Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA.
Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA.
Alzheimers Dement. 2019 Nov;15(11):1402-1411. doi: 10.1016/j.jalz.2019.07.005. Epub 2019 Sep 4.
There is insufficient understanding of diagnosis of etiologic dementia subtypes and contact with specialized dementia care among older Americans.
We quantified dementia diagnoses and subsequent health care over five years by etiologic subtype and physician specialty among Medicare beneficiaries with incident dementia diagnosis in 2008/09 (226,604 persons/714,015 person-years).
Eighty-five percent of people were diagnosed by a nondementia specialist physician. Use of dementia specialists within one year (22%) and five years (36%) of diagnosis was low. "Unspecified" dementia diagnosis was common, higher among those diagnosed by nondementia specialists (33.2%) than dementia specialists (21.6%). Half of diagnoses were Alzheimer's disease.
Ascertainment of etiologic dementia subtype may inform hereditary risk and facilitate financial and care planning. Use of dementia specialty care was low, particularly for Hispanics and Asians, and associated with more detection of etiological subtype. Dementia-related professional development for nonspecialists is urgent given their central role in dementia diagnosis and care.
美国老年人对病因性痴呆亚型的诊断以及与专门的痴呆护理的接触了解不足。
我们在 2008/09 年（226,604 人/714,015 人年）期间，对患有偶发性痴呆诊断的医疗保险受益人，按病因亚型和医生专业对五年内的诊断和随后的医疗保健进行了量化。
85%的人是由非痴呆症专家医生诊断的。在诊断后一年内（22%）和五年内（36%）使用痴呆症专家的比例较低。“未特指”的痴呆诊断很常见，在由非痴呆症专家诊断的患者中（33.2%）比痴呆症专家（21.6%）更高。一半的诊断为阿尔茨海默病。
病因性痴呆亚型的确定可以提供遗传风险信息，并有助于财务和护理规划。痴呆症专科护理的使用率较低，尤其是西班牙裔和亚洲人，且与病因亚型的检出率更高相关。鉴于非专家在痴呆症诊断和护理中的核心作用，对他们进行痴呆症相关的专业发展是当务之急。
