National Academy of Neuropsychology, Denver, Colorado (Hilsabeck, Perry, Lacritz, Arnett)
The University of Texas at Austin Dell Medical School, Austin, Texas (Hilsabeck).
Ann Fam Med. 2024 Nov-Dec;22(6):543-549. doi: 10.1370/afm.3174.
As the population ages, the prevalence of cognitive impairment due to neurodegenerative diseases such as Alzheimer disease (AD) is expected to double in the United States to nearly 14 million over the next 40 years. AD and related dementias (ADRD) are a leading cause of morbidity and mortality and among the costliest to society. Although emerging biomedical interventions for ADRD focus on early stages and are currently limited to AD, care management can benefit patients with ADRD across the disease course. Moreover, some causes of cognitive impairment are modifiable, and optimal overall management may slow or prevent additional decline. Nevertheless, a sizable proportion of cases of cognitive impairment among older adults remain undiagnosed. Primary care practitioners are often the first health care professionals to encounter cognitive concerns or to be able to observe changes in function resulting from cognitive impairment; hence, they have much to contribute to population health solutions for detecting cognitive impairment among older adults. In this report, we present key points and gaps in knowledge about methods for detecting cognitive impairment in primary care clinics. These were developed via an interdisciplinary Geriatrics Summit hosted by the National Academy of Neuropsychology in 2022, attended by representatives of national organizations engaged in work to improve care of older adults. We propose a novel workflow to facilitate detecting cognitive impairment during routine primary care, focusing on opportunities provided by the annual wellness visit, a preventive visit available to Medicare beneficiaries, along with additional recommendations and opportunities for clinical practice and research.
随着人口老龄化，美国因神经退行性疾病（如阿尔茨海默病 (AD)）导致的认知障碍的患病率预计在未来 40 年内将翻一番，达到近 1400 万。AD 和相关痴呆症（ADRD）是发病率和死亡率的主要原因，也是社会成本最高的疾病之一。尽管新兴的针对 ADRD 的生物医学干预措施侧重于早期阶段，目前仅限于 AD，但护理管理可以使 ADRD 患者受益于整个疾病过程。此外，一些认知障碍的原因是可以改变的，最佳的整体管理可能会减缓或预防进一步的下降。然而，相当一部分老年人的认知障碍仍然未被诊断出来。初级保健医生通常是第一个遇到认知问题或能够观察到认知障碍导致的功能变化的医疗保健专业人员；因此，他们在为老年人检测认知障碍方面为解决人口健康问题做出了重要贡献。在本报告中，我们介绍了初级保健诊所中检测认知障碍的方法的要点和知识空白。这些方法是通过 2022 年由国家神经心理学学院主办的跨学科老年病学峰会制定的，来自致力于改善老年人护理的国家组织的代表参加了会议。我们提出了一种新颖的工作流程，以促进在常规初级保健中检测认知障碍，重点关注年度健康检查提供的机会，这是一种可供医疗保险受益人使用的预防检查，以及临床实践和研究的其他建议和机会。
