呆症”以及“真相披露”或“对健康的态度”对1966年1月至1999年12月期间的MEDLINE进行检索。文献中没有随机对照试验（一级证据）。所检索到的文章提供了二级证据（病例对照研究和横断面研究）或三级证据（专家意见）。所有检索到的文章均被纳入本研究。
在试图确定是否告知患者阿尔茨海默病的诊断结果时，医生面临着一个困境：想要诚实地与患者直接沟通的愿望，有时与同样强烈的、认同患者家属不愿透露诊断结果的愿望相矛盾。大多数阿尔茨海默病患者应该被告知他们的诊断结果，但讨论的时机和方式对于取得良好结果至关重要。大多数患者接受这一信息时不会产生灾难性反应。医生必须获得患者家属的支持，因为他们可能需要时间来接受对这一被视为“无望”诊断的披露。
我们必须继续支持阿尔茨海默病患者并给予希望。
