Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2931. doi: 10.1370/afm.20.s1.2931.
Context: Dementia, characterized by a progressive decline in cognition, affects more than 50 million people globally. In 2020, the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations to guide the clinical management of persons living with dementia (PLWD) and their caregivers. However, primary care clinicians are not always up-to-date with current evidence as the information might be fragmented. Objective: To provide selected new and updated clinical guidance on the management of patients with dementia that are simple to use in a routine primary care practice. Study design: Recommendations were approved and graded based on the Appraisal of Guidelines for Research and Evaluation (AGREE II collaboration), GRADE, and a Delphi process. Setting: Working groups included experts from different backgrounds (primary care physicians, nurse practitioners and other primary care clinicians, neurologists, psychiatrists and geriatricians, researchers, knowledge translation experts, decisions makers, and PLWD and caregivers' representatives). The experts carried out systematic reviews, which guided the development of new recommendations for dementia care. Recommendations included: We summarize the most relevant CCCDTD5 recommendations for primary care clinicians Results: The relevant recommendations for primary care were focused on: a) risk reduction for the general population (nutrition, exercise, social engagement, education, and medication management), as well as for persons at risk of dementia (evaluation of hearing status and sleep, and cognitive training stimulation); b) screening and diagnosis of dementia, including the role of the informant, screening for patients at risk or with symptoms, use of cognitive tests and neuro-imaging, management of subjective cognitive decline); c) de-prescribing medications for dementia, including aspirin and cognitive enhancers; and d) non-pharmacological interventions for persons with dementia (exercise, cognitive stimulation therapy, psychoeducational interventions for caregivers, case management and dementia-friendly community/organizations). Conclusions: The development of recommendations for ongoing management of dementia is an iterative process as new evidence on interventions for dementia are published. The present recommendations are of importance for dementia care in a primary care setting as the entry point for PLWD into the health system.
痴呆症表现为认知能力逐渐下降，全球有超过 5000 万人受其影响。2020 年，第 5 届加拿大痴呆症诊断和治疗共识会议（CCCDTD5）发布了最新建议，以指导痴呆症患者及其照护者的临床管理。然而，由于信息可能碎片化，初级保健临床医生对当前证据并不总是了解最新情况。目的：提供有关痴呆症管理的精选新的和更新的临床指导，这些指导在常规初级保健实践中易于使用。研究设计：建议是根据评估研究和评估指南（AGREE II 合作）、GRADE 和 Delphi 流程进行批准和分级的。背景：工作组由来自不同背景的专家组成（初级保健医生、护士从业者和其他初级保健临床医生、神经病学家、精神科医生和老年科医生、研究人员、知识转化专家、决策者以及痴呆症患者及其照护者的代表）。专家们进行了系统审查，这些审查指导了痴呆症护理新建议的制定。建议包括：我们总结了与初级保健临床医生最相关的 CCCDTD5 建议。结果：与初级保健相关的建议侧重于：a）降低一般人群（营养、锻炼、社交参与、教育和药物管理）和痴呆症高危人群（评估听力状况和睡眠、认知训练刺激）的风险；b）痴呆症的筛查和诊断，包括知情者的作用、对有风险或有症状的患者进行筛查、使用认知测试和神经影像学、管理主观认知下降）；c）减少痴呆症药物的使用，包括阿司匹林和认知增强剂；d）痴呆症患者的非药物干预（锻炼、认知刺激疗法、照护者心理教育干预、病例管理和痴呆症友好社区/组织）。结论：随着针对痴呆症干预措施的新证据的发表，痴呆症持续管理建议的制定是一个迭代过程。本建议对初级保健环境中的痴呆症护理具有重要意义，因为这是痴呆症患者进入卫生系统的切入点。
