Newens A J, Forster D P, Kay D W
Centre for Health Services Research, University of Newcastle upon Tyne.
Br J Gen Pract. 1994 Sep;44(386):405-7.
Presenile dementia of alzheimer type is a rare condition, and a report drawn from a large population may be useful to general practitioners.
A study was undertaken in the Northern Regional Health Authority area to investigate general practitioner referral practice, hospital investigations and diagnosis in cases of presenile alzheimers disease.
Reviews of 186 sets of case notes of patients diagnosed between 1985 and 1989, and follow-up interviews with the principal carer in a subsample of 73 surviving patients were undertaken.
In 63% of cases, formal diagnosis of presenile alzheimers disease was made by a neurologist, in 27% of cases by a psychiatrist and in 9% by a physician. Symptoms of depression had been noted in 45 patients (24%) and 21 had been prescribed antidepressant drugs prior to specialist referral. Computerized tomography scans were requested significantly more frequently by neurologists than other specialists and lumbar puncture was virtually only done by neurologists, but there were no significant differences between specialists regarding other clinical investigations. Domiciliary care or day centre attendance were more likely to be arranged at hospital discharge by psychiatrists than other specialists, but at follow-up interview no differences in community care provision were found according to initial specialty. Interviews with relatives of surviving patients revealed that at initial contact with general practitioners 48% of patients were unaware that they had any problem. Only 13 relatives (18%) felt they had been given sufficient information at diagnosis concerning the chronic and progressive nature of the disease, and at follow up 26% remained unaware of the existence of the Alzheimer's Disease Society.
These results reinforce the importance of the role of general practitioners in arranging and coordinating appropriate support for patients and their relatives, in providing continuity of care and in advising the families of the existence of voluntary organizations.
早老性阿尔茨海默型痴呆是一种罕见病症，来自大量人群的报告可能对全科医生有用。
在北部地区卫生局辖区开展一项研究，以调查全科医生对早老性阿尔茨海默病病例的转诊做法、医院检查及诊断情况。
回顾了1985年至1989年间确诊的186例患者的病历，并对73例存活患者子样本中的主要照料者进行了随访访谈。
63%的病例由神经科医生做出早老性阿尔茨海默病的正式诊断，27%由精神科医生诊断，9%由内科医生诊断。45名患者（24%）有抑郁症状记录，21名在转诊至专科医生之前已开具抗抑郁药物。神经科医生比其他专科医生更频繁地要求进行计算机断层扫描，腰椎穿刺实际上仅由神经科医生进行，但在其他临床检查方面专科医生之间无显著差异。与其他专科医生相比，精神科医生在患者出院时更有可能安排居家护理或日间护理中心照料，但在随访访谈中，根据最初的专科情况，在社区护理提供方面未发现差异。对存活患者亲属的访谈显示，在最初与全科医生接触时，48%的患者未意识到自己有任何问题。只有13名亲属（18%）觉得在诊断时就疾病的慢性和渐进性得到了足够信息，在随访时，26%的亲属仍不知道阿尔茨海默病协会的存在。
这些结果强化了全科医生在为患者及其亲属安排和协调适当支持、提供持续护理以及告知家庭志愿组织存在方面作用的重要性。
