Small G W, Rabins P V, Barry P P, Buckholtz N S, DeKosky S T, Ferris S H, Finkel S I, Gwyther L P, Khachaturian Z S, Lebowitz B D, McRae T D, Morris J C, Oakley F, Schneider L S, Streim J E, Sunderland T, Teri L A, Tune L E
JAMA. 1997;278(16):1363-71.
A consensus conference on the diagnosis and treatment of Alzheimer disease (AD) and related disorders was organized by the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society on January 4 and 5, 1997. The target audience was primary care physicians, and the following questions were addressed: (1) How prevalent is AD and what are its risk factors? What is its impact on society? (2) What are the different forms of dementia and how can they be recognized? (3) What constitutes safe and effective treatment for AD? What are the indications and contraindications for specific treatments? (4) What management strategies are available to the primary care practitioner? (5) What are the available medical specialty and community resources? (6) What are the important policy issues and how can policymakers improve access to care for dementia patients? (7) What are the most promising questions for future research?
Consensus panel members and expert presenters were drawn from psychiatry, neurology, geriatrics, primary care, psychology, nursing, social work, occupational therapy, epidemiology, and public health and policy.
The expert presenters summarized data from the world scientific literature on the questions posed to the panel.
The panelists listened to the experts' presentations, reviewed their background papers, and then provided responses to the questions based on these materials. The panel chairs prepared the initial drafts of the consensus statement, and these drafts were read by all panelists and edited until consensus was reached.
Alzheimer disease is the most common disorder causing cognitive decline in old age and exacts a substantial cost on society. Although the diagnosis of AD is often missed or delayed, it is primarily one of inclusion, not exclusion, and usually can be made using standardized clinical criteria. Most cases can be diagnosed and managed in primary care settings, yet some patients with atypical presentations, severe impairment, or complex comorbidity benefit from specialist referral. Alzheimer disease is progressive and irreversible, but pharmacologic therapies for cognitive impairment and nonpharmacologic and pharmacologic treatments for the behavioral problems associated with dementia can enhance quality of life. Psychotherapeutic intervention with family members is often indicated, as nearly half of all caregivers become depressed. Health care delivery to these patients is fragmented and inadequate, and changes in disease management models are adding stresses to the system. New approaches are needed to ensure patients' access to essential resources, and future research should aim to improve diagnostic and therapeutic effectiveness.
1997年1月4日至5日，美国老年精神病学协会、阿尔茨海默病协会和美国老年医学会联合组织了一次关于阿尔茨海默病（AD）及相关疾病诊断与治疗的共识会议。目标受众为初级保健医生，会议探讨了以下问题：（1）AD的患病率如何，其危险因素有哪些？它对社会有何影响？（2）痴呆症有哪些不同形式，如何识别？（3）AD的安全有效治疗方法有哪些？特定治疗的适应证和禁忌证是什么？（4）初级保健医生可采用哪些管理策略？（5）有哪些可用的医学专科和社区资源？（6）重要的政策问题有哪些，政策制定者如何改善痴呆症患者的医疗服务可及性？（7）未来研究最有前景的问题有哪些？
共识小组成员和专家演讲者来自精神病学、神经病学、老年医学、初级保健、心理学、护理、社会工作、职业治疗、流行病学以及公共卫生与政策等领域。
专家演讲者总结了世界科学文献中与小组所探讨问题相关的数据。
小组成员听取专家的报告，审阅背景文件，然后根据这些材料对问题做出回应。小组主席起草了共识声明的初稿，所有小组成员阅读并编辑这些初稿，直至达成共识。
阿尔茨海默病是导致老年人认知能力下降的最常见疾病，给社会带来了巨大成本。尽管AD的诊断常常被漏诊或延误，但它主要是一种纳入性诊断，而非排除性诊断，通常可依据标准化临床标准做出诊断。大多数病例可在初级保健机构进行诊断和管理，但一些临床表现不典型、严重受损或合并复杂疾病的患者需要转诊至专科医生处。阿尔茨海默病是进行性且不可逆的，但针对认知障碍的药物治疗以及针对痴呆相关行为问题的非药物和药物治疗可提高生活质量。通常需要对患者家属进行心理治疗干预，因为近一半的照料者会出现抑郁情绪。为这些患者提供的医疗服务分散且不足，疾病管理模式的变化给该系统带来了更多压力。需要新的方法来确保患者能够获取必要资源，未来的研究应致力于提高诊断和治疗效果。
