Moll van Charante E P, Richard E, Eurelings L S, van Dalen J W, Ligthart S A, van Bussel E F, Hoevenaar-Blom M P, Vermeulen M, van Gool W A
* Dit onderzoek werd eerder gepubliceerd in de Lancet (2016;388:797-805) met als titel 'Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial.' Afgedrukt met toestemming.
Ned Tijdschr Geneeskd. 2017;161:D1184.
To assess whether intensive vascular care in GP practices can prevent dementia in a population of community-dwelling older people.
This pragmatic cluster-randomised open-label study (ISRCTN29711771) was conducted in persons aged 70-78 years who were registered with Dutch GP practices. The only exclusion criteria were a diagnosis of dementia and limited life expectancy. Practices were randomly assigned to an intervention arm or a control arm. Participants in the interventional arm underwent a cardiovascular check-up every 4 months for six years by a practice nurse. Primary outcomes were cumulative incidence of dementia and functional limitations. Main secondary outcomes were the incidence of cardiovascular disease and mortality.
Between June 2006 and March 2009, 116 GP practices (3526 participants) were recruited and randomly assigned: 63 (1890 participants) to the intervention group and 53 (1636 participants) to the control group. Primary outcome data were obtained for 3454 (98%) participants; median follow-up was 6.7 years. In this period, dementia was diagnosed in 121/1853 (6.5%) participants in the intervention group and in 112/1601 (7.0%) participants in the control group. This difference was not significant (hazard ratio 0.92, 95% CI 0.71-1.19). No differences were found with regard to functional decline, incident cardiovascular disease and mortality.
Long-term intensive vascular care for community-dwelling elderly patients, provided in a primary care setting, does not result in a reduced incidence of dementia, functional limitations or mortality. There is, however, possibly an effect in elderly patients with untreated or sub-optimally treated hypertension; this warrants further research.
评估全科医生诊所的强化血管护理能否预防社区居住老年人患痴呆症。
这项实用的整群随机开放标签研究（ISRCTN29711771）在年龄70 - 78岁、在荷兰全科医生诊所登记的人群中进行。唯一的排除标准是痴呆症诊断和预期寿命有限。诊所被随机分配到干预组或对照组。干预组的参与者由一名执业护士每4个月进行一次心血管检查，为期6年。主要结局是痴呆症的累积发病率和功能受限情况。主要次要结局是心血管疾病的发病率和死亡率。
2006年6月至2009年3月期间，招募了116家全科医生诊所（3526名参与者）并随机分配：63家（1890名参与者）分配到干预组，53家（1636名参与者）分配到对照组。获得了3454名（98%）参与者的主要结局数据；中位随访时间为6.7年。在此期间，干预组1853名参与者中有121名（6.5%）被诊断为痴呆症，对照组1601名参与者中有112名（7.0%）被诊断为痴呆症。这种差异不显著（风险比0.92，95%置信区间0.71 - 1.19）。在功能衰退、心血管疾病发病率和死亡率方面未发现差异。
在初级保健环境中为社区居住的老年患者提供长期强化血管护理，并不能降低痴呆症、功能受限或死亡率的发病率。然而，对于未治疗或治疗不充分的高血压老年患者可能有影响；这值得进一步研究。
