Tjin Anna, Thang Leng Leng, Sondh Harsharon Kaur, Stewart Robert
Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Department of Japanese Studies, National University of Singapore, Singapore.
J Geriatr Psychiatry Neurol. 2025 Aug 28:8919887251371725. doi: 10.1177/08919887251371725.
IntroductionThe global rise in dementia presents significant challenges for healthcare systems. While Alzheimer's disease (AD) dominates dementia care, people with non-Alzheimer's dementias (non-AD), such as dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), vascular dementia (VD), and Parkinson's disease dementia (PDD), often have distinct and unmet healthcare needs.AimThis systematic review aimed to summarise evidence on healthcare utilisation (HCU) patterns and factors affecting care among people living with non-AD dementias.MethodsFollowing a PROSPERO-registered protocol (CRD42024568391), comprehensive searches of Embase, Ovid MEDLINE, Global Health, PsycINFO, and PubMed were conducted in February and June 2024. Peer-reviewed English-language studies reporting on HCU or its determinants in DLB, FTD, VD, or PDD were included. Reviews, case reports, grey literature, and studies without subtype-specific data were excluded. Quality was assessed using the Newcastle-Ottawa Scale.ResultsThirty-one studies (16 cohort; 10 cross-sectional, 4 case-description, and 1 chart review) were included. HCU varied by dementia subtype and was influenced by sociodemographic, cognitive, and clinical factors. Compared with AD, non-AD dementias had higher healthcare use and costs. PDD showed the highest inpatient, outpatient, and skilled nursing care use, driven by severe cognitive decline. DLB was linked to unplanned hospital admissions and frequent ambulance use, often due to falls and pneumonia. FTD resulted in extended hospital stays related to behavioural symptoms, while VD incurred high costs due to chronic comorbidities and long-term care needs.ConclusionPeople with non-AD dementias have greater and distinct healthcare needs. Future research should develop standardised measures and tailored interventions to address their complex socioeconomic and clinical requirements.
引言
痴呆症在全球范围内的增加给医疗保健系统带来了重大挑战。虽然阿尔茨海默病（AD）在痴呆症护理中占主导地位，但患有非阿尔茨海默病痴呆症（非AD）的人，如路易体痴呆（DLB）、额颞叶痴呆（FTD）、血管性痴呆（VD）和帕金森病痴呆（PDD），往往有独特且未得到满足的医疗保健需求。
目的
本系统评价旨在总结关于非AD痴呆症患者医疗保健利用（HCU）模式及影响护理的因素的证据。
方法
按照PROSPERO注册协议（CRD42024568391），于2024年2月和6月对Embase、Ovid MEDLINE、Global Health、PsycINFO和PubMed进行了全面检索。纳入了报告DLB、FTD、VD或PDD中HCU或其决定因素的同行评审英文研究。排除综述、病例报告、灰色文献以及无亚型特异性数据的研究。使用纽卡斯尔-渥太华量表评估质量。
结果
纳入了31项研究（16项队列研究；10项横断面研究、4项病例描述研究和1项图表回顾研究）。HCU因痴呆症亚型而异，并受社会人口统计学、认知和临床因素影响。与AD相比，非AD痴呆症的医疗保健使用和成本更高。PDD的住院、门诊和专业护理使用最高，这是由严重认知衰退导致的。DLB与非计划性住院和频繁使用救护车有关，通常是由于跌倒和肺炎。FTD导致与行为症状相关的住院时间延长，而VD由于慢性合并症和长期护理需求而产生高昂成本。
结论
非AD痴呆症患者有更大且独特的医疗保健需求。未来的研究应制定标准化措施和量身定制的干预措施，以满足他们复杂的社会经济和临床需求。
