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基层医疗中慢性病患者的认知筛查:实践中的挑战与建议

Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice.

作者信息

Athilingam Ponrathi, Visovsky Constance, Elliott Amanda F, Rogal Philip J

机构信息

Morsani College of Medicine, University of South Florida, Tampa, FL, USA.

出版信息

Am J Alzheimers Dis Other Demen. 2015 Sep;30(6):547-58. doi: 10.1177/1533317515577127.

Abstract

An integrative literature review was performed to identify the challenges in current cognitive screening. The aim of the review was to serve as an evaluative resource to guide clinicians in the selection of the best available cognitive screening measures for early assessment of mild cognitive impairment (MCI) in people with chronic diseases. The review classified the available cognitive screening measures according to purpose, time to administer, and cognitive domains assessed as: 1) simple/ brief cognitive screening measures, 2) disease specific screening measures, 3) domain specific screening measures, 4) self-administered screening measures, and 5) technology-based screening measures. There is no single optimal cognitive measure for all patient populations and settings. Although disease specific cognitive screening measures are optimal, there is a lack of validated screening measures for many chronic diseases. Technology-based screening measure is a promising avenue for increasing the accessibility of cognitive screening. Future work should focus on translating available screening measures to mobile technology format to enhance the utility in busy primary care settings. Early cognitive screening in persons with chronic disease should enhance appropriate referrals for detailed neurocognitive examination and cognitive interventions to preserve and or minimize cognitive decline.

摘要

进行了一项综合文献综述,以确定当前认知筛查中的挑战。该综述的目的是作为一种评估资源,指导临床医生选择最佳的认知筛查措施,以便对慢性病患者的轻度认知障碍(MCI)进行早期评估。该综述根据目的、实施时间和评估的认知领域,将现有的认知筛查措施分类为:1)简单/简短认知筛查措施,2)疾病特异性筛查措施,3)领域特异性筛查措施,4)自我管理筛查措施,以及5)基于技术的筛查措施。对于所有患者群体和情况,没有单一的最佳认知测量方法。虽然疾病特异性认知筛查措施是最佳的,但许多慢性病缺乏经过验证的筛查措施。基于技术的筛查措施是提高认知筛查可及性的一个有前景的途径。未来的工作应侧重于将现有的筛查措施转化为移动技术格式,以提高在繁忙的初级保健环境中的效用。对慢性病患者进行早期认知筛查应加强适当转诊,以便进行详细的神经认知检查和认知干预,以保持和/或尽量减少认知衰退。

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