Christensen Daniel D, Lin Peter
Neuropsychiatric Institute, University of Utah School of Medicine, Salt Lake City, UT USA.
J Fam Pract. 2007 Dec;56(12 Suppl New):S17-23.
With the "baby boomers" entering retirement and beyond and the life expectancy of the entire population increasing, the burden of Alzheimer's Disease (AD) grows alarmingly greater. Over 5 million people in the United States currently have AD, and that number could triple by 2050. The financial impact of caring for these patients is substantial. Estimates of direct and indirect costs are as high as $148 billion per year. In addition to its substantial economic impact, AD has devastating effects on patients and their families. Alzheimer's disease begins with gradual memory loss and progresses to personality change, behavioral disturbance, loss of executive function, and loss of the ability to perform basic activities of daily living, including eating, walking, dressing, and grooming. These impairments strain families and caregivers and create challenges to the care and safety of the patient as well as threaten the health and well-being of the caregiver. As the number of patients diagnosed with AD increases, there is an ever-growing need for early diagnosis, which often is first observed in the primary care setting. While AD cannot be reversed or stopped, disease progression can be delayed and quality of life enhanced with early diagnosis and treatment. Early and accurate diagnosis has become increasingly important and will become even more so with the anticipated new generation of medications. Though several consensus statements on diagnosis and treatment of AD have been developed, few primary care physicians routinely follow evidence-based guidelines in their clinical practices. A 2006 survey conducted by the American Academy of Family Physicians identified a moderate to high level of need for education on AD in a majority of respondents. This article illustrates the primary care management of AD beginning with diagnosis and concluding with autopsy. Enhancing diagnostic and treatment skills in primary care will promote earlier diagnosis, improved patient management, and ongoing research into this increasingly important dilemma of aging.
随着“婴儿潮一代”步入退休年龄及更年长阶段，且整个人口的预期寿命不断增加，阿尔茨海默病（AD）的负担正以惊人的速度增长。目前美国有超过500万人患有AD，到2050年这一数字可能会增至三倍。照料这些患者的经济影响巨大。直接和间接成本估计每年高达1480亿美元。除了巨大的经济影响外，AD对患者及其家庭具有毁灭性影响。阿尔茨海默病始于逐渐的记忆丧失，进而发展为性格改变、行为紊乱、执行功能丧失以及丧失进行包括进食、行走、穿衣和洗漱等日常生活基本活动的能力。这些损害给家庭和照料者带来压力，对患者的护理和安全构成挑战，同时也威胁到照料者的健康和幸福。随着被诊断患有AD的患者数量增加，对早期诊断的需求日益增长，而早期诊断往往首先在初级保健环境中被观察到。虽然AD无法逆转或停止，但通过早期诊断和治疗可以延缓疾病进展并提高生活质量。早期准确的诊断变得越来越重要，随着新一代药物的出现，其重要性将更加凸显。尽管已经制定了几份关于AD诊断和治疗的共识声明，但很少有初级保健医生在临床实践中常规遵循循证指南。美国全科医生学会在2006年进行的一项调查发现，大多数受访者对AD教育有中度到高度的需求。本文阐述了从诊断到尸检的AD初级保健管理。提高初级保健中的诊断和治疗技能将促进早期诊断、改善患者管理，并推动对这一日益重要的老龄化难题的持续研究。
