关键词: 痴呆, 阿尔茨海默病, 社区管理, 指南, 质量评价, 临床指南研究与评估系统Ⅱ

Abstract: Background　Dementia is a term describing a group of symptoms of acquired cognitive impairment，whose progression is associated with significantly decreased activities of daily living，learning，work and social abilities，seriously affecting the quality of life. Comprehensive and effective community management of dementia contributes to the delay of dementia progression，and high-quality clinical practice guidelines can provide effective management strategies，so the use of both of them may improve the quality and consistency of community management of dementia. Objective　 To assess the qualities of clinical practice guidelines and consensuses covering community management of dementia，providing a reference for the management of dementia in primary care. Methods　From September 2019 to January 2020，we searched for evidence-based clinical practice guidelines on dementia management and dementia care consensuses published between 2008 and 2020 from literature databases and websites，and screened them based on the inclusion and exclusion criteria. We reviewed the eligible guidelines and consensuses using the AGREE Ⅱ，and assessed the overall agreement among reviewers using the kappa coefficient. Results　A total of 45 guidelines were finally included. The mean values of standardized percentage of these guidelines in terms of six domains of scope and purpose，stakeholder involvement，rigour of development，clarity of presentation，applicability，and editorial independence were （77.2±8.96）%，（46.3±21.16）%，（39.19±20.8）%，（71.70±17.3）%，（26.3±17.35）%，and（40.6±33.73）%，respectively. By comprehensive evaluation，one was A-rated，23 were B-rated，and 21 were C-rated. Inter-rater agreement was good and the kappa coefficient was（0.73±0.16）（P<0.001）. Finally，24 moderate-to-high quality guidelines were selected，and the mean values of their standardized percentage scores in the above-mentioned six domains were （80.20%±7.90）%，（54.50±16.98）%，（48.90±16.03）%，（77.90±7.99）%，（33.20±17.34）%，（53.3±35.63）%，respectively. The average kappa coefficient for inter-rater agreement for rating these 24 guidelines was （0.73±0.16）（P<0.001）. Conclusion　 By use of the AGREE Ⅱ，we singled out evidence-based moderate-to-high quality guidelines/consensuses on the management of people with dementia. Although the methodology needs to be further standardized and strengthened，these overall high-quality guidelines could be used as guidance for the management of dementia in primary care，and as a reference for the development of guidelines on the management of dementia in primary care.

Key words: Dementia, Alzheimer disease, Community management, Guideline, Quality appraisal, AGREE Ⅱ