Fereshtehnejad Seyed-Mohammad, Johannsen Peter, Waldemar Gunhild, Eriksdotter Maria
Department of Neurobiology, Care Sciences, and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
J Alzheimers Dis. 2015;48(1):229-39. doi: 10.3233/JAD-150144.
Two dementia quality registries have been developed in Denmark and Sweden with the aim to assess quality of dementia care based on adherence to national guidelines.
To compare patient characteristics, diagnostics, treatment, and quality indicators of dementia care among patients referred to specialist units in Sweden and Denmark.
Data from the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry were merged. Newly diagnosed dementia cases referred to memory clinics during 2007-2012 were included (19,629 Swedish and 6,576 Danish patients).
The median duration between initial assessment and confirmed diagnosis was 56 and 57 days in Sweden and Denmark, respectively. Brain imaging using MRI was twice as common in Sweden. A diagnosis of dementia was established at an average MMSE of 21. An etiological diagnosis was concluded in 89.6% of the Swedish and 87.3% of the Danish cases. Alzheimer's disease (AD) was the most common disorder (47.7% in Denmark and 36.6% in Sweden); however, more cases were diagnosed as mixed AD in Sweden (24.7% versus 10.6% ). More than 80% of patients with AD, dementia with Lewy bodies, and Parkinson's disease with dementia were treated with anti-dementia drugs.
The targets of several quality indicators in both registries were met, such that structural brain imaging and MMSE were performed in >90% and an etiological diagnosis was concluded in >80% of the patients. However, there were also results of concern. The diagnosis of dementia was established at a mean MMSE of 21, which is already late in the course of most dementia disorders. A higher chance of vascular findings following the higher rate of MRI in Sweden may have resulted in more mixed AD diagnosis, which could be one explanation for diagnostic differences but also highlights the need to harmonize diagnostic criteria.
丹麦和瑞典已建立了两个痴呆症质量登记处，旨在根据对国家指南的遵循情况评估痴呆症护理质量。
比较瑞典和丹麦转诊至专科单位的痴呆症患者的患者特征、诊断、治疗及痴呆症护理质量指标。
合并瑞典痴呆症登记处（SveDem）和丹麦痴呆症登记处的数据。纳入2007 - 2012年期间转诊至记忆诊所的新诊断痴呆症病例（19629名瑞典患者和6576名丹麦患者）。
在瑞典和丹麦，从初次评估到确诊的中位时长分别为56天和57天。瑞典使用MRI进行脑成像的情况是丹麦的两倍。痴呆症诊断确立时的平均简易精神状态检查表（MMSE）评分为21分。瑞典89.6%的病例和丹麦87.3%的病例得出了病因诊断。阿尔茨海默病（AD）是最常见的疾病（丹麦为47.7%，瑞典为36.6%）；然而，瑞典被诊断为混合型AD的病例更多（24.7%对10.6%）。超过80%的AD、路易体痴呆和帕金森病痴呆患者接受了抗痴呆药物治疗。
两个登记处的几个质量指标目标均已达成，即超过90%的患者进行了结构性脑成像和MMSE检查，超过80%的患者得出了病因诊断。然而，也有令人担忧的结果。痴呆症诊断确立时的平均MMSE评分为21分，这在大多数痴呆症病程中已经较晚。瑞典MRI检查率较高导致血管性病变发现的可能性更大，这可能是诊断差异的一个原因，但也凸显了统一诊断标准的必要性。
