Tang-Wai David F, Smith Eric E, Bruneau Marie-Andrée, Burhan Amer M, Chatterjee Atri, Chertkow Howard, Choudhury Samira, Dorri Ehsan, Ducharme Simon, Fischer Corinne E, Ghodasara Sheena, Herrmann Nathan, Hsiung Ging-Yuek Robin, Kumar Sanjeev, Laforce Robert, Lee Linda, Massoud Fadi, Shulman Kenneth I, Stiffel Michael, Gauthier Serge, Ismail Zahinoor
Department of Medicine, Divisions of Neurology and Geriatric Medicine University of Toronto, University Health Network Memory Clinic, Krembil Brain Institute Toronto Ontario Canada.
Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada.
Alzheimers Dement (N Y). 2020 Nov 11;6(1):e12057. doi: 10.1002/trc2.12057. eCollection 2020.
Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice.
A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at-risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in-depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations.
We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self- or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self-care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice.
The CCCDTD5 provides evidence-based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.
为了实施预防性干预措施、将危害降至最低并降低在未被发现的疾病情况下被剥削的风险，需要对神经认知障碍和神经退行性疾病进行早期诊断。从主观认知下降（SCD）到痴呆症的整个范围内，关于检测、分期和监测的证据不断涌现。临床实践需要对先前的指南进行更新。
第五届加拿大痴呆症诊断与治疗共识会议（CCCDTD）的一个小组委员会审查了新出现的证据，以解决以下问题：（1）对没有临床问题的高危患者进行筛查是否有作用？在什么情况下进行痴呆症评估是合适的？（2）可以使用哪些工具来评估疑似认知下降的患者？（3）通过哪些措施可以从信息提供者那里获得哪些重要信息？（4）可以使用哪些工具来获取更深入的信息以诊断轻度认知障碍（MCI）或痴呆症？（5）对于有认知问题但无客观变化（即SCD）的患者应采取什么方法？（6）我们如何跟踪治疗反应并随时间变化？使用推荐评估、制定和评价系统对证据质量和推荐强度进行评级。
我们推荐使用工具来评估和监测整个认知范围内的认知、行为和功能，包括患者和信息提供者的报告。我们不建议对无症状的老年人进行筛查，但建议对自我或信息提供者报告的认知变化、行为或精神症状的出现、功能或自我护理能力下降进行调查。对于在临床实践中具有足够有效性的认知和行为变化，应使用标准化评估。
CCCDTD5为神经认知障碍的检测、评估和监测提供了循证推荐。尽管这些指南是为在加拿大使用而制定的，但它们在其他司法管辖区可能也有用。
