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Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews

机译：优化初级保健中痴呆症的诊断和管理：系统评价系统审查

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To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100?%, 95?% CI: 70-100?%) and specificity (82?%, 95?% CI: 72-90?%) within the shortest amount of time (3.16 to 5?min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.
机译：要了解如何在初级保健和挑战中接近痴呆症的最佳护理，我们检查了与初级保健中诊断和管理痴呆症有关的证据。搜索的数据库包括：MEDLINE，EMBASE，PSYCINFO和系统性评论的Cochrane数据库从成立于2020年5月11日。如果描述涉及诊断，治疗和/或管理的干预措施，则包括定量或定性的英语系统评价初级保健/家庭医学和结果数据中的痴呆症可获得。使用AMSTAR评估偏见的风险。审查遵循PRISMA准则，并在公开科学框架中注册。包括二十一篇文章。 Mini-Cog和MMSE是最广泛研究的认知筛查工具。缩写的精神测试得分（AMTs）在最短的情况下实现了高灵敏度（100μl％，95℃：70-100μl，95μl：72-90？％）在初级保健中的时间（3.16到5？min）。六项研究中的五项发现，在参加教育研讨会后，家庭医生在怀疑痴呆症的可能性增加。案例管理改善了行为症状，同时降低住院治疗和紧急访问。初级保健教育干预，加强阿尔茨海默氏症的护理人员健康（退伍军人事务部），成功地提高了Carer管理问题行为和改善护理人员成果的能力。有明确的工具可以帮助确定初级保健中的认知障碍，但管理层的策略需要进一步研究。该系统评论的调查结果将为家庭医生提供如何在初级保健实践中提高痴呆症诊断和管理。

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