Identification of dementia using standard clinical assessments by primary care physicians in Japan
Identification of dementia using standard clinical assessments by primary care physicians in Japan
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DOI：
10.1111/ggi.13243
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发表时间：
2018-05-01
影响因子：
3.3
通讯作者：
Iso, Hiroyasu
中科院分区：
文献类型：
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作者：
Noda, Hiroyuki;Yamagishi, Kazumasa;Iso, Hiroyasu
AimThe本研究的目的是开发一种方法来识别痴呆症的初级保健医生根据现有的医疗保健系统在Japanes.MethodsA的623人年龄65 years进行了标准的初级保健医生根据长期护理保险计划的临床评估，以确定他们的日常生活活动有关的痴呆症的等级。为了检查诊断的有效性，神经精神科医生对所有参与者进行了进一步的痴呆诊断。我们认为，痴呆症患者谁收到的长期护理保险计划下的残疾护理为残疾demential.ResultsMultivariable优势比（95%置信区间）在单级增量的活动为2.1（1.7-2.5）为痴呆症和2.8（2.2-3.4）为残疾痴呆症。受试者工作特征曲线中I级和IIa级位于左上角附近。将分界点设置在I级或IIa级产生了更高的综合区分改善，这表明通过使用这些分界点在减少误分类方面有重大改进。当我们以I级为分界点时，痴呆的敏感性（95%置信限）为65%（58-72%），特异性为93%（91-96%），而IIa级的相应值为54%（47-62%）和96%（94-97%）。失能性痴呆的相应值分别为83%（76-90%），92%（90-95%），73%（65-80%）和96%（94- 97%.ConclusionsOur研究结果表明，选择I级或IIa级作为分界点，将减少在识别痴呆和失能性痴呆的错误分类的情况。Geriatr Gerontol Int 2018; 18：738-744
AimThe aim of the present study was to develop a way of identifying dementia using clinical assessments made by primary care physicians under the existing medical care system in Japan.MethodsA total of 623 people aged 65years underwent standard clinical assessments by primary care physicians under the long-term-care insurance program to determine their grade of activities of daily living related to dementia. To examine the validity of the diagnosis, neuropsychiatrists carried out further diagnosis of dementia for all the participants. We regarded the dementia patients who received care for disability under the long-term care insurance program as having disabling dementia.ResultsMultivariable odds ratio (95% confidence interval) in single-grade increments of the activity was 2.1 (1.7-2.5) for dementia and 2.8 (2.2-3.4) for disabling dementia. The gradesI and IIa were near the upper-left corner in the receiver operating characteristic curves. Setting the cut-off point at gradesI or IIa yielded a higher integrated discrimination improvement, suggesting a major improvement in reducing misclassification by using these cut-off points. When we used gradesI as the cut-off point, the sensitivity (95% confidence limits) was 65% (58-72%) and the specificity was 93% (91-96%) for dementia, and the corresponding values in gradesIIa were 54% (47-62%) and 96% (94-97%). The corresponding values for disabling dementia were 83% (76-90%), 92% (90-95%), 73% (65-80%) and 96% (94-97%).ConclusionsOur findings suggest that selection of gradesI or IIa as the cut-off point would reduce instances of misclassification in the identification of dementia and disabling dementia. Geriatr Gerontol Int 2018; 18: 738-744