Lang Linda, Clifford Angela, Wei Li, Zhang Dongmei, Leung Daryl, Augustine Glenda, Danat Isaac M, Zhou Weiju, Copeland John R, Anstey Kaarin J, Chen Ruoling
Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK.
Post Graduate Academic Institute of Medicine, University of Wolverhampton, Wolverhampton, UK.
BMJ Open. 2017 Feb 3;7(2):e011146. doi: 10.1136/bmjopen-2016-011146.
Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.
METHODS/SETTING/PARTICIPANTS: A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation.
The outcome measures of interest were the prevalence and determinants of undetected dementia.
23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.
The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
痴呆症的检测对于改善患者生活至关重要，但全球范围内检测不足的程度及其原因尚不清楚。本研究旨在量化未被检测出的痴呆症的患病率，并探讨其相关因素。
方法/研究背景/参与者：截至2016年10月，我们进行了系统检索，以查找报告全球社区或机构护理环境中未被检测出的痴呆症比例及其决定因素的研究。随机效应模型计算了未被检测出的痴呆症的合并率，并进行了亚组分析以确定变异的决定因素。
感兴趣的结局指标是未被检测出的痴呆症的患病率及其决定因素。
23项研究符合纳入本综述的条件。未被检测出的痴呆症的合并率为61.7%（95%置信区间55.0%至68.0%）。在中国和印度（与欧洲和北美相比）、社区环境（与机构/护理环境相比）、年龄小于70岁、男性以及由全科医生诊断的情况下，检测不足的比例更高。然而，在使用简易精神状态检查表（MMSE）诊断标准的研究中，该比例较低。
全球范围内未被检测出的痴呆症患病率很高。迫切需要研究痴呆症检测方面的广泛差异，特别是在社会经济地位较低的人群中。需要努力减少诊断不平等现象，并改善社区中的早期诊断。
