How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review.
How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review.
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DOI：
10.1093/fampra/cmab014
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发表时间：
2021-09-25
期刊：
影响因子：
2.2
通讯作者：
Walters K
中科院分区：
文献类型：
--
作者：
Hallam B;Rees J;Petersen I;Cooper C;Avgerinou C;Walters K
初级保健通常是医疗保健系统中对记忆力有疑虑的人们的第一个接触点。然而，关于初级保健专业人员 (PCP) 目前如何管理罹患痴呆症的高风险人群，仍然缺乏高质量的证据和理解。系统地审查 PCP 提供的管理策略，以减少轻度认知障碍和主观记忆抱怨患者的认知衰退。 2019 年 12 月，我们对五个数据库（EMBASE、Medline、PsycInfo、CINAHL 和 Web of Science）进行了系统性研究检索。纳入研究的方法学质量由两位作者使用混合方法评估工具独立评估。最初发现了 11 719 项，筛选了 7250 项，并纳入了 9 项研究。大多数研究都是自我报告的行为调查。对于非药物策略，PCP 提供的最常见的建议是增加体力活动、认知刺激、饮食和社交刺激。对于药物策略，PCP 通常不会开出任何治疗处方。如果 PCP 确实开出处方，最常见的处方是针对血管危险因素，以降低认知能力进一步下降的风险。 PCP 报告称，根据预防痴呆症发作的指南，他们更有可能提供非药物策略，而不是药物策略。然而，纳入研究中的证据质量较低，并且依赖于主观的自我报告行为。需要观察研究来准确反映初级保健中如何管理有记忆问题的人。人们通常会去找全科医生（也称为初级保健专业人员 (PCP)），提出对其记忆力的担忧。然而，对于 PCP 为有记忆问题、痴呆症高危人群提供哪些建议或治疗，目前还没有明确的了解。本综述旨在总结 PCP 会给有记忆问题的人提供哪些建议或治疗的研究结果。经过筛选 11 719 项研究后，9 项研究被纳入审查。目前的审查发现，PCP 更有可能提供建议，而不是开出任何药物治疗处方。 PCP 提供的最常见建议是增加身体活动、认知刺激和社交刺激。如果 PCP 决定开药，最常见的处方是改善血流。改善血液流动与降低患痴呆症的风险有关。然而，本次综述中纳入的研究质量较低，因为许多研究依赖于 PCP 回答调查问卷，了解他们管理有记忆问题的人的意图。因此，未来的研究需要观察PCP的现实生活实践，以准确反映初级保健中如何管理有记忆问题的人。
Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia. To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints. A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool. An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline. PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care. People will typically go to their general practitioners, also known as primary care professionals (PCPs), to raise concerns about their memory. However, there is no clear understanding of what advice or treatment PCPs provide to people with memory concerns who are at high risk of dementia. This review aims to summarize the findings from research that studied what advice or treatments PCPs would give to a person with memory concerns. Nine studies were included in the review after screening through 11 719 studies. The current review found that PCPs were more likely to provide advice rather than prescribe any drug treatment. The most common advice that PCPs provided was to increase physical activity, cognitive stimulation and social stimulation. If PCPs decided to prescribe drugs, the most common prescriptions were to improve blood flow. Improving blood flow has been linked with reducing the risk of developing dementia. However, the quality of the studies included in this review is low because many relied on PCPs answering questionnaires on their intentions to manage people with memory concerns. Therefore, future research needs to observe PCPs’ real-life practice to provide an accurate reflection of how people with memory problems are managed in primary care.
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