Boustani Malaz, Callahan Christopher M, Unverzagt Frederick W, Austrom Mary G, Perkins Anthony J, Fultz Bridget A, Hui Siu L, Hendrie Hugh C
Indiana University Center for Aging Research, Indianapolis, USA.
J Gen Intern Med. 2005 Jul;20(7):572-7. doi: 10.1111/j.1525-1497.2005.0126.x.
Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care.
We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records.
Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment-no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record.
Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.
初级保健医生有能力对痴呆症进行早期识别和治疗。我们评估了初级保健中痴呆症综合筛查与诊断项目的可行性和实用性。
我们对印第安纳波利斯市7家城市且种族多样的初级保健机构中65岁及以上的个体进行了筛查。由一个专家小组根据国际疾病分类（ICD）-10标准，利用神经心理学测试结果以及从患者、照料者和病历中收集的信息来诊断痴呆症。
在3340名接受筛查的患者中，434人筛查呈阳性，但只有227人同意进行正式的诊断评估。在完成诊断评估的患者中，47%被诊断为痴呆症，33%有认知障碍但无痴呆（CIND），20%被认为没有认知缺陷。痴呆症的总体估计患病率为6.0%（95%置信区间（CI）5.5%至6.6%），该项目的总体成本估计为每位接受痴呆症筛查的患者128美元，每位被诊断为痴呆症的患者3983美元。在确诊为痴呆症的患者中，只有19%在其病历中有痴呆症的记录。
痴呆症在初级保健中很常见且未被诊断出来。在综合筛查项目中单独使用筛查工具时，其特异性不足以确立有效的痴呆症诊断；这些结果可能不适用于有认知主诉的老年人。多种卫生系统和患者层面的因素对这种正式评估构成了障碍，因此使得目前痴呆症诊断的护理标准在初级保健环境中不切实际。
