Lau Josyane, Cations Monica, O'Malley Mary, Stamou Vasileios, Oyebode Jan R, Parkes Jacqueline H, Carter Janet, Loi Samantha M
University of Notre Dame, Sydney, Australia.
College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia.
Int J Geriatr Psychiatry. 2024 Dec;39(12):e70028. doi: 10.1002/gps.70028.
A modified e-Delphi was used to explore subject-expert consensus to create a minimum & gold standard assessment for young-onset dementia (YOD) for clinicians based in Australia.
A list of 72 statements adapted from an international study, O'Malley et al. 2020, was included in an online survey that was distributed to clinical experts in the field. Respondents were asked to rate statements on a Likert scale of 1-7 (ranging from '1' being 'not at all important' to '7' being 'absolutely essential'). The mean and standard deviation (SD) were calculated for each statement. Full consensus, designated as 'minimum standard' was defined as 100% of respondents rating statement(s) as 'absolutely essential' (7) or 'very important' (6), while high consensus, designated as 'gold standard' was defined as 80% (16 out of 20) of respondents rating statement(s) as either 'absolutely essential' or 'very important' in the assessment for YOD. The statements that had overall mean scores below 6 did not reach consensus.
Full consensus was achieved on 13 statements ('minimum standard'), 80% consensus was reached on 37 statements ('gold standard'), and no consensus was reached on 35 statements. Most clinicians agreed that the diagnosis of YOD is largely based on history, with less emphasis placed on aspects of the examination and investigations conducted. History of first-degree family members with YOD and any past psychiatric symptoms were reported to be potential triggers for a YOD diagnosis. There was agreement that the routine dementia blood screen and baseline structural imaging should be a part of the diagnostic assessment criteria of YOD. Comparisons were made between the results of this Australian-based study to the original international study, which found that 55/72 statements (76%) were similarly rated.
Based on the results of this modified e-Delphi study, full and high consensus was reached on 37 statements which were comparable to results in an international study. This suggests that in general, clinicians in Australia have agreement with international experts about what is important for the assessment and diagnosis of YOD. Because the statements used in the international study were used in this Australian study, consideration of what issues may be specific to the Australian context such as YOD in Aboriginal Australians and rurality may have not been ascertained. In spite of this, these results may be useful to aid clinicians in their assessment for YOD but consensus statements may change over time as development in knowledge and available tests increases.
采用改良的电子德尔菲法，探讨专家共识，为澳大利亚的临床医生制定针对早发性痴呆（YOD）的最低标准和金标准评估。
一项在线调查纳入了从国际研究（O'Malley等人，2020年）改编而来的72条陈述清单，并分发给该领域的临床专家。要求受访者按照1-7的李克特量表对陈述进行评分（从“1”表示“完全不重要”到“7”表示“绝对必要”）。计算每条陈述的平均值和标准差（SD）。完全共识，即“最低标准”，定义为100%的受访者将陈述评为“绝对必要”（7）或“非常重要”（6）；高度共识，即“金标准”，定义为80%（20人中的16人）的受访者在YOD评估中将陈述评为“绝对必要”或“非常重要”。总体平均得分低于6的陈述未达成共识。
13条陈述达成了完全共识（“最低标准”），37条陈述达成了80%的共识（“金标准”），35条陈述未达成共识。大多数临床医生一致认为，YOD的诊断主要基于病史，对检查和调查方面的重视程度较低。有YOD的一级家庭成员病史和任何既往精神症状被报告为YOD诊断的潜在触发因素。大家一致认为，常规痴呆血液筛查和基线结构成像应成为YOD诊断评估标准的一部分。将这项基于澳大利亚的研究结果与原始国际研究结果进行了比较，发现55/72条陈述（76%）的评分相似。
基于这项改良电子德尔菲研究的结果，37条陈述达成了完全和高度共识，这与国际研究结果相当。这表明，总体而言，澳大利亚的临床医生与国际专家在YOD评估和诊断的重要方面达成了一致。由于本澳大利亚研究使用了国际研究中的陈述，可能未确定澳大利亚背景下的特定问题，如澳大利亚原住民中的YOD和农村地区的情况。尽管如此，这些结果可能有助于临床医生进行YOD评估，但随着知识和可用检测的发展，共识陈述可能会随时间而变化。
