Gérontopôle, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
J Nutr Health Aging. 2010 Feb;14(2):110-20. doi: 10.1007/s12603-010-0022-0.
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
本文旨在明确初级保健医生（PCP）在阿尔茨海默病（AD）管理中的作用，并提出一份工作计划模式。本文中的建议源于参与 AD 患者护理的专家的合作工作。它结合了文献综述和 2009 年 7 月在法国巴黎举行的国际老年学和老年医学协会（IAGG）世界大会期间，专家意见的证据。PCP 的干预在多个层面上似乎至关重要：痴呆的早期发现、诊断管理、治疗和随访。PCP 在 AD 管理中作为医疗保健提供者和护理计划者的关键作用，得到了家庭照顾者对其技能的信任的巩固。在初级保健实践中，第一步是识别痴呆症。该小组提出了一种“病例发现”策略，在某些情况下应在目标情况下检测痴呆症，以便在某些情况下进行 AD 诊断。我们建议 PCP 识别“典型”病例。在典型病例中，在老年患者中，PCP 可以做出“可能 AD”的诊断，然后由专家确认。虽然 AD 的诊断不足，但披露也不足。应该由专家和 PCP 向患者和家属进行披露。然后，PCP 在疾病管理中发挥核心作用，主要目标是发现、预防和治疗疾病的并发症（跌倒、营养不良、行为和心理症状），如果可能的话。PCP 需要向照顾者提供有关暂息护理和家庭支持服务的基本信息，以防止出现非计划性机构化和“紧急”住院等危机情况。最后，必须将治疗研究纳入 PCP 的日常实践中。这是患者享有获得创新和临床研究的权利的问题，无论其年龄或疾病如何，当然要充分尊重现行的规则和保护措施。
