Wolfs Claire A G, Dirksen Carmen D, Severens Johan L, Verhey Frans R J
Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands.
Int J Geriatr Psychiatry. 2006 Mar;21(3):223-32. doi: 10.1002/gps.1454.
The impact of dementia constitutes a major public health challenge to our society. A multidisciplinary approach to dementia is generally recommended.
The objective of this review is to give an overview of the reported empirical studies on the added value of a multidisciplinary approach to diagnosing dementia, i.e. whether differences can be found between diagnostic multidisciplinary approaches, and/or monodisciplinary ones with respect to the diagnostic outcomes, the impact of diagnostics and their effects on quality of life and costs.
Critical review of studies which involve a multidisciplinary assessment of dementia. Literature was systematically searched in a number of international databases (Medline, PsychInfo, Pubmed and EconLit). A first selection was based on screening titles by one author. Interrater reliability was determined by scoring all abstracts by two authors. The reliability of selecting full articles was based on scoring a random sample by two authors. Kappa values were calculated. The Kappa statistic (k) was also used as an indicator of the diagnostic agreement between single disciplines and multidisciplinary teams.
Five studies were identified as relevant for the purpose of this review. The most important outcome was the level of diagnostic agreement between single disciplines and multidisciplinary teams (MTs). Overall, there was substantial agreement (kappa: 0.37-0.76) on the diagnosis dementia (syndrome), but not on the subtypes (aetiology) (AD: 0.26-0.60; VD: 0.35-0.52; depression: 0.30-0.46). Diagnoses also differed between the disciplines.
Merely studies on diagnostic accuracy were found, all using different reference standards. Kappa values were chosen as outcome measure and every diagnosis was considered of equal value. Therefore, the added value could not definitively be demonstrated. However, the potential added value of a multidisciplinary approach to diagnosing dementia probably lies in the ability to differentiate among the subtypes of dementia and to detect comorbid psychiatric conditions such as depression. Disciplines within an MT complement each other in establishing a specific diagnosis, which is considered to be the added value of such a multidisciplinary team.
痴呆症的影响对我们的社会构成了重大的公共卫生挑战。一般建议采用多学科方法来应对痴呆症。
本综述的目的是概述已报道的关于多学科方法在痴呆症诊断中的附加价值的实证研究，即诊断多学科方法与单学科方法在诊断结果、诊断影响及其对生活质量和成本的影响方面是否存在差异。
对涉及痴呆症多学科评估的研究进行批判性综述。在多个国际数据库（Medline、PsychInfo、Pubmed和EconLit）中系统检索文献。首先由一位作者筛选标题进行初步选择。通过两位作者对所有摘要进行评分来确定评分者间信度。选择全文的信度基于两位作者对随机样本进行评分。计算卡帕值。卡帕统计量（k）也用作单学科与多学科团队之间诊断一致性的指标。
确定了五项与本综述目的相关的研究。最重要的结果是单学科与多学科团队（MTs）之间的诊断一致性水平。总体而言，在痴呆症（综合征）诊断上存在实质性一致性（卡帕值：0.37 - 0.76），但在亚型（病因）诊断上并非如此（阿尔茨海默病：0.26 - 0.60；血管性痴呆：0.35 - 0.52；抑郁症：0.30 - 0.46）。各学科之间的诊断也存在差异。
仅发现了关于诊断准确性的研究，所有研究都使用了不同的参考标准。选择卡帕值作为结果衡量指标，且每种诊断被视为具有同等价值。因此，无法确切证明附加价值。然而，多学科方法在痴呆症诊断中的潜在附加价值可能在于能够区分痴呆症的亚型并检测出共病的精神疾病，如抑郁症。多学科团队中的各学科在确立特定诊断时相互补充，这被认为是此类多学科团队的附加价值。
