Barth Janina, Nickel Franziska, Kolominsky-Rabas Peter L
Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Germany.
National Graduate College "Optimization strategies in Dementia (OptiDem)", Karl and Veronica Carstens-Foundation, Essen, Germany.
Int J Geriatr Psychiatry. 2018 Mar;33(3):459-474. doi: 10.1002/gps.4841. Epub 2018 Jan 5.
Due to the demographic change, the global prevalence of dementia will continually rise. Barriers to diagnosis and care are still high. But timely diagnosis is associated with valuable benefits and can promote timely and optimal management. Receiving an early diagnosis is especially in rural areas a problem due to the limited access to assessments. Therefore, the aim of our scoping review is to investigate different interventions targeted at rural living elderly to screen and diagnose cognitive decline and dementia.
A scoping review was conducted in line with the framework of Arksey and O'Malley. The following databases were systematically searched: PubMed, PsycINFO, Cochrane Library, and ScienceDirect. The interventions were categorized in four main categories (interventions for general practitioners/institutions; online/mobile offers; telehealth applications; telephone-based screenings).
Thirty studies were included. The four categories show different scopes of application. Telehealth applications show that it is feasible and valid to diagnose dementia via videoconference. Assessments described in three other categories show that remotely used tools are appropriate to screen for mild cognitive impairment or cognitive decline, but are not valid to establish a dementia diagnosis.
Telehealth applications can appropriately be used to diagnose dementia. However, most of the studies included only small sample sizes and did not test the applications explicitly in rural or remote populations. Therefore, studies taking these limitations into account are needed. On top, only two RCTs are included in this review indicating that more high quality studies in this field are needed.
由于人口结构变化，全球痴呆症患病率将持续上升。诊断和护理的障碍仍然很高。但及时诊断具有重要益处，可促进及时和优化管理。由于评估机会有限，在农村地区获得早期诊断尤其成问题。因此，我们的范围综述旨在研究针对农村老年居民的不同干预措施，以筛查和诊断认知能力下降和痴呆症。
按照阿克西和奥马利的框架进行范围综述。系统检索了以下数据库：PubMed、PsycINFO、考科蓝图书馆和科学Direct。干预措施分为四大类（针对全科医生/机构的干预措施；在线/移动服务；远程医疗应用；基于电话的筛查）。
纳入30项研究。这四类显示出不同的应用范围。远程医疗应用表明通过视频会议诊断痴呆症是可行且有效的。其他三类中描述的评估表明，远程使用的工具适用于筛查轻度认知障碍或认知能力下降，但对确诊痴呆症无效。
远程医疗应用可适用于诊断痴呆症。然而，大多数研究样本量较小，且未在农村或偏远人群中明确测试这些应用。因此，需要考虑这些局限性的研究。此外，本综述仅纳入两项随机对照试验，表明该领域需要更多高质量研究。
