Drexel University College of Medicine, Philadelphia, PA 19127, USA.
Am Fam Physician. 2011 Oct 15;84(8):895-902.
As the proportion of persons in the United States older than 65 years increases, the prevalence of dementia will increase as well. Risk factors for dementia include age, family history of dementia, apolipoprotein E4 genotype, cardiovascular comorbidities, chronic anticholinergic use, and lower educational level. Patient history, physical examination, functional assessment, cognitive testing, laboratory studies, and imaging studies are used to assess a patient with suspected dementia. A two-visit approach is time-effective for primary care physicians in a busy outpatient setting. During the first visit, the physician should administer a screening test such as the verbal fluency test, the Mini-Cognitive Assessment Instrument, or the Sweet 16. These tests have high sensitivity and specificity for detecting dementia, and can be completed in as little as 60 seconds. If the screening test result is abnormal or clinical suspicion of another disease is present, appropriate laboratory and imaging tests should be ordered, and the patient should return for additional cognitive testing. A second visit should include a Mini-Mental State Examination, Geriatric Depression Scale, and verbal fluency and clock drawing tests, if not previously completed.
随着美国 65 岁以上人口比例的增加，痴呆的患病率也将增加。痴呆的危险因素包括年龄、痴呆家族史、载脂蛋白 E4 基因型、心血管合并症、慢性抗胆碱能药物使用和较低的教育水平。病史、体检、功能评估、认知测试、实验室研究和影像学研究用于评估疑似痴呆的患者。对于在繁忙的门诊环境中的初级保健医生来说，两次就诊的方法是有效的。在第一次就诊时，医生应进行筛选测试，如语言流畅性测试、迷你认知评估工具或甜 16 测试。这些测试对检测痴呆具有很高的敏感性和特异性，并且可以在 60 秒内完成。如果筛选测试结果异常或存在其他疾病的临床怀疑，应适当安排实验室和影像学检查，患者应返回进行额外的认知测试。如果之前未完成，第二次就诊应包括迷你精神状态检查、老年抑郁量表以及语言流畅性和时钟绘制测试。
