Shaji K S, Arun Kishore N R, Lal K Praveen, Prince Martin
Department of Psychiatry, Medical College, Thrissur-680596, Kerala, India.
Int J Geriatr Psychiatry. 2002 Mar;17(3):222-5. doi: 10.1002/gps.553.
Dementia in India is largely a hidden problem with no community awareness and little help seeking from affected families, despite high levels of strain. Cases must therefore be identified before practical help can be offered.
After two and a half hours of formal training, local community health workers in rural Kerala were asked to identify possible cases of dementia from the community they served. Diagnoses were then verified by a senior local psychiatrist with clinical and research interests in old age psychiatry.
The community health workers identified 51 out of 1979 over 60 year old residents (a prevalence of 2.6%) as suspected cases of dementia. Following the psychiatrist's assessment, 33 met DSM-IV criteria for dementia. The majority of confirmed cases were of the Alzheimer's Disease sub-type. Most "non-cases" were found to be suffering from other major psychiatric disorders, with substantial unmet need. The positive predictive value of the community health workers informal screening was 64.7%.
This simple cost-effective case-finding method can be of practical use in the development of community based dementia care services in India and other developing countries with similar health care systems.
在印度，痴呆症在很大程度上是一个隐蔽的问题，尽管压力很大，但社区对此缺乏认识，患病家庭也很少寻求帮助。因此，必须在提供实际帮助之前识别出病例。
在接受两个半小时的正规培训后，喀拉拉邦农村地区的当地社区卫生工作者被要求从他们服务的社区中识别可能的痴呆症病例。然后由一位对老年精神病学有临床和研究兴趣的当地资深精神科医生对诊断结果进行核实。
社区卫生工作者在1979名60岁以上居民中识别出51例（患病率为2.6%）疑似痴呆症病例。经过精神科医生的评估，33例符合痴呆症的DSM-IV标准。大多数确诊病例为阿尔茨海默病亚型。大多数“非病例”被发现患有其他主要精神疾病，有大量未满足的需求。社区卫生工作者非正式筛查的阳性预测值为64.7%。
这种简单且具有成本效益的病例发现方法在印度以及其他具有类似医疗保健系统的发展中国家开展基于社区的痴呆症护理服务方面具有实际用途。
