Brodaty H, Clarke J, Ganguli M, Grek A, Jorm A F, Khachaturian Z, Scherr P
Academic Department of Psychogeriatrics, University of New South Wales, Sydney, Australia.
Alzheimer Dis Assoc Disord. 1998 Mar;12(1):1-13. doi: 10.1097/00002093-199803000-00001.
We considered whether general practitioners should examine all older patients over a certain age for cognitive impairment in screening for early dementia. We invited presentations from key experts, selectively reviewed the literature, and developed a consensus statement. The efficacy of and benefits from unselective use of cognitive testing and informant questionnaires for detecting early dementia in older patients attending general practice are limited. Positive predictive values of cognitive screening for dementia are less than 50%, even for older patient populations. Higher values may be obtained by testing patients who have a relevant history of cognitive or functional decline. Whatever procedures are adopted for screening older general practice attenders for cognitive impairment or early dementia, investigation is still required into the relative merits of different health professionals performing the screening, the positive and negative effects on patients and their families, and the cost-benefit ratio. The majority view of workshop participants was that cognitive testing should occur for older patients when there is a reason to suspect dementia. Testing may occur in an individual considered to be at risk because of an informant history of cognitive or functional decline, clinical observation, or, sometimes, very old age. No single instrument for cognitive screening is suitable for global use. Screening programs must be supported by training and supplemented by education for professionals and families in management of dementia.
我们思考了全科医生是否应该对所有超过一定年龄的老年患者进行认知功能障碍检查，以筛查早期痴呆症。我们邀请了关键专家进行报告，有选择地查阅了文献，并制定了一份共识声明。在全科医疗中，无差别地使用认知测试和知情者问卷来检测老年患者的早期痴呆症，其效果和益处有限。即使是针对老年患者群体，痴呆症认知筛查的阳性预测值也不到50%。对有认知或功能衰退相关病史的患者进行检测，可能会得到更高的阳性预测值。无论采用何种程序对老年全科就诊者进行认知功能障碍或早期痴呆症筛查，仍需调查不同卫生专业人员进行筛查的相对优点、对患者及其家庭的正负影响以及成本效益比。研讨会参与者的多数观点是，当有理由怀疑患有痴呆症时，应对老年患者进行认知测试。对于因知情者提供的认知或功能衰退病史、临床观察，或有时因年龄过大而被认为处于风险中的个体，可进行测试。没有单一的认知筛查工具适用于全球范围。筛查项目必须得到培训的支持，并辅以针对专业人员和家庭的痴呆症管理教育。
