Geriatric Hospital, Italian National Research Centres on Aging, Ancona, Italy.
J Am Med Dir Assoc. 2012 Oct;13(8):759.e7-13. doi: 10.1016/j.jamda.2012.05.015. Epub 2012 Jun 23.
To determine the prevalence of dementia diagnoses and the use of antidementia drugs in a cohort of Italian older nursing home (NH) residents.
Cross-sectional study.
The NH residents participating in 2 studies: the U.L.I.S.S.E. study and the Umbria Region survey.
A total of 2215 nursing home residents.
Each resident underwent a comprehensive geriatric assessment at baseline by means of the RAI MDS 2.0. Dementia diagnosis was based on ICD-9 codes.
The prevalence of dementia diagnosis according to ICD-9 codes was 50.7% (n = 1123), whereas 312 subjects had cognitive impairment with a cognitive performance scale score ≥3 without a diagnosis of dementia. Only 56 NH residents were treated (5% of the sample) and the main drugs used were cholinesterase inhibitor, whereas only 1 subject was treated with memantine. Limiting our analysis to patients with mild to moderate Alzheimer's disease, who are those reimbursed by the public health care system for receiving antidementia drugs, the percentage rose to 11.3%.
These findings demonstrate a high rate of underdiagnosis and undertreatment of dementia in Italian NH residents. Potential explanations include the lack of systematic assessment of cognitive functions, the limitations to antidementia drug reimbursement, the complexity of the reimbursement procedure itself, and the high prevalence of patients with severe dementia. Older NH residents still lack proper access to state-of-the-art diagnosis and treatment for a devastating condition such as dementia.
确定意大利老年护理院（NH）居民队列中痴呆诊断的流行率和使用抗痴呆药物的情况。
横断面研究。
参与两项研究的 NH 居民：ULISSE 研究和乌姆比亚地区调查。
共 2215 名 NH 居民。
每位居民在基线时通过 RAI MDS 2.0 进行全面的老年综合评估。痴呆诊断基于 ICD-9 代码。
根据 ICD-9 代码，痴呆诊断的患病率为 50.7%（n=1123），而 312 名受试者有认知障碍，认知表现量表评分≥3 而没有痴呆诊断。只有 56 名 NH 居民接受了治疗（样本的 5%），主要使用的药物是胆碱酯酶抑制剂，而只有 1 名患者使用了美金刚。将我们的分析仅限于轻度至中度阿尔茨海默病患者，这些患者是公共医疗保健系统为接受抗痴呆药物治疗而报销的，这一比例上升到了 11.3%。
这些发现表明意大利 NH 居民的痴呆诊断和治疗不足率很高。潜在的解释包括缺乏对认知功能的系统评估、抗痴呆药物报销的限制、报销程序本身的复杂性以及严重痴呆患者的高患病率。老年 NH 居民仍然缺乏适当的途径获得针对痴呆等毁灭性疾病的最先进的诊断和治疗。
