J Okla State Med Assoc. 1998 Aug;91(5):298-306.
This report responds to Substitute Resolution 518, I-96, which asks that the AMA, in cooperation with appropriate medical specialty societies, study Alzheimer's disease (AD) and other dementias, with particular emphasis on their diagnosis and treatment, issues relating to patient and caregiver education, the financing of care of affected individuals, the identification of research needs, and consideration of issues pertaining to the quality of life of individuals with these conditions.
This report is based on a review of guidelines produced by the Agency for Health Care Policy and Research (AHCPR), the American Academy of Neurology (AAN), the Veterans Health Administration (VHA), and the American Psychiatric Association (APA), combined with review of the latest published literature on AD and related disorders and consultation with experts in the field. This analysis was used as a basis for policy formulation.
The guidelines reviewed were: (1) Recognition and Initial Assessment of Alzheimer's Disease and Related Disorders, published by the AHCPR; (2) Dementia Identification and Assessment, published by the VHA; (3) Practice Parameter: Diagnosis and Evaluation of Dementia. published by the AAN; and (4) Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias of Late Life, published by the APA. These documents are targeted for the following audiences: primary care physicians (VHA and AHCPR), neurologists (AAN), and psychiatrists (APA). Only the APA guide makes provision for continuity of care. The literature review revealed that ongoing research into AD focuses on three broad areas: etiology/risk factors, diagnosis and treatment.
AD is a common and costly public health problem. With the increase in life expectancy in the United States, AD is expected to afflict approximately 14 million people within the next few decades. Irreversible dementia takes a heavy economic, social, physical, and psychological toll on patients and families. The financial costs to society are enormous. There is currently no cure for AD, only interventions that can temporarily ameliorate the profound cognitive losses and behavioral manifestations of the disorder. Community services for AD patients and families are fragmented and underutilized. As traditional gatekeepers for services, physicians can encourage more families to use supportive services. Several valuable guidelines exist related to the diagnosis and treatment of AD and related disorders.
本报告回应替代决议518，即I - 96号决议，该决议要求美国医学协会（AMA）与相关医学专业学会合作，研究阿尔茨海默病（AD）及其他痴呆症，特别关注其诊断与治疗、患者及护理者教育相关问题、患病个体护理的资金筹集、研究需求的确定以及对这些病症患者生活质量相关问题的考量。
本报告基于对医疗保健政策与研究机构（AHCPR）、美国神经病学学会（AAN）、退伍军人健康管理局（VHA）以及美国精神病学协会（APA）制定的指南的审查，同时结合对关于AD及相关疾病的最新已发表文献的审查以及与该领域专家的咨询。这一分析被用作政策制定的基础。
所审查的指南包括：（1）AHCPR发布的《阿尔茨海默病及相关疾病的识别与初始评估》；（2）VHA发布的《痴呆症的识别与评估》；（3）AAN发布的《实践参数：痴呆症的诊断与评估》；以及（4）APA发布的《阿尔茨海默病及其他老年痴呆症患者治疗实践指南》。这些文件针对以下受众：初级保健医生（VHA和AHCPR）、神经科医生（AAN）以及精神科医生（APA）。只有APA指南对持续护理做出了规定。文献综述表明，目前对AD的研究集中在三个广泛领域：病因/风险因素、诊断和治疗。
AD是一个常见且代价高昂的公共卫生问题。随着美国预期寿命的增加，预计在未来几十年内AD将影响约1400万人。不可逆性痴呆给患者和家庭带来了沉重的经济、社会、身体和心理负担。对社会的经济成本巨大。目前AD无法治愈，只有一些干预措施可以暂时缓解该病症严重的认知丧失和行为表现。为AD患者及其家庭提供的社区服务零散且未得到充分利用。作为服务的传统把关人，医生可以鼓励更多家庭使用支持性服务。存在一些与AD及相关疾病的诊断和治疗有关的有价值的指南。
