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[脑部检查:在基层医疗环境中诊断轻度认知障碍的结构化方法]

[Brain check-up: a structured approach diagnosing mild cognitive impairment in the primary care setting].

作者信息

Wolski Lucas, Bopp Ann-Kathrin, Schwientek Ann-Kathrin, Langer Sandra, Dogan Vildan, Grimmer Timo

机构信息

Klinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar, Technische Universität München, Möhlstraße 26, 81675, München, Deutschland.

Roche Pharma AG, Grenzach-Wyhlen, Deutschland.

出版信息

Z Gerontol Geriatr. 2024 Dec;57(8):645-651. doi: 10.1007/s00391-024-02319-y. Epub 2024 Jun 5.

Abstract

BACKGROUND

The reason-related identification of mild cognitive impairment (MCI) in primary care is helpful to treat reversible causes or decelerate progression to dementia by optimal management of existing risk factors. In this process general practitioners are in a key position. The present feasibility study investigated the practicability of a diagnostic algorithm (brain check-up), comprising neuropsychological examinations, differential diagnoses and follow-up measures.

METHOD

By means of a standardized questionnaire, the utilization and practicability of the brain check-up was surveyed in n = 37 medical practices of general practitioners and internists in Germany.

RESULTS

The brain check-up was performed by n = 37 physicians in 389 patients (66%). The main barriers to implementation included patients' fear of facing the results, the professionals' lack of time, and costs. Overall, 73% of the participants agreed that the brain check-up was practical in everyday treatment. Long waiting times for an appointment with a neurological/psychiatric specialist were perceived as a barrier for optimal care.

CONCLUSION

The structured algorithm is convenient in physician's everyday practice and can contribute to identify patients with MCI more easily. Therefore, it appears to be a helpful tool in primary care. To achieve sustainability in everyday use, identified barriers need to be addressed during the implementation phase.

摘要

背景

在初级保健中对轻度认知障碍(MCI)进行病因相关识别,有助于通过对现有风险因素的优化管理来治疗可逆病因或减缓向痴呆症的进展。在此过程中,全科医生处于关键地位。本可行性研究调查了一种诊断算法(脑部检查)的实用性,该算法包括神经心理学检查、鉴别诊断和后续措施。

方法

通过标准化问卷,对德国n = 37家全科医生和内科医生诊所中脑部检查的使用情况和实用性进行了调查。

结果

n = 37名医生对389名患者(66%)进行了脑部检查。实施的主要障碍包括患者对面对检查结果的恐惧、专业人员时间不足和成本问题。总体而言,73%的参与者认为脑部检查在日常治疗中是实用的。与神经科/精神科专家预约的长时间等待被视为获得最佳护理的障碍。

结论

该结构化算法在医生的日常实践中很方便,有助于更轻松地识别MCI患者。因此,它似乎是初级保健中的一个有用工具。为了在日常使用中实现可持续性,在实施阶段需要解决已识别的障碍。

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