Strengthening Primary Healthcare Workers' Identification，Diagnosis and Treatment of Dementia Is the Key to the Prevention and Control of Dementia in China

doi:10.12114/j.issn.1007-9572.2021.00.058

Abstract

Abstract: With the aggravation of aging population，the number of dementia patients in China has shown a rapid growth trend in recent years.However，current available dementia care resources are mainly distributed in large-scale general hospitals in China，which is far from meeting the needs of the majority of dementia patients.And most dementia patients seeking care in primary care may not receive accurate diagnosis and treatment as primary healthcare workers can not distinguish dementia from normal aging due to lack of related experience，which may lead to dementia progression because of delayed diagnosis and treatment.To prevent and control dementia，it is necessary to improve primary healthcare workers' abilities in identifying，diagnosing and treating dementia，and to develop a specific mechanism to strength the cooperation（including bi-directional referrals and continued management of dementia）between primary healthcare workers and memory disorders outpatient healthcare workers in tertiary care.This paper mainly analyzes the epidemiological characteristics of dementia，status and difficulties in diagnosing and treating dementia，and effective measures to improve the standardized management of dementia in China.

Key words: Dementia, Eearly diagnosis, Medical staff, Grassroots medicine, China, Medical association

摘要： 随着人口老龄化进程加剧，近年来我国痴呆患者数量呈现快速增多趋势，但目前我国痴呆诊治相关医疗资源主要集中在大型综合医院，远不能满足广大痴呆患者需求。目前仍存在基层医务工作者由于缺乏痴呆识别和诊治经验、不能区分痴呆与正常老化而导致多数痴呆患者得不到及时救治，进而贻误病情、导致患者错过早期治疗的最佳时间等问题。提高广大基层医务工作者对痴呆的识别和诊治能力、建立基层医务工作者与三甲医院记忆门诊的上下联动机制并进行连续性管理是中国痴呆防控的必要措施。本文主要就我国痴呆流行病学特征、诊治现状及困境、提高痴呆规范化管理水平的有效改进措施等进行了分析。

关键词: 痴呆, 早期诊断, 医务人员, 基层医疗, 中国, 医联体

WANG Wei1,TAN Shuhui2,ZHANG Bin3, et al. Strengthening Primary Healthcare Workers' Identification，Diagnosis and Treatment of Dementia Is the Key to the Prevention and Control of Dementia in China　[J]. Chinese General Practice, 2021, 24(6): 637-642. DOI: 10.12114/j.issn.1007-9572.2021.00.058.
王伟,谭淑慧,张斌等. 加强基层医务工作者对痴呆的识别与诊治是中国痴呆防控的关键[J]. 中国全科医学, 2021, 24(6): 637-642. DOI: 10.12114/j.issn.1007-9572.2021.00.058.

References

［1］中共中央国务院印发“健康中国2030”规划纲要［EB/OL］．（2016-12-30）［2020-07-20］．http：//www.mohrss.gov.cn/SYrlzyhshbzb/zwgk/ghcw/ghjh/201612/t20161230_263500.html.
［2］JIA L，QUAN M，FU Y，et al．Dementia in China：epidemiology，clinical management，and research advances［J］．Lancet Neurol，2020，19（1）：81-92．DOI：10.1016/S1474-4422（19）30290-X.
［3］高迪，张红杰.人口老龄化背景下医养结合养老模式［J］．医学研究与教育，2020，37（2）：55-62．DOI：10.3969/j.issn.1674-490X.2020.02.009.
GAO D，ZHANG H J.Analysis of the integrating medical care and aged care model in the background of aging population［J］．Medical Research and Education，2020，37（2）：55-62．DOI：10.3969/j.issn.1674-490X.2020.02.009.
［4］SHAH H，ALBANESE E，DUGGAN C，et al．Research priorities to reduce the global burden of dementia by 2025［J］．Lancet Neurol，2016，15（12）：1285-1294．DOI：10.1016/S1474-4422（16）30235-6.
［5］JIA J，WANG F，WEI C，et al．The prevalence of dementia in urban and rural areas of China［J］．Alzheimers Dement，2014，10（1）：1-9．DOI：10.1016/j.jalz.2013.01.012.
［6］JIA J，ZHOU A，WEI C，et al．The prevalence of mild cognitive impairment and its etiological subtypes in elderly Chinese［J］．Alzheimers Dement，2014，10（4）：439-447．DOI：10.1016/j.jalz.2013.09.008.
［7］JIA J，WEI C，CHEN S，et al．The cost of Alzheimer's disease in China and re-estimation of costs worldwide［J］．Alzheimers Dement，2018，14（4）：483-491．DOI：10.1016/j.jalz.2017.12.006.
［8］胡丽丽，王华丽.社区医生痴呆识别技能及相关培训研究进展［J］．中国继续医学教育，2015，7（1）：6-8．DOI：10.3969/j.issn.1674-9308.2015.01.004.
HU L L，WANG H L.Skills for recognition of dementia for community doctors and related training research［J］．China Continuing Medical Education，2015，7（1）：6-8．DOI：10.3969/j.issn.1674-9308.2015.01.004.
［9］张振馨，陈霞，刘协和，等．北京、西安、上海、成都四地区痴呆患者卫生保健现状调查［J］．中国医学科学院学报，2004，26（2）：116-121.
［10］GUEST F L，RAHMOUNE H，GUEST P C.Early diagnosis and targeted treatment strategy for improved therapeutic outcomes in Alzheimer's Disease［J］．Adv Exp Med Biol，2020，1260：175-191．DOI：10.1007/978-3-030-42667-5_8.
［11］郭峰，张振馨.痴呆的流行病学研究现状［J］．中华神经科杂志，2007，40（5）：343-346．DOI：10.3760/j.issn：1006-7876.2007.05.021.
［12］中国痴呆与认知障碍诊治指南写作组，中国医师协会神经内科医师分会认知障碍疾病专业委员会.2018中国痴呆与认知障碍诊治指南（九）：中国记忆障碍门诊建立规范［J］．中华医学杂志，2018，98（21）：1653-1657．DOI：10.3760/cma.j.issn.0376-2491.2018.21.007.
［13］JIA J，ZUO X，JIA X，et al．Diagnosis and treatment of dementia in neurology outpatient departments of general hospitals in China［J］．Alzheimers Dement，2016，12（4）：446-453．DOI：10.1016/j.jalz.2015.06.1892.
［14］贾建平，李妍.中国痴呆的现状和未来［J］．中华神经科杂志，2020，53（2）：81-84．DOI：10.3760/cma.j.issn.1006-7876.2020.02.001.
JIA J P，LI Y.The present and future of China's dementia［J］．Chinese Journal of Neurology，2020，53（2）：81-84．DOI：10.3760/cma.j.issn.1006-7876.2020.02.001.
［15］贾建平，龚敏.“认知单元”是适合我国认知障碍疾病临床实践的诊疗模式［J］．中华医学杂志，2020，100（9）：645-647．DOI：10.3760/cma.j.issn.0376-2491.2020.09.002.
JIA J P，GONG M."Cognitive unit" is a diagnosis and treatment pattern suitable for the clinical practice of cognitive disorders in China［J］．National Medical Journal of China，2020，100（9）：645-647．DOI：10.3760/cma.j.issn.0376-2491.2020.09.002.
［16］中国老年学和老年医学学会脑认知与健康分会，中国老年医学学会认知障碍分会.适用于记忆门诊和痴呆风险筛查的电子化测评工具与应用方案专家共识（2019）［J］．中华老年医学杂志，2019，38（12）：1317-1321．DOI：10.3760/cma.j.issn.0254-9026.2019.12.001.
China Association of Gerontology and Geriatrics，Academy of Cognitive Neuroscience and Health；Chinese Geriatrics Society，Academy of Cognitive Disorder of China.Expert consensus on electronic assessment tools and application protocols for memory clinics and dementia risk screening［J］．Chinese Journal of Geriatrics，2019，38（12）：1317-1321．DOI：10.3760/cma.j.issn.0254-9026.2019.12.001.
［17］VELAYUDHAN L，RYU S H，RACZEK M，et al．Review of brief cognitive tests for patients with suspected dementia［J］．Int Psychogeriatr，2014，26（8）：1247-1262．DOI：10.1017/S1041610214000416.
［18］NASREDDINE Z S，PHILLIPS N A，BÉDIRIAN V，et al．The Montreal Cognitive Assessment，MoCA：a brief screening tool for mild cognitive impairment［J］．J Am Geriatr Soc，2005，53（4）：695-699．DOI：10.1111/j.1532-5415.2005.53221.x.
［19］TANG Y，XING Y，ZHU Z，et al．The effects of 7-week cognitive training in patients with vascular cognitive impairment，no dementia（the Cog-VACCINE study）：a randomized controlled trial［J］．Alzheimers Dement，2019，15（5）：605-614．DOI：10.1016/j.jalz.2019.01.009.
［20］刘谦，刘阳.用信息化手段促进医联体的建设［J］．中国数字医学，2020，15（1）：118-120．DOI：10.3969/j.issn.1673-7571.2020.01.039.
LIU Q，LIU Y.Promote the construction of medical treatment alliance by information means［J］．China Digital Medicine，2020，15（1）：118-120．DOI：10.3969/j.issn.1673-7571.2020.01.039.

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