Manchester Academic Health Science Centre, Mental Health and Neurodegeneration Research Group, School of Community Based Medicine, The University of Manchester, UK.
Aging Ment Health. 2011 Nov;15(8):978-84. doi: 10.1080/13607863.2011.596805. Epub 2011 Jul 21.
Dementia is a major and growing health problem. Diagnosis is an important step in the access to care, but many dementia patients remain undiagnosed. This study investigated the magnitude and variation in the difference between 'observed' and 'estimated' prevalence of dementia in general practices. We also explored practice characteristics associated with observed prevalence rates.
Six Primary Care Trusts (PCTs) provided data on all general practices (N = 351) in their area in terms of number of doctors, patient list size, number of patients over 65 years of age, socio-economic deprivation status of practices and number of patients on dementia registers.
The average observed prevalence overall of dementia amongst patients 65 years and over was 3.0% [95CI 2.8, 3.2]. The observed prevalence was 54.5% [95CI 49.2, 58.9] lower than the prevalence observed in the epidemiological studies in the UK. For an average size general practice (list size of 5269 patients) approximately 27 [95CI 22, 32] patients with dementia may remain undiagnosed. Statistically significant differences in prevalence rates were found between the different PCTs (Wald chi-square = 103.8 p < 0.001). The observed prevalence of dementia was significantly lower among practices run by one GP compared to multiple GPs (p = 0.003), and in more affluent areas (p < 0.001).
Just under a half of the expected numbers of patients with dementia are recognised in GP dementia registers. The underdiagnosis of dementia varies with practice characteristics, socio-economic deprivation and between PCTs, which has implications for the local implementation of the National Dementia Strategy.
痴呆是一个主要且日益严重的健康问题。诊断是获得治疗的重要步骤，但许多痴呆患者仍未得到诊断。本研究调查了一般实践中“观察到”和“估计”痴呆患病率之间差异的程度和变化。我们还探讨了与观察到的患病率相关的实践特征。
六个初级保健信托（PCT）根据医生人数、患者名单规模、65 岁以上患者人数、实践的社会经济贫困状况以及痴呆登记患者人数，提供了其所在地区所有一般实践的数据。
65 岁及以上患者中痴呆的平均观察患病率总体为 3.0%[95%置信区间 2.8, 3.2]。观察到的患病率比英国流行病学研究中观察到的患病率低 54.5%[95%置信区间 49.2, 58.9]。对于一个平均规模的普通实践（患者名单规模为 5269 名患者），大约有 27 名[95%置信区间 22, 32]患有痴呆症的患者可能未被诊断。不同 PCT 之间的患病率存在统计学上的显著差异（Wald 卡方=103.8，p<0.001）。与多名全科医生相比，由一名全科医生管理的实践中痴呆的观察患病率显著较低（p=0.003），且在较富裕的地区（p<0.001）也较低。
在 GP 痴呆登记处，只有不到一半的预期痴呆患者被识别出来。痴呆症的漏诊情况因实践特征、社会经济贫困状况以及 PCT 之间的差异而有所不同，这对国家痴呆症战略的地方实施有影响。
