UCL Research Department of Primary Care and Population Health, London, UK.
Division of Psychiatry, University College London, London, UK.
Fam Pract. 2021 Sep 25;38(5):669-683. doi: 10.1093/fampra/cmab014.
Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia.
To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints.
A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool.
An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline.
PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care.
初级保健通常是人们对记忆力问题提出担忧时首先接触的医疗保健系统。然而，对于初级保健医生（PCP）如何管理那些有更高痴呆风险的人，目前仍然缺乏高质量的证据和理解。
系统评价 PCP 为减少轻度认知障碍和主观记忆抱怨人群的认知下降而提供的管理策略。
在 2019 年 12 月，我们在五个数据库（EMBASE、Medline、PsycInfo、CINAHL 和 Web of Science）中进行了系统搜索。两位作者使用混合方法评估工具独立评估了纳入研究的方法学质量。
最初发现了 11719 项，筛选了 7250 项，有 9 项研究纳入了综述。大多数研究是自我报告的行为调查。对于非药物策略，PCP 最常提供的建议是增加身体活动、认知刺激、饮食和社会刺激。对于药物策略，PCP 最不可能开任何治疗。如果 PCP 确实开了处方，最常见的处方是针对血管危险因素，以降低进一步认知下降的风险。
PCP 报告说，他们更有可能提供非药物策略，而不是药物策略，这与预防痴呆发作的指南一致。然而，纳入研究的证据质量较低，依赖于主观的自我报告行为。需要观察性研究来准确反映初级保健中如何管理有记忆问题的人群。
