Community screening and diagnosis of mild cognitive impairment (MCI) in the community are of great value in the prevention of dementia. Currently, there is still no consensus on the management of community screening and diagnosis in the MCI population. This study conducted a detailed review of the current management of community screening and diagnosis, specific items for screening and diagnosis, and peri-diagnostic support for the MCI population, and found that community screening and diagnosis of MCI need to be comprehensively assessed in terms of population definition, history taking, cognitive assessment and auxiliary testing; peri-diagnostic support should include post-diagnostic disclosure, development of post-diagnostic support program and guidance on post-diagnostic support. Thus, it is suggested that community healthcare workers should carry out comprehensive assessment and diagnosis of the MCI population, and actively carry out rapid post-diagnostic support actions to promote the dementia prevention to be really moved forward.
China has now launched the Alzheimer's disease prevention and treatment promotion action, and local communities are actively carrying out cognitive function screening around the community elderly population. However, there is no suitable evaluation standard to be used as the basis for the screening of cognitive impairment in the community.
To construct an evaluation system for cognitive impairment screening services applicable to the community, and to provide a reference for the appraisal and quality control of large-scale community-based cognitive function screening programs among older adults in various regions of China.
By literature research and policy analysis, the first draft of the indicator system was proposed around the five elements of the RE-AIM framework, and 15 experts were selected to carry out a Delphi expert consultation to construct an evaluation indicator system for community-based cognitive impairment screening services from October 2023 to January 2024. The weights of the indicators were determined using the multiplier method.
The positive coefficients of experts in the two rounds of Delphi were 100.0% and 93.3%, the experts' authority coefficients were 0.83 and 0.86, and the coordination coefficients of experts' opinions were 0.242 and 0.265 (P<0.001), and the final evaluation system consisted of 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators. The first-level indicators and their weights were screening reachability (0.203 5), screening efficacy (0.203 5), program adoption by the organization (0.194 8), program implementation (0.203 5), and program maintenance (0.194 8).
The evaluation index system of the community cognitive impairment screening service initially constructed in this study, which contains 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators, is of good scientific validity and reliability, and has certain reference value for improving the assessment system of cognitive impairment screening.
Day care service is an important component of the community care service system for elderly people with dementia. However, the concept of dementia day care has not been unified, and its connotation and implementation framework have not been clarified, which greatly affects the continuous construction and high-quality service supply of dementia day care service. The Walker classic concept analysis method was used and five attributes of the concept was introduced including (1) daytime intensive, non-residential care; (2) professional coordination and integrated care focused on families with dementia; (3) public respite care support for families with dementia; (4) a crucial complement to high-quality care for dementia; (5) a driving force in promoting a dementia-friendly community. The preconditions of dementia day care include high care needs, weakened family functions and the dominant role of public care, and the consequences involve dementia, family caregivers and social welfare. The implementation factors identification, implementation strategy design, implementation and effect evaluation were carried out respectively using the consolidated framework for implementation research, the replicating effective programs implementation framework and the RE-AIM evaluation framework in the field of implementation science. The specialization, high quality, integrated care, and the philosophy of the friendly community should be highlighted in the future development of dementia day care. The service content, facilities and implementation process need to be improved to promote the quality of dementia day care service.
