Vernooij-Dassen Myrra J F J, Moniz-Cook Esme D, Woods Robert T, De Lepeleire Jan, Leuschner Antonio, Zanetti Orazio, de Rotrou Joycelyn, Kenny Geraldine, Franco Manuel, Peters Vincent, Iliffe Steve
Alzheimer Centre/Centre for Quality of Care Research/Vocational training General Practitioners of University Medical Centre Nijmegen, The Netherlands.
Int J Geriatr Psychiatry. 2005 Apr;20(4):377-86. doi: 10.1002/gps.1302.
Timely recognition and diagnosis of dementia is the pre-condition for improving dementia care, but diagnosis often occurs late in the disease process.
To compare facilitators and obstacles to the timely recognition of dementia across eight European Union states, in order to implement established policies for earlier diagnosis.
A modified focus group technique, including a pre and posterior procedure.
Twenty-three participants from different disciplines, purposively sampled for professional expertise in dementia research and innovative practice, attended two focus groups. Stigma in ageing and dementia, accompanied by a sense that there is little to offer until later on in the disease, underpinned the widespread reluctance of GPs to recognise dementia at an early stage and were major obstacles to the timely diagnosis of dementia across all eight countries. Dementia care services varied widely across Europe. Countries with the greatest development of dementia health care services were characterised by national guidelines, GPs fulfilling a gatekeeper function, multi-disciplinary memory clinics and innovative programmes that stimulated practice and new services. Dementia-related stigma was perceived as being less prominent in these countries.
Overcome of delays in the timely diagnosis of dementia needs more than specialist services. They should address the processes associated with stigma, age and dementia, especially where these relate to physician practice and diagnostic disclosure. Stigma is perceived as variable across European States, with a promising finding that its impact is relatively small in countries with the widest range of dementia care services.
及时识别和诊断痴呆症是改善痴呆症护理的前提条件，但诊断往往在疾病进程的后期才进行。
比较欧盟八个国家在及时识别痴呆症方面的促进因素和障碍，以便实施早期诊断的既定政策。
采用改良的焦点小组技术，包括前后程序。
来自不同学科的23名参与者，因在痴呆症研究和创新实践方面的专业知识而被有目的地抽样，参加了两个焦点小组。衰老和痴呆症的污名化，以及一种认为在疾病后期才有办法的感觉，是全科医生普遍不愿在早期识别痴呆症的原因，也是所有八个国家及时诊断痴呆症的主要障碍。欧洲各地的痴呆症护理服务差异很大。痴呆症医疗服务发展最完善的国家的特点是有国家指南、全科医生发挥把关作用、多学科记忆诊所以及刺激实践和新服务的创新项目。在这些国家，与痴呆症相关的污名化现象被认为不那么突出。
克服痴呆症及时诊断的延误需要的不仅仅是专科服务。它们应该解决与污名化、年龄和痴呆症相关的过程，特别是那些与医生实践和诊断披露有关的过程。在欧洲各国，污名化的程度被认为各不相同，一个有希望的发现是，在痴呆症护理服务范围最广的国家，其影响相对较小。
