Eichler Tilly, Thyrian Jochen René, Hertel Johannes, Köhler Leonore, Wucherer Diana, Dreier Adina, Michalowsky Bernhard, Teipel Stefan, Hoffmann Wolfgang
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.
Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany.
J Alzheimers Dis. 2014;42(2):451-8. doi: 10.3233/JAD-140354.
Primary data about rates of formal diagnosis of dementia in the German primary care sector are widely lacking.
Main objectives are to analyze the rate of syndrome diagnosis in primary care patients who screened positive for dementia, the distribution of differential diagnoses, and factors associated with undiagnosed dementia.
DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4,064 patients (≥70 years, living at home) recruited from 108 participating GP practices were screened for dementia (DemTect < 9). Of 692 eligible patients (17%), a total of 406 subjects (59%) provided informed consent. Present analyses are based on the data of 243 patients with complete baseline assessment on January 1, 2014 (preliminary data). Formal diagnoses were retrieved from the medical records of the treating GPs. A conditional fixed effect regression analysis was performed to analyze factors associated with undiagnosed dementia.
A total of 40% of patients who screened positive for dementia had been formally diagnosed with dementia. Unspecified dementia was diagnosed in 53%, vascular dementia in 24%, and Alzheimer's disease in 19% of these patients. Undiagnosed dementia was significantly associated with a higher mean score in the Mini-Mental State Examination (odds ratio, 1.11; p < 0.01, 95% confidence interval 1.04-1.18).
The diagnosis rate of dementia in German primary care (40%) is well within the range of the international data (20-50%). The results emphasize the need for action to enhance recognition and differential diagnosis of dementia.
德国基层医疗部门关于痴呆症正式诊断率的原始数据普遍缺乏。
主要目的是分析痴呆症筛查呈阳性的基层医疗患者的综合征诊断率、鉴别诊断的分布情况以及与未诊断出的痴呆症相关的因素。
DelpHi-MV（痴呆症：梅克伦堡-前波美拉尼亚以生活和人为中心的帮助）是一项正在进行的、基于全科医生（GP）的随机对照干预试验。从108家参与的全科医生诊所招募了总共4064名患者（≥70岁，居家生活）进行痴呆症筛查（DemTect<9）。在692名符合条件的患者（17%）中，共有406名受试者（59%）提供了知情同意。目前的分析基于2014年1月1日进行了完整基线评估的243名患者的数据（初步数据）。从治疗全科医生的病历中检索正式诊断。进行了条件固定效应回归分析，以分析与未诊断出的痴呆症相关的因素。
痴呆症筛查呈阳性的患者中，共有40%被正式诊断为痴呆症。在这些患者中，53%被诊断为未明确的痴呆症，24%为血管性痴呆，19%为阿尔茨海默病。未诊断出的痴呆症与简易精神状态检查中较高的平均得分显著相关（优势比，1.11；p<0.01，95%置信区间1.04-1.18）。
德国基层医疗中痴呆症的诊断率（40%）完全在国际数据范围（20%-50%）内。结果强调了采取行动加强痴呆症识别和鉴别诊断的必要性。
